bluuebunny/crossref_metadata_2025 huggingface dataset:
Noninvasive Positive Pressure Ventilation Using a Helmet in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Authors: Antonelli Massimo , Pennisi Mariano Alberto , Pelosi Paolo , Gregoretti Cesare , Squadrone Vincenzo , Rocco Monica , Cecchini Luca , Chiumello Davide , Severgnini Paolo , Proietti Rodolfo , Navalesi Paolo , Conti Giorgio
Published: December 2003

Background

Noninvasive positive pressure ventilation (NPPV) with a facemask (FM) is effective in patients with acute exacerbation of their chronic obstructive pulmonary disease. Whether it is feasible to treat these patients with NPPV delivered by a helmet is not known.

Methods

Over a 4-month period, the authors studied 33 chronic obstructive pulmonary disease patients with acute exacerbation who were admitted to four intensive care units and treated with helmet NPPV. The patients were compared with 33 historical controls treated with FM NPPV, matched for simplified acute physiologic score (SAPS II), age, PaCO2, pH, and PaO2:fractional inspired oxygen tension. The primary endpoints were the feasibility of the technique, improvement of gas exchange, and need for intubation.

Results

The baseline characteristics of the two groups were similar. Ten patients in the helmet group and 14 in the FM group (P = 0.22) were intubated. In the helmet group, no patients were unable to tolerate NPPV, whereas five patients required intubation in the FM group (P = 0.047). After 1 h of treatment, both groups had a significant reduction of PaCO2 with improvement of pH; PaCO2 decreased less in the helmet group (P = 0.01). On discontinuing support, PaCO2 was higher (P = 0.002) and pH lower (P = 0.02) in the helmet group than in the control group. One patient in the helmet group, and 12 in the FM group, developed complications related to NPPV (P < 0.001). Length of intensive care unit stay, intensive care unit, and hospital mortality were similar in both groups.

Conclusions

Helmet NPPV is feasible and can be used to treat chronic obstructive pulmonary disease patients with acute exacerbation, but it does not improve carbon dioxide elimination as efficiently as does FM NPPV.
High Incidence of Myocardial Ischemia during Postpartum Hemorrhage
Authors: Karpati Peter C. J. , Rossignol Mathias , Pirot Marcus , Cholley Bernard , Vicaut Eric , Henry Patrick , Kévorkian Jean-Philippe , Schurando Patrick , Peynet Jacqueline , Jacob Denis , Payen Didier , Mebazaa Alexandre
Published: December 2003

Background

Postpartum hemorrhage remains a major cause of global maternal morbidity and mortality, even in developed countries, despite the use of intensive care units. This study sought to (1) assess whether myocardial ischemia could be associated with and even aggravate hemorrhagic shock in young parturients admitted for postpartum hemorrhage, and (2) identify the independent risk factors for myocardial ischemia.

Methods

On their referral to the intensive care unit, a multidisciplinary team managed parturients with severe postpartum hemorrhage. Ventilation, transfusion, catecholamines, surgery, or angiography with uterine embolization were provided as clinically indicated. Plasma cardiac troponin I levels were used as a surrogate marker of acute myocardial injury and electrocardiograms of myocardial ischemia.

Results

A total of 55 parturients were referred with severe postpartum hemorrhage, all in hemorrhagic shock. Twenty-eight parturients (51%) had elevated serum levels of cardiac troponin I (9.4 microg/l [3.7-26.6 microg/l]), which were associated with electrocardiographic signs of ischemia and deteriorated myocardial contractility and correlated with the severity of hemorrhagic shock. Indeed, multivariate analysis identified low systolic and diastolic arterial blood pressure (< 88 and < 50 mmHg, respectively) and increased heart rate (> 115 beats/min) as independent predictors of myocardial injury. In addition, all patients who were given catecholamines also had elevated cardiac troponin I levels.

Conclusions

These results suggest that treatment of postpartum hemorrhage-induced hemorrhagic shock should be coupled with concomitant prevention of myocardial ischemia, even in young parturients.
Nefopam, a Nonsedative Benzoxazocine Analgesic, Selectively Reduces the Shivering Threshold in Unanesthetized Subjects
Authors: Alfonsi Pascal , Adam Frederic , Passard Andrea , Guignard Bruno , Sessler Daniel I. , Chauvin Marcel
Published: December 2003

Background

The analgesic nefopam does not compromise ventilation, is minimally sedating, and is effective as a treatment for postoperative shivering. The authors evaluated the effects of nefopam on the major thermoregulatory responses in humans: sweating, vasoconstriction, and shivering.

Methods

Nine volunteers were studied on three randomly assigned days: (1) control (saline), (2) nefopam at a target plasma concentration of 35 ng/ml (low dose), and (3) nefopam at a target concentration of 70 ng/ml (high dose, approximately 20 mg total). Each day, skin and core temperatures were increased to provoke sweating and then reduced to elicit peripheral vasoconstriction and shivering. The authors determined the thresholds (triggering core temperature at a designated skin temperature of 34 degrees C) by mathematically compensating for changes in skin temperature using the established linear cutaneous contributions to control of each response.

Results

Nefopam did not significantly modify the slopes for sweating (0.0 +/- 4.9 degrees C. microg-1. ml; r2 = 0.73 +/- 0.32) or vasoconstriction (-3.6 +/- 5.0 degrees C. microg-1. ml; r2 = -0.47 +/- 0.41). In contrast, nefopam significantly reduced the slope of shivering (-16.8 +/- 9.3 degrees C. microg-1. ml; r2 = 0.92 +/- 0.06). Therefore, high-dose nefopam reduced the shivering threshold by 0.9 +/- 0.4 degrees C (P < 0.001) without any discernible effect on the sweating or vasoconstriction thresholds.

Conclusions

Most drugs with thermoregulatory actions-including anesthetics, sedatives, and opioids-synchronously reduce the vasoconstriction and shivering thresholds. However, nefopam reduced only the shivering threshold. This pattern has not previously been reported for a centrally acting drug. That pharmacologic modulations of vasoconstriction and shivering can be separated is of clinical and physiologic interest.
Albumin and Hydroxyethyl Starch Modulate Oxidative Inflammatory Injury to Vascular Endothelium
Authors: Lang John D. , Figueroa Mario , Chumley Phillip , Aslan Mutay , Hurt John , Tarpey Margaret M. , Alvarez Beatriz , Radi Rafael , Freeman Bruce A.
Published: December 2003

Background

Human serum albumin is used clinically to maintain colloid osmotic pressure and is viewed to serve an antioxidant role in the vascular compartment via binding of redox-active metal complexes, transport of nitric oxide, and the oxidant-scavenging reactions of the single thiol of human serum albumin, cys34. Because of these potentially desirable adjunctive actions, we evaluated the purity and thiol redox state and compared the relative effects of clinically available 25% human serum albumin preparations with a starch-derived colloid, 6% hydroxyethyl starch, in in vitro models of inflammatory vascular injury.

Methods

Bovine aortic endothelial cell responses to chemical, enzymatic, and cell-derived reactive inflammatory mediators in the presence of human serum albumin or hydroxyethyl starch were assessed.

Results

The cys34 thiol of fresh human serum albumin preparations was 70-85% oxidized and contained a population of human serum albumin (approximately 25% of total) having the cys34 resistant to reduction by 2-mercaptoethanol and NaBH4. Treatment of bovine aortic endothelial cells with human serum albumin dose-dependently protected from HOCl-mediated 14C-adenine release, with this protective effect of human serum albumin not dependent on protein thiol status. Addition of human serum albumin to cell media provided no protection from the cytotoxic actions of peroxynitrite and xanthine oxidase-derived reactive species. Binding of activated polymorphonuclear leukocytes to bovine aortic endothelial cells was significantly amplified by hydroxyethyl starch and inhibited by human serum albumin administration. The binding of neutrophil-derived myeloperoxidase to bovine aortic endothelial cells, a mediator of multiple oxidative and nitric oxide-consuming reactions, was also inhibited by human serum albumin and enhanced by hydroxyethyl starch.

Conclusions

Clinical human serum albumin preparations show modest intrinsic non-thiol-dependent antiinflammatory properties in vitro, a phenomenon that was not observed with hydroxyethyl starch.
Differential Activation of Mitogen-activated Protein Kinases in Ischemic and Anesthetic Preconditioning
Authors: da Silva Rafaela , Grampp Thomas , Pasch Thomas , Schaub Marcus C. , Zaugg Michael
Published: December 2003

Background

Accumulating evidence pinpoints to the pivotal role of mitogen-activated protein kinases (MAPKs) in the signal transduction underlying cardiac preconditioning.

Methods

PD98059, an inhibitor of extracellular signal-regulated protein kinase (MEK-ERK1/2), and SB203580, an inhibitor of p38 MAPK, were used to evaluate the role of MAPKs with respect to postischemic functional recovery in isolated perfused rat hearts subjected to ischemic preconditioning (IPC) and anesthetic preconditioning (APC). Western blot analyses were used to determine the degree of ERK1/2 and p38 MAPK activation after the application of the preconditioning stimulus and after ischemia-reperfusion. Immunohistochemical staining served to visualize subcellular localization of activated MAPKs.

Results

PD98059 and SB203580 abolished postischemic functional recovery in IPC but not in APC. IPC but not APC markedly activated ERK1/2 and p38 MAPK, which were abrogated by coadministration of the specific blockers. Conversely, IPC and APC enhanced ERK1/2 activity after ischemia-reperfusion as compared to nonpreconditioned hearts, and IPC in addition enhanced p38 MAPK activity. Coadministration of PD98059 and SB203580 during IPC but not during APC inhibited postischemically enhanced MAPK activities. Moreover, chelerythrine and 5-hydroxydecanoate, effective blockers of IPC and APC, annihilated IPC- and APC-induced enhanced postischemic responses of MAPKs. Finally, administration of PD98059 during ischemia-reperfusion diminished the protective effects of IPC and APC. Immunohistochemistry revealed increased ERK1/2 activity primarily in intercalated discs and nuclei and increased p38 MAPK activity in the sarcolemma and nuclei of IPC-treated hearts.

Conclusions

Although MAPKs may orchestrate cardioprotection as triggers and mediators in IPC, they are devoid of triggering, but they may have mediator effects in APC.
Hyperoxic Ventilation Reduces 6-Hour Mortality at the Critical Hemoglobin Concentration
Authors: Meier Jens , Kemming Gregor I. , Kisch-Wedel Hille , Wölkhammer Stefan , Habler Oliver P.
Published: December 2003

Background

Acute normovolemic hemodilution reduces the circulating erythrocyte mass and, thus, the hemoglobin concentration. After extreme acute normovolemic hemodilution to the critical hemoglobin concentration (Hbcrit), oxygen demand of the tissues is no longer met by oxygen supply, and death occurs with increasing oxygen debt. The aim of the current study was to investigate whether ventilation with 100% oxygen (fraction of inspired oxygen [FiO2] = 1.0; hyperoxic ventilation) initiated at Hbcrit could restore adequate tissue oxygenation and prevent death.

Methods

Fourteen anesthetized pigs ventilated with room air (FiO2 = 0.21) were hemodiluted by exchange of whole blood for 6% hydroxyethyl starch (200,000:0.5) until the individual Hbcrit was reached. Hbcrit was defined as the onset of oxygen supply dependency of oxygen consumption and was identified with indirect calorimetry. For the next 6 h, animals were either ventilated with an FiO2 of 0.21 (n = 7) or an FiO2 of 1.0 (n = 7).

Results

All animals in the 0.21 FiO2 group died within the first 3 h at Hbcrit (i.e., 6-h mortality 100%). Death was preceded by an increase of serum concentrations of lactate and catecholamines. In contrast to that, six of the seven animals of the 1.0 FiO2 group survived the complete 6-h observation period without lactacidosis and increased serum catecholamines (i.e., 6-h mortality 14%; FiO2 0.21 vs. FiO2 1.0, P < or = 0.05). After 6 h at Hbcrit, the FiO2 was reduced from 1.0 to 0.21, and five of the six animals died within the next 3 h.

Conclusion

In anesthetized pigs submitted to lethal anemia, hyperoxic ventilation enabled survival for 6 h without signs of circulatory failure.
Sodium Bisulfite
Authors: Taniguchi Masahiko , Bollen Andrew W. , Drasner Kenneth
Published: December 2003

Background

Neurologic deficits after apparent intrathecal injection of 3% Nesacaine-CE intended for epidural administration created concern about the potential toxicity of chloroprocaine and the preservative sodium bisulfite. Although bisulfite-free formulations of chloroprocaine were subsequently introduced into clinical practice, the relative toxicities of this anesthetic and preservative were never clearly established. The current studies used a relevant functional and histologic model to investigate the intrathecal neurotoxicity of these two compounds.

Methods

In the first experiment, rats implanted with intrathecal catheters were given one of two commercially available solutions of chloroprocaine, one of which contained sodium bisulfite; control animals received saline. Animals were assessed for sensory impairment 7 days after administration using the tail-flick test and were killed to obtain histologic specimens to quantify nerve injury. In the second experiment, identical methodology was used to investigate the effects of freshly prepared solutions of chloroprocaine, chloroprocaine with sodium bisulfite, sodium bisulfite, and saline.

Results

The two experiments yielded similar results. In experiment 1, tail-flick latencies and nerve injury scores after administration of plain chloroprocaine were significantly greater than those of chloroprocaine containing bisulfite. Injury scores for animals receiving chloroprocaine with bisulfite were elevated compared with those for animals given saline. In experiment 2, animals receiving plain chloroprocaine developed elevations in tail-flick latencies and nerve injury scores that were significantly greater than those for all other groups. Nerve injury scores with chloroprocaine containing bisulfite were greater than with saline or bisulfite alone. Tail-flick latencies and nerve injury scores with bisulfite alone were similar to those with saline.

Conclusions

Clinical deficits associated with unintentional intrathecal injection of chloroprocaine likely resulted from a direct effect of the anesthetic, not the preservative. The data also suggest that bisulfite can reduce neurotoxic damage induced by intrathecal local anesthetic.
Developmental Regulation of Codeine Analgesia in the Rat
Authors: Williams D. Glyn , Dickenson Anthony , Fitzgerald Maria , Howard Richard F.
Published: December 2003

Background

Codeine analgesia is dependent on metabolism to morphine. Metabolic capability is genetically determined in rats and humans, and individuals can be classified as extensive or poor metabolizers, as determined by the extent of production of morphine. Codeine is often given to infants and children. The aim of this study was to investigate the effects of developmental age on codeine analgesia in rats.

Methods

The effects of codeine were compared with those of morphine using withdrawal reflex responses to mechanical stimuli (with and without inflammation) and to noxious heat in two strains of rats (Sprague-Dawley and Dark Agouti) that have been used to model human metabolic phenotypes because of marked differences in enzyme activity. Effects of the opioids were compared at 3, 10, and 21 days of age and in adult rats.

Results

Consistent age-related changes in the efficacy of codeine relative to morphine were noted for both strains of rats. For the extensive metabolizer (Sprague-Dawley) strain, codeine efficacy was substantially lower at 3 days of age (P < 0.001), but there was no difference between the effects of codeine and morphine for 10- and 21-day-old rats and adults (P > 0.05). Poor metabolizers (Dark Agouti strain) also had comparatively low efficacy for codeine compared with morphine in 3-day-old rats and in adults (P < 0.001). In 10- and 21-day-old Dark Agouti rats, there was no difference between either drug (P < 0.05).

Conclusions

Codeine analgesia is developmentally regulated, with low efficacy in the early postnatal period. Effects in the adult rat were not predictive of efficacy in development in either strain, which has important implications for further study and, possibly, for clinical use.
Chronic Pain Management
Authors: Fitzgibbon Dermot R. , Posner Karen L. , Domino Karen B. , Caplan Robert A. , Lee Lorri A. , Cheney Frederick W.
Published: December 2003

Background

The practice of chronic pain management has grown steadily in recent years. The purpose of this study was to identify and describe issues and trends in liability related to chronic pain management by anesthesiologists.

Methods

Data from 5,475 claims in the American Society of Anesthesiologists Closed Claims Project database between 1970 and 1999 were reviewed to compare liability related to chronic pain management with that related to surgical and obstetric (surgical/obstetric) anesthesia. Acute pain management claims were excluded from analysis. Outcomes and liability characteristics between 284 pain management claims and 5,125 surgical/obstetric claims were compared.

Results

Claims related to chronic pain management increased over time (P < 0.01) and accounted for 10% of all claims in the 1990s. Compensatory payment amounts were lower in chronic pain management claims than in surgical/obstetric anesthesia claims from 1970 to 1989 (P < 0.05), but during the 1990s, there was no difference in size of payments. Nerve injury and pneumothorax were the most common outcomes in invasive pain management claims. Epidural steroid injections accounted for 40% of all chronic pain management claims. Serious injuries, involving brain damage or death, occurred with epidural steroid injections with local anesthetics and/or opioids and with maintenance of implantable devices.

Conclusions

Frequency and payments of claims associated with chronic pain management by anesthesiologists increased in the 1990s. Brain damage and death were associated with epidural steroid injection only when opioids or local anesthetics were included. Anesthesiologists involved in home care of patients with implanted devices such as morphine pumps and epidural injections or patient-controlled analgesia should be aware of potential complications that may have severe outcomes.
Influence of Lumbosacral Cerebrospinal Fluid Density, Velocity, and Volume on Extent and Duration of Plain Bupivacaine Spinal Anesthesia
Authors: Higuchi Hideyuki , Hirata Jyun-ichi , Adachi Yushi , Kazama Tomiei
Published: December 2003

Background

The current study was designed to investigate the influence of lumbosacral cerebrospinal fluid (CSF) density, velocity, and volume on the extent and duration of plain bupivacaine spinal anesthesia.

Methods

Forty-one patients scheduled to undergo orthopedic surgery with spinal block were enrolled. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images. CSF velocity at the L3-L4 level was derived from phase-contrast magnetic resonance images. Spinal anesthesia was performed in the lateral decubitus position. CSF (2 ml) was sampled to measure CSF density before injection of 3 ml plain bupivacaine (0.5%). Statistical correlation coefficients (rho) between CSF characteristics and measurements of spinal anesthesia were assessed by Spearman rank correlation. In addition, stepwise multiple linear regression models were used to select important predictors of measures of spinal anesthesia.

Results

There was a significant correlation between CSF density and peak sensory block level (rho = 0.33, P = 0.034). Lumbosacral CSF volume inversely correlated with peak sensory block level (rho = -0.65, P < 0.0001) and positively correlated with onset time of complete motor block (rho = 0.42, P = 0.008). CSF volume also inversely correlated with time required for regression of the sensory block to L1 (rho = -0.35, P = 0.026) and L2 (rho = -0.33, P = 0.039). There was a significant inverse correlation between peak diastolic CSF velocity and duration of motor blockade (rho = -0.44, P = 0.005). Multiple regression analysis revealed that weight and CSF volume significantly contributed to the peak sensory block level (R2 = 0.46).

Conclusions

These findings indicate that CSF density and volume influence the spread of spinal anesthesia with plain bupivacaine and that CSF volume also influences the duration of spinal anesthesia. CSF velocity might also influence the duration of plain bupivacaine spinal anesthesia.
Prediction of Postoperative Pain by Preoperative Nociceptive Responses to Heat Stimulation
Authors: Werner Mads U. , Duun Preben , Kehlet Henrik
Published: December 2003

Background

Despite major advances in the understanding of the neurobiologic mechanisms of pain, the wide variation in acute pain experience has not been well explained. Therefore, the authors investigated the potential of a preoperatively induced heat injury to predict subsequent postoperative pain ratings in patients undergoing knee surgery.

Methods

Twenty patients were studied. The burn injury was induced 6 days before surgery with a contact thermode (12.5 cm2, 47 degrees C for 7 min). The sensory testing, before and 1 h after the injury, included pain score during induction of the burn, secondary hyperalgesia area, thermal and mechanical pain perception, and pain thresholds. Postoperative analgesia consisted of ibuprofen and acetaminophen. Pain ratings (visual analog scale) at rest and during limb movement were followed for 10 days after surgery.

Results

The burn injury was associated with development of significant hyperalgesia. There was a significant correlation between preoperative pain ratings during the burn injury and early (0-2 days, area under the curve) and late (3-10 days, area under the curve) postoperative dynamic pain ratings during limb movement.

Conclusion

The results of this study suggest that the pain response to a preoperative heat injury may be useful in research in predicting the intensity of postoperative pain. These findings may have important implications to identify patients at risk for development of chronic pain and to stratify individuals for investigations of new analgesics.
Pharmacokinetic-Pharmacodynamic Modeling of Morphine-6-glucuronide-induced Analgesia in Healthy Volunteers
Authors: Romberg Raymonda , Olofsen Erik , Sarton Elise , den Hartigh Jan , Taschner Peter E. M. , Dahan Albert
Published: December 2003

Background

Morphine-6-glucuronide (M6G) is a metabolite of morphine and a micro-opioid agonist. To quantify the potency and speed of onset-offset of M6G and explore putative sex dependency, the authors studied the pharmacokinetics and pharmacodynamics of M6G in volunteers using a placebo-controlled, randomized, double-blind study design.

Methods

Ten men and 10 women received 0.3 mg/kg intravenous M6G and placebo (two thirds of the dose as bolus, one third as a continuous infusion over 1 h) on separate occasions. For 7 h, pain tolerance was measured using gradually increasing transcutaneous electrical stimulation, and blood samples were obtained. A population pharmacokinetic (inhibitory sigmoid Emax)-pharmacodynamic analysis was used to analyze M6G-induced changes in tolerated stimulus intensity. The improvement in model fits by inclusion of covariate sex was tested for significance. P values less than 0.01 were considered significant. Taking into account previous morphine data, a predictive pharmacokinetic-pharmacodynamic model was constructed to determine the contribution of M6G to morphine analgesia.

Results

M6G concentrations did not differ between men and women. M6G caused analgesia significantly greater than that observed with placebo (P < 0.01). The M6G analgesia data were well described by the pharmacokinetic-pharmacodynamic model. The M6G effect site concentration causing a 25% increase in current (C25) was 275 +/- 135 nm (population estimate +/- SE), the blood effect site equilibration half-life was 6.2 +/- 3.3 h, and the steepness parameter was 0.71 +/- 0.18. Intersubject variability was 167% for C25 and 218% for the effect half-life. None of the model parameters showed sex dependency.

Conclusions

A cumulative dose of 0.3 mg/kg M6G, given over 1 h, produces long-term analgesia greater than that observed with placebo, with equal dynamics (potency and speed of onset-offset) in men and women. Possible causes for the great intersubject response variability, such as genetic polymorphism of the micro-opioid receptor and placebo-related phenomena, are discussed. The predictive pharmacokinetic-pharmacodynamic model was applied successfully and was used to estimate M6G analgesia after morphine in patients with normal and impaired renal function.
Effects of Perioperative Oral Amantadine on Postoperative Pain and Morphine Consumption in Patients after Radical Prostatectomy
Authors: Snijdelaar Dirk G. , Koren Gideon , Katz Joel
Published: December 2003

Background

Amantadine is known to be a noncompetitive N-methyl-D-aspartate receptor antagonist and may be useful in preventing postoperative central sensitization, acute opioid tolerance, and opioid-induced hyperalgesia, thereby decreasing pain and analgesic requirements. The aim of this pilot study was to evaluate the effects of perioperative oral amantadine on postoperative pain and analgesic consumption.

Methods

Twenty-four patients scheduled to undergo radical prostatectomy were given oral amantadine before and after surgery in a randomized, double-blind, placebo-controlled manner. After surgery, patients received intravenous patient-controlled analgesia with morphine for 48 h. Wound pain intensity, sensitivity to mechanical pressure around the surgical wound, and incidence of bladder spasm pain were assessed. Blood samples were drawn for analysis of amantadine, morphine, and the morphine metabolites. Adverse effects and patient satisfaction were assessed.

Results

The cumulative morphine consumption was significantly lower in the amantadine group at all time points (except at 48 h), amounting to a 32% reduction over the 48-h period. Forty-eight hours after surgery, visual analog pain scores to pressure applied near the wound were significantly lower in the amantadine group than in the placebo group. In addition, the number of patients reporting bladder spasm pain was significantly lower in the amantadine group. Plasma concentration of morphine-3-glucuronide was significantly lower at the end of surgery in the amantadine group. Pharmacokinetic analyses showed that the plasma clearance of morphine at 22-24 h after surgery was also significantly lower in the amantadine group.

Conclusion

The results suggest that perioperative oral amantadine reduces postoperative opioid consumption by pharmacokinetic mechanisms, although additional pharmacodynamic interactions may also be involved.
Labor Analgesia and Cesarean Delivery
Authors: Sharma Shiv K. , McIntire Donald D. , Wiley Jackie , Leveno Kenneth J.
Published: December 2003

Background

The authors performed an individual patient meta-analysis of 2,703 nulliparous women who were randomized to either epidural analgesia or intravenous opioids for pain relief during labor from five trials conducted at their hospital. The primary purpose in this meta-analysis was to evaluate the effects of epidural analgesia during labor on the rate of cesarean delivery.

Methods

Between November 1, 1993, and November 3, 2000, 2,703 nulliparous women (2,188 healthy parturients and 515 women with pregnancy-induced hypertension) in spontaneous labor at term were randomized to receive either epidural analgesia or intravenous opioid analgesia in the five studies. Epidural analgesia was initiated with either epidural bupivacaine or intrathecal sufentanil and was maintained with a low-dose (0.0625% or 0.125%) mixture of bupivacaine with fentanyl. Intravenous opioid analgesia was initiated with 50 mg meperidine and 25 mg promethazine hydrochloride and was maintained with intravenous boluses of meperidine as needed.

Results

A total of 1,339 nulliparous women were randomized to receive epidural analgesia, and 1,364 women were randomized to receive intravenous meperidine analgesia. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 10.5% [140 of 1,339] vs. intravenous meperidine analgesia, 10.3% [141 of 1,364]; adjusted odds ratio, 1.04; 95% confidence interval, 0.81-1.34; P = 0.920). Significantly more women randomized to epidural analgesia had forceps deliveries compared to meperidine analgesia (13% [172 of 1,339] vs. 7% [101 of 1,364]; adjusted odds ratio, 1.86; 95% confidence interval, 1.43-2.40; P < 0.001). Epidural women had longer first and second stages of labor. Women who received epidural analgesia reported lower pain scores during labor and delivery compared to women who received intravenous meperidine analgesia.

Conclusion

Epidural analgesia compared to intravenous meperidine analgesia during labor does not increase the number of cesarean deliveries.
Mobilization of Opioid-containing Polymorphonuclear Cells by Hematopoietic Growth Factors and Influence on Inflammatory Pain
Authors: Brack Alexander , Rittner Heike L. , Machelska Halina , Beschmann Karin , Sitte Nicolle , Schäfer Michael , Stein Christoph
Published: December 2003

Background

Leukocytes can control inflammatory pain by secretion of opioid peptides, stimulated by cold-water swimming or local injection of corticotropin-releasing factor, and subsequent activation of opioid receptors on peripheral sensory neurons. This study investigated whether mobilization of polymorphonuclear cells (PMN) by granulocyte colony-stimulating factor (G-CSF) and stem cell factor (SCF) enhances immigration of opioid-containing PMN and peripheral opioid analgesia in rats with Freund complete adjuvant-induced hind paw inflammation.

Methods

In circulating PMN of rats treated with G-CSF+SCF and sham-treated rats, opioid peptide content was measured by radioimmunoassay. Expression of adhesion molecules (CD62L, CD49d, CD18), in vitro migration in the Boyden chamber, and infiltrating leukocytes were analyzed by flow cytometry. Chemokine messenger RNA transcription was quantified by LightCycler polymerase chain reaction. Paw pressure threshold was measured at baseline, after cold-water swimming, and after injection of corticotropin-releasing factor.

Results

G-CSF+SCF treatment increased circulating PMN (11-fold, P < 0.05). Mobilized PMN had decreased content of beta-endorphin but not of Met-enkephalin per cell, down-regulation of CD62L, up-regulation of CD49d (but no change in CD18), and reduced migration toward higher chemokine concentrations (all P < 0.05). In the paw, one of four chemokine messenger RNAs was significantly expressed during the first 2 h of inflammation (P < 0.05), immigration of PMN and opioid-containing cells was slightly increased (1.5-fold, P < 0.05), and baseline paw pressure threshold, as well as paw pressure threshold increases induced by corticotropin-releasing factor and cold-water swimming, were unchanged (P > 0.05).

Conclusions

G-CSF+SCF mobilized circulating opioid-containing PMN but had a minor influence on cell migration and peripheral analgesia, probably because of the low expression of chemokines in the inflamed paw and one of the decreased beta-endorphin content in PMN.
Influencing ideas and inspirations. Scenarios as an instrument in evaluation
Authors: Barbanente Angela , Khakee Abdul
Published: December 2003

In his review of notable planning disasters, Hall proposes two ways for avoiding future disasters. In a turbulent age, the improvement of forecasting methods is quite problematic. Ranking near and distant futures requires images of alternative future developments. This paper investigates the use of scenarios constructed through interactive knowledge in order to evaluate near‐future policies and programmes. However, since scenarios normally have long‐time horizons, there is a tenuous link between the ideas and aspirations outlined in alternative scenarios and near‐future policies and programmes. This implies that such scenarios can in the first place be used to assess preferences in the near future in relation to distant ideas and aspirations expressed in them. They may also help structure the context and its underlying plural values, and enlarge the range of possible criteria for evaluation. In this sense, they require that evaluation remains open to the discovery of societal preferences, interests and desires. For this purpose uses the concept “exploratory evaluation”. The latter hopefully provides a useful instrument in evaluation. While the emphasis in this paper is on the methodological implications of using long‐term scenarios to evaluate current choices, it nevertheless indicates how scenarios might be used in evaluating policies for sustainable development in southern Mediterranean cities: Tunis, Izmir and Rabat‐Casablanca.
Competition and Long–run Productivity Growth in the UK and US Tobacco Industries, 1879–1939
Authors: Zitzewitz Eric W.
Published: December 2003

The UK and US tobacco industries provide a particularly clean place to examine the impact of changes in market structure on firm conduct and productivity in a rapidly innovating industry. Although each industry had roughly equal access to new manufacturing technologies, the industries were monopolized at different times. The US lost an early productivity lead after the formation of the Tobacco Trust in 1890, but regained it after the UK industry merged to monopoly in 1902 and the Trust was broken up in 1911. Supplementary evidence suggests that technological innovation and consolidation of production were more rapid during competitive periods.
An empirical evaluation of the determinants of Research Joint Venture Formation
Authors: Hernán Roberto , Marín Pedro L. , Siotis Georges
Published: December 2003

This paper empirically analyses the determinants of firm participation in Research Joint Ventures (RJVs). A review of the theoretical literature highlights the difficulty of identifying testable hypotheses. Using a large database of European RJVs, we estimate a participation equation at the firm level using the logit procedure. We find that sectorial R&D intensity, industry concentration, firm size, technological spillovers, and past RJV participation positively influence the probability of forming RJVs. By contrast, patents’ effectiveness reduce the likelihood of RJV formation. Last, country fixed effects suggest that firms from larger countries are less likely to participate in cross–border RJVs.
Entry, Exit and Establishment Survival in UK Manufacturing
Authors: Disney Richard , Haskel Jonathan , Heden Ylva
Published: December 2003

We study entry, exit and survival of UK manufacturing establishments from 1986 to 1991 using the newly released ARD database. We document patterns of entry and exit across industries and over time. We estimate an augmented Cox proportional hazard to examine the survival of new plants in the UK in this period. We find interactions between survival, size and age of establishment that differ between establishments that are singles and part of a group. We speculate that this finding may be consistent with market selection models based on learning.
Lower Bound Estimation – Quantile Regression and Simplex Method: An Application to Italian Manufacturing Sectors
Authors: Giorgetti Maria Letizia
Published: December 2003

This paper estimates Sutton's lower bound [1991, 1998] by quantile regression, and thus shows the influence of outliers on previous estimates that used the simplex method. The lower bound estimates are obtained separately for exogenous and endogenous sunk cost industries in Italian manufacturing sectors in 1995, using microdata from the SCI’95 (Firms Accounts System) survey conducted by ISTAT (National Institute of Statistics, Italy). The results suggest that Sutton's predictions are robust.
Do Value Stocks Earn Higher Returns than Growth Stocks in an Emerging Market? Evidence from the Istanbul Stock Exchange
Authors: Gonenc Halit , Karan Mehmet Baha
Published: December 2003

We study the comparison of returns between value and growth, and between small and large capitalization portfolios for an emerging market, the Istanbul Stock Exchange (ISE). We show that growth portfolios have superior performance over value portfolios. Thus, our results do not confirm the evidence from most developed and emerging markets. Moreover, inconsistent with the evidence from developed markets, monthly and annually small–large portfolio spreads favour large stocks. These results reflect that the structure of the market and the fundamental of stocks traded in the ISE differ from markets around the world. Time series regression results show that the average returns on value and growth portfolios are not sensitive to market movements. Size and B/M risk factors along with market risk premium produce better descriptions of the returns on value and growth portfolios.
Compliance with the Disclosure Requirements of Germany's New Market: IAS Versus US GAAP
Authors: Glaum Martin , Street Donna L.
Published: December 2003

This research examines compliance with both International Accounting Standards (IAS) and United States Generally Accepted Accounting Principles (US GAAP) for companies listed on Germany's New Market. Based on a sample of 100 firms that apply IAS and 100 that apply US GAAP, we investigate the extent to which companies comply with IAS and US GAAP disclosure requirements in their year–2000 financial statements. Compliance levels range from 100% to 41.6%, with an average of 83.7%. The average compliance level is significantly lower for companies that apply IAS as compared to companies applying US GAAP. This study provides the first systematic evidence regarding the enforcement of US GAAP outside the US, and accordingly not subject to Securities Exchange Commission (SEC) review. The results unveil a considerable extent of non–compliance. The overall level of compliance with IAS and US GAAP disclosures is positively related to firms being audited by Big 5 auditing firms and to cross–listings on US exchanges. Compliance is also associated with references to the use of International Standards of Auditing (ISA) or US GAAS in the audit opinion. The findings add to the growing concerns regarding the lack of effective supervision in the German capital market.
Notes on Surface: toward a genealogy of flatness
Authors: Joselit David
Published: December 2003

This essay revisits the issue of flatness, typically associated with teleological readings of modernist painting. At its outset, the text highlights a paradox: that some of the most powerful and prestigious accounts of postmodernism, including Frederic Jameson’s, identify flatness –the modernist trope par excellence – as postmodernism’s distinguishing feature. In an effort to untangle this contradiction, a new genealogy of flatness is proposed. Firstly, a powerful link is noted in Greenbergian modernism between optical flatness and psychological depth. Secondly, a preoccupation with the appropriation and reframing of stereotypes is identified in more recent art. Here, the psychological depth tied to optical flatness in modern art is itself deflated, producing a marriage of optical and psychological flatness. These transformations in the meaning surface and superficiality are traced through the art of Jackson Pollock, Jasper Johns, David Hammons and Kara Walker.
Vostell’s Ruins: dé‐collage and the mnemotechnic space of the postwar city
Authors: Mesch Claudia
Published: December 2003

This essay considers Wolf Vostell’s agenda of commemoration in his dé‐collage performances Tour de Vanves. Theater is in the Street (Paris, 1958) and Cityrama (Cologne, 1961). Vostell’s fully collaborative and performative notion of dé‐collage reconfigured the avant‐garde paradigms of performance and collage, once geared toward forgetfulness, in order to fix the specific importance of remembering destruction in the postwar period. Dé‐collage marked the evacuation of the symbolic content these avant‐gardist forms once possessed in connection with the modern city. While the dé‐collage object may superficially resemble the déaffiche lacerée, it is clearly distinguishable from it through its collective and performative mode of production; the essential contradictions of the concept of dé‐collage contained a critique of the modernist form of collage. Vostell’s commemorative project in dé‐collage resonates with the theorization of collage as a materialist paradigm of art by Louis Aragon and Walter Benjamin, who tied collage to revolutionary intent and even transcendence by means of its relation to remembrance and its function as allegory. Vostell turned to the spaces of the postwar German city in 1961 further to investigate the performative spatial mnemonics of dé‐collage. Dé‐collage staged the postwar city as ‘mnemotechnic space’, to recover Benjamin’s term, thereby escaping the empty repetitions of ‘neo‐avant‐gardism‘ in rethinking flânerie and collage to encompass the cultural necessity of remembrance. Tours de Vanves and Cityrama actively engaged the issue of collective memory that critical theory had foregrounded as a cultural and epistemological priority of the postwar world.
The Critical Echo Chamber
Authors: Podro Michael
Published: December 2003

Books reviewed in this article:

James Elkins Our Beautiful, Dry and Distant Texts. Art History as Writing

Charles Harrison and Paul Wood with Jason Gaiger Art in Theory 1815–1900. An Anthology of Changing Ideas
Shifting Canons
Authors: Klonk Charlotte
Published: December 2003

Book reviewed in this article:

Gill Perry and Colin Cunningham Academies, Museums and Canons of Art
Eye‐to‐Eye
Authors: Durden Mark
Published: December 2003

Book reviewed in this article:

Alfredo Jaar Let There Be Light: The Rwanda Project 1994–1998

Gilles Peress The Silence
Women Artists and the Limits of Modernist Art History
Authors: Rowe Dorothy
Published: December 2003

Books reviewed in this article:

Katy Deepwell, Women Artists and Modernism

Marsha Meskimmon, We Weren’t Enough: Women Artists and the Limits of German Modernism

Annegret Friedrich, Birgit Haehnel, Viktoria Schmidt‐Lisenhoff and Christina Threuter, eds, Projektionen: Rassismus und Sexismus in der Visuellen Kultur

Kathrin Hoffmann‐Curtius and Silke Wenke, eds, Mythen von Autorschaft und Wieblichkeit im 20. Jahrhundert
Equalization and the Decentralization of Revenue–Raising in a Federation
Authors: Boadway Robin , Cuff Katherine , Marchand Maurice
Published: December 2003

We study federal economies in which regional governments have responsibility for delivering public services and redistributive objectives apply. The implications of these for the assignment of revenue–raising instruments and fiscal transfers, both vertical and horizontal, are considered. Models of heterogeneous regions of varying degrees of complexity and generality are constructed. For each case, we determine what fiscal instruments must be given to the regions and what intergovernmental transfers must be made in order that the social optimum is achieved. With heterogenous households and regions, the social optimum can be decentralized by making regions responsible for redistribution and implementing equalization transfers that depend on the number of households of each type.
Efficient Migration and Income Tax Competition
Authors: Bucovetsky S.
Published: December 2003

This paper examines the consequence of the brain drain for the income tax systems of the source and destination countries for the migration, if the two countries’ policies are set noncooperatively by self–interested voters. It is assumed that the brain drain does increase the value of world output: workers with the highest income–earning ability are assumed to be more productive in one country than in another. There are costs to migration of these high–ability workers, costs that are less than the gain in the value of their production. However, for lower–ability workers, the gains in production in moving from the low–productivity country to the high–productivity country are assumed to be less than the migration costs. Voters in the high–productivity country want to capture rents from migrants. These voters are aware of the influence their tax policy has on people's migration decisions. Voters in the low–productivity country also behave strategically. I solve for the Nash equilibrium income tax rates. Increased mobility of highly skilled workers cannot decrease, and may increase, progressivity in the income tax system of the destination country, if migration actually occurs. Finally, the effects of transfers between countries on their income tax systems are examined. Redistribution between countries tends to lead to less redistribution within countries. If transfers between countries are set by a vote of all residents of both countries, then the transfer chosen will be the one that leads to the least progressive tax possible being chosen in each country.
Tax Competition and Economic Geography
Authors: Andersson Fredrik , Forslid Rikard
Published: December 2003

Tax competition between two countries is considered in a trade–and–location setting with differentiated products and monopolistic competition. There are two groups of workers, mobile ones and immobile ones. Taxes are used for producing a public good. It is shown that an equilibrium with mobile workers dispersed across countries is destabilized by increased taxes on these mobile workers—even for perfectly coordinated tax increases. It is also shown that while tax competition gives rise to standard distortions in a tax–competition game when mobile workers are dispersed, different distortions result when they are concentrated in one country.
Fiscal Coordination and Political Competition
Authors: Grazzini Lisa , Van Ypersele Tanguy
Published: December 2003

This contribution investigates fiscal coordination in the framework of two countries asymmetric in respect of their capital–labor endowment. When tax policies are decided by majority voting inside each country, and they are not coordinated at a supranational level, factors of production are inefficiently allocated, at equilibrium. Our main result shows that fiscal coordination, via a minimum capital tax, does not always lead to a Pareto–improvement for the median voter's welfare, with respect to the noncooperative outcome.
Employment Subsidy with Capital Mobility
Authors: Leite–Monteiro Manuel , Marchand Maurice , Pestieau Pierre
Published: December 2003

Most models of tax competition assume full employment. Yet, actually one often observes that fiscal competition, particularly when it is aimed at attracting investment, is motivated by the concern of fighting unemployment and enhancing job creation. The present paper considers a multicountry model with capital mobility and unemployment. Fiscal policy has two opposing objectives: financing unemployment insurance and increasing employment. In each country there is a majority vote on this policy.

The purpose of the paper is to analyse how opening borders to capital flows modifies the median voter's choice of the employment subsidy. Assuming that capital and labour are complements, economic integration is shown to raise the employment subsidy with fixed wages. This agrees with intuition as a larger employment subsidy attracts more capital. However, when wages are set by labour unions economic integration can change the median voter's choice in either direction.