bluuebunny/crossref_metadata_2025 huggingface dataset:
Subintimal Angioplasty for Advanced Lower Extremity Ischemia due to TASC II C and D Lesions of the Superficial Femoral Artery
Authors: Sidhu Ramandeep , Pigott John , Pigott Matthew , Comerota Anthony
Published: July 2010

Objective: Subintimal angioplasty (SA) has evolved into a viable revascularization procedure for complex lower extremity lesions. Although patency rates are lower than those for autogenous bypass, limb salvage rates are comparable. This study reviewed the 8-year experience of SA in a single center.

Methods: Records of patients undergoing SA were reviewed. Clinical presentation and noninvasive exams were used to classify patients. Lesions were categorized by TransAtlantic InterSociety Consensus (TASC) II guidelines. Outcomes included technical success, patency, amputation-free survival, and limb salvage.

Results: 120 patients with TASC II C/D lesions underwent SA. Technical success was 91%. Primary patency at 6 and 12 months was 90% and 73%. Secondary patency at 6 and 12 months was 94% and 85%. One-year amputation-free survival was 90%. One-year limb salvage was 98%.

Conclusions: SA for TASC C/D lesions is a safe procedure and may be considered an alternative to bypass, especially in high-risk patients.
Early Mortality Following Endovascular Versus Open Repair of Ruptured Abdominal Aortic Aneurysms
Authors: Chagpar Ryaz B. , Harris Jeremy R. , Lawlor D. Kirk , DeRose Guy , Forbes Thomas L.
Published: July 2010

Purpose: To determine whether endovascular repair (EVAR) offers a survival advantage over open repair (OAR) with ruptured abdominal aortic aneurysms (RAAA). Methods: Retrospective analysis of RAAA patients treated between 2003 and 2008. Univariate and multivariate analyses were performed. Results: 167 patients presented with RAAA (OAR = 135, 80.8%, EVAR = 32, 19.2%). On univariate analysis, EVAR was associated with a decreased mortality relative to OAR, (15.6% vs 43.7%, P = .004). Patients who survived were younger (P < .0005), had a higher blood pressure (P < .0005), level of consciousness (P < .0005), and hemoglobin (P = .018), and a lower urea (P = .005) and international normalized ratio (INR; P = .001). On multivariate analysis, type of repair remained an independent predictor of 30-day mortality (OR: 0.121; 95% CI: 0.021-0.682, P = .017). Conclusion: Controlling for preoperative factors, EVAR is an independent predictor of lower 30 day mortality relative to open repair after RAAA. This supports the wider use of endovascular repair in all patients with RAAA.
Diagnostic Accuracy of Contrast-Enhanced Magnetic Resonance Angiography and Duplex Ultrasound in Patients With Peripheral Vascular Disease
Authors: Bueno Dra Alicia , Acín Francisco , Cañibano Dra Cristina , Fernandez-Casado Jose L. , Castillo E.
Published: July 2010

Introduction: Noninvasive techniques such as duplex ultrasound (DU) and contrast-enhanced magnetic resonance angiography (CE-MRA) are valid alternatives in the preoperative evaluation of such patients. Our aim is to assess the diagnostic accuracy of CE-MRA and DU in patients with peripheral arterial disease (PAD). Methods: Forty consecutive patients underwent DU, hybrid CE-MRA, and digital subtraction angiography (DSA). Magnetic resonance angiography and DSA images were evaluated independently and in a blinded fashion. Every segment was graded as normal, stenosed less than 50%, stenosed more than 50%, or occluded. Results: There were 1720 segments for analysis. Duplex ultrasound depicting stenosis >50% demonstrated a sensitivity (S) 81.4%, specificity (E) 99%, positive predictive value (PPV) 96.2%, and negative predictive value (NPV) 94.8%. Occlusions showed S 90%, E 97%, PPV 98.1%, and NPV 88.4%. Magnetic resonance angiography depicting stenosis >50% demonstrated a S 91%, E 99%, PPV 96.7%, and NPV 97.6%. Occlusions showed S 95.4%, E 98%, PPV 98.4%, and NPV 94.7%. Conclusion: Combined CE-MRA and DU is the first diagnostic approach in the preoperative assessment of PAD, leading to the use of DSA for selected cases
The Effects of Acarbose Treatment on Intimal Hyperplasia in a Rat Carotid Endarterectomy Model of Diet-Induced Insulin Resistance
Authors: Nyalala John O. , Shaoke Luo  , Campbell Danielle N. , Brown Aliza T. , Moursi Mohammed M.
Published: July 2010

Background: Increased carotid restenosis due to revascularization therapy is associated with insulin resistance. We hypothesize that glucose control using acarbose may attenuate intimal hyperplasia in rat carotid endarterectomy model of diet-induced insulin resistance. Methods: Rats were fed low-fat complex carbohydrate (control) or high-fat sucrose (insulin resistance) for 4 months. Three days preoperatively, some high-fat-sucrose rats were on acarbose, remainder of the rats received placebo. Rat carotids were assessed with duplex pre-and postoperatively. Acarbose and placebo continued for 2 weeks. Glucose, insulin, blood flow velocities and intimal hyperplasia were determined. Results: High-fat sucrose plus acarbose attenuated intimal hyperplasia. Post-drug high-fat sucrose glucose decreased. Blood flow velocities postoperatively elevated above baseline. High-fat sucrose increased blood flow velocities postoperatively, which was attenuated with acarbose. Conclusion: Glucose control by acarbose in rat carotid endarterectomy model of diet-induced insulin resistance resulted in attenuation of intimal hyperplasia.
Conversion of Tunneled Hemodialysis Catheter into HeRO Device Can Provide Immediate Access for Hemodialysis
Authors: Vasquez Julio C. , DeLaRosa Jacob , Rahim Fahim , Rahim Naeem
Published: July 2010

Patients with central venous occlusion who are ‘‘tunneled catheter dependent’’ are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ‘‘self-sealing’’ Flixene graft. This allowed almost immediate use of the HeRO device without the need for placement of a catheter.
Brachial Artery Aneurysm Following Open Repair of Posttraumatic False Aneurysm and Arteriovenous Fistula
Authors: O'Neill Stephen , O'Donnell Mark E. , Collins Anton , Harkin Denis W.
Published: July 2010

True brachial artery aneurysms remain extremely rare and are most commonly related to repetitive blunt trauma. Although operative repair of false aneurysms is well established, management of true aneurysms is varied due to their rarity. We present a true brachial artery aneurysm, in a 55-year old male, which occurred some 22-years following the repair of a posttraumatic false aneurysm. Following arterial duplex and computerised tomography, aneurysectomy with reversed interposition vein graft was performed.
Motivation and diabetes self-management
Authors: Shigaki Cheryl , Kruse Robin L. , Mehr David , Sheldon Kennon M. , Bin Ge  , Moore Cherith , Lemaster Joseph
Published: July 2010

Objective: To examine the relationship between autonomous motivation and diabetes self-care activities among individuals with diabetes.

Methods: Seventy-seven individuals recruited from outpatient clinic registries (64% female, 77% Caucasian, mean age 63 years) completed measures of diabetes-related self-care (Summary of Diabetes Self-care Activities), motivation (Treatment Self-regulation Questionnaire), health literacy (Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign), health (SF-36v2), social support (Social Support Survey) and self-efficacy (Perceived Competence Scale).

Results: Autonomous motivation was the only variable significantly associated with maintaining diet (p<0.0001) and blood glucose testing (p<0.04) in regression analyses. No significant associations were identified for exercise. The variable of age approached significance (p = 0.06), with older individuals being less likely to have exercised in the past week.

Discussion: Individuals in this study had difficulty in maintaining self-care demands, especially exercise. Meeting recommended levels of self-care activity was challenging, even for patients with adequate levels of health literacy. Individuals with higher levels of autonomous motivation reported higher frequencies for maintaining diet and testing blood glucose, however, which supports the utility of Self-Determination Theory in promoting diabetes self-care.
Knee Cartilage Defect Patients Enrolled in Randomized Controlled Trials Are Not Representative of Patients in Orthopedic Practice
Authors: Engen C.N. , Engebretsen L. , Årøen A.
Published: July 2010

Objective:

Knee cartilage defects represent a socioeconomic burden and may cause lifelong disability. Studies have shown that cartilage defects are detected in approximately 60% of knee arthroscopies. In clinical trials, the majority of these patients are excluded. This study investigates whether patients included in randomized controlled trials (RCTs) represent a selected group compared to general cartilage patients.

Design:

Published randomized clinical trials on cartilage repair studies were identified (May 2009) and analyzed to define common inclusion criteria that in turn were applied to all patients submitted to our cartilage repair center during 2008. Patient-administered Lysholm knee score was used to evaluate functional level at referral. In addition, previous surgery and size and localization of cartilage defects were recorded.

Results:

Common inclusion criteria in the referred patients and patients included in the published RCTs were single femoral condyle lesion, age range 18 to 40 years, and size of lesion range 3.2 to 4.0 cm2. Six of 137 referred patients matched all the 7 RCTs. Previous cartilage repair and multiple lesions were associated with decreased Lysholm score ( P < 0.002). Lysholm score was independent of age, gender, and time of symptoms from the defect.

Conclusion:

The heterogeneity of the referred cartilage patients and the variation in inclusion criteria in the RCTs may question whether RCTs actually represent the general cartilage patients. The present study suggests that results from published RCTs may not be representative of the gross cartilage population.
Bag1 directly routes immature BCR-ABL for proteasomal degradation
Authors: Tsukahara Fujiko , Maru Yoshiro
Published: July 2010

Degradation of BCR-ABL oncoproteins by heat shock protein 90 (Hsp90) inhibitors in chronic myelogenous leukemia is expected to overcome resistance to ABL tyrosine kinase inhibitors. However, the precise mechanisms still remain to be uncovered. We found that while c-Cbl E3 ligase induced ubiquitin-dependent degradation of mature and phosphorylated BCR-ABL proteins, another E3 ligase CHIP (carboxyl terminus of the Hsc70-interacting protein) degraded immature BCR-ABL proteins and efficiently suppressed BCR-ABL–dependent leukemic growth. Interestingly, Bag1 (Bcl-2-associated athanogene-1), a nucleotide exchange factor for Hsc70, directly bound BCR-ABL with a high affinity, which was enhanced by CHIP and Hsp90 inhibitors, inhibited by imatinib and competed with Hsc70. Bag1 knockdown abrogated Hsp90 inhibitor-induced BCR-ABL degradation. Bag1 induced binding of immature BCR-ABL to proteasome. Expression of Bag1 induced BCR-ABL degradation and growth suppression in Ba/F3 cells when Hsc70 was knocked down with or without CHIP induction. CHIP appears to sort newly synthesized Hsp90-unchaperoned BCR-ABL to the proteasome not only by inhibiting Hsc70 and thereby promoting Bag1 to bind BCR-ABL, but also by ubiquitinating BCR-ABL. Bag1 may direct CHIP/Hsc70-regulated protein triage decisions on BCR-ABL immediately after translation to the degradation pathway.
Laser-induced endothelial cell activation supports fibrin formation
Authors: Atkinson Ben T. , Jasuja Reema , Chen Vivien M. , Nandivada Prathima , Furie Bruce , Furie Barbara C.
Published: July 2010

Laser-induced vessel wall injury leads to rapid thrombus formation in an animal thrombosis model. The target of laser injury is the endothelium. We monitored calcium mobilization to assess activation of the laser-targeted cells. Infusion of Fluo-4 AM, a calcium-sensitive fluorochrome, into the mouse circulation resulted in dye uptake in the endothelium and circulating hematopoietic cells. Laser injury in mice treated with eptifibatide to inhibit platelet accumulation resulted in rapid calcium mobilization within the endothelium. Calcium mobilization correlated with the secretion of lysosomal-associated membrane protein 1, a marker of endothelium activation. In the absence of eptifibatide, endothelium activation preceded platelet accumu-lation. Laser activation of human umbilical vein endothelial cells loaded with Fluo-4 resulted in a rapid increase in calcium mobilization associated cell fluorescence similar to that induced by adenosine diphosphate (10μM) or thrombin (1 U/mL). Laser activation of human umbilical vein endothelial cells in the presence of corn trypsin inhibitor treated human plasma devoid of platelets and cell microparticles led to fibrin for-mation that was inhibited by an inhibitory monoclonal anti–tissue factor antibody. Thus laser injury leads to rapid endothelial cell activation. The laser activated endothelial cells can support formation of tenase and prothrombinase and may be a source of activated tissue factor as well.
A meta-analysis for the effect of prophylactic GTN on the incidence of post-ERCP pancreatitis and on the successful rate of cannulation of bile ducts
Authors: Chen Bin , Fan Tao , Wang Chun-hui
Published: July 2010

Background

Glyceryl trinitrate (GTN) has been shown to be able to relax the sphincter of Oddi (SO) both in animals and humans. Theoretically, the use of these compounds during and after endoscopic retrograde cholangiopancreatgraphy (ERCP) could relax the biliary and pancreatic sphincters, facilitating cannulation of common bile duct (CBD) during the procedure, or minimizing potential pancreatic outflow obstruction after the procedure. However, clinical trials evaluating the protective effect of GTN on the post-endoscopic retrograde cholangiopancreatgraphy pancreatitis (PEP) have yielded inconclusive results. This meta-analysis is to systematically assess the effect of prophylactic administration of glyceryl trinitrate (GTN) on the prevention of PEP and the effect on the cannulation of bile ducts.

Methods

By searching PubMed (1966 to September 2009), CENTRAL (Cochrane Controlled trials Register; issue 3, 2009) and EMBASE.com (1984 to September 2009), two independent reviewers systematically identified prospective randomized controlled trials (RCTs) detecting the effect of prophylactic GTN on the incidence of PEP and on the cannulation of bile ducts. A meta-analysis of these clinical trials was then performed.

Results

There are 55/899(6.1%) patients suffering PEP in the treatment group versus 95/915(10.4%) patients in the placebo group. The overall pooled risk of PEP was significantly lower in the GTN group than in the placebo group (OR 0.56, 95% CI: 0.40 to 0.79, p = 0.001). Subgroup analyses suggested that GTN administered by the sublingual form (OR 0.34,95% CI:0.16 to 0.75, p = 0.007) is more effective than transdermal route(OR 0.64,95% CI:0.40 to 1.01, p = 0.05), and the protective effect of GTN was far more obvious in the centers with high incidence of PEP (OR 0.40, 95% CI:0.24 to 0.67, p = 0.0006) than those centers with a low incidence of PEP (OR 0.75, 95% CI: 0.47 to 1.20, p = 0.22). Additionally, the meta-analysis suggests that GTN was not helpful for the cannulation of bile ducts.

Conclusion

We concluded that prophylactic administration of GTN may significantly reduce the incidence of PEP and not be helpful for the cannulation of bile ducts.
Characterization of Two Runx1-Dependent Nociceptor Differentiation Programs Necessary for Inflammatory versus Neuropathic Pain
Authors: Samad Omar Abdel , Liu Yang , Yang Fu-Chia , Kramer Ina , Arber Silvia , Ma Qiufu
Published: July 2010

Background:

The cellular and molecular programs that control specific types of pain are poorly understood. We reported previously that the runt domain transcription factor Runx1 is initially expressed in most nociceptors and controls sensory neuron phenotypes necessary for inflammatory and neuropathic pain.

Results:

Here we show that expression of Runx1-dependent ion channels and receptors is distributed into two nociceptor populations that are distinguished by persistent or transient Runx1 expression. Conditional mutation of Runx1 at perinatal stages leads to preferential impairment of Runx1-persistent nociceptors and a selective defect in inflammatory pain. Conversely, constitutive Runx1 expression in Runx1-transient nociceptors leads to an impairment of Runx1-transient nociceptors and a selective deficit in neuropathic pain. Notably, the subdivision of Runx1-persistent and Runx1-transient nociceptors does not follow the classical nociceptor subdivision into IB4+ nonpeptidergic and IB4- peptidergic populations.

Conclusion:

Altogether, we have uncovered two distinct Runx1-dependent nociceptor differentiation programs that are permissive for inflammatory versus neuropathic pain. These studies lend support to a transcription factor-based distinction of neuronal classes necessary for inflammatory versus neuropathic pain.
Translational competence of ribosomes released from a premature termination codon is modulated by NMD factors
Authors: Ghosh Shubhendu , Ganesan Robin , Amrani Nadia , Jacobson Allan
Published: July 2010

In addition to their well-documented roles in the promotion of nonsense-mediated mRNA decay (NMD), yeast Upf proteins (Upf1, Upf2/Nmd2, and Upf3) also manifest translational regulatory functions, at least in vitro, including roles in premature translation termination and subsequent reinitiation. Here, we find that all upfΔ strains also fail to reinitiate translation after encountering a premature termination codon (PTC) in vivo, a result that led us to seek a unifying mechanism for all of these translation phenomena. Comparisons of the in vitro translational activities of wild-type (WT) and upf1Δ extracts were utilized to test for a Upf1 role in post-termination ribosome reutilization. Relative to WT extracts, non-nucleased extracts lacking Upf1 had approximately twofold decreased activity for the translation of synthetic CAN1/LUC mRNA, a defect paralleled by fewer ribosomes per mRNA and reduced efficiency of the 60S joining step at initiation. These deficiencies could be complemented by purified FLAG-Upf1, or 60S subunits, and appeared to reflect diminished cycling of ribosomes from endogenous PTC-containing mRNAs to exogenously added synthetic mRNA in the same extracts. This hypothesis was tested, and supported, by experiments in which nucleased WT or upf1Δ extracts were first challenged with high concentrations of synthetic mRNAs that were templates for either normal or premature translation termination and then assayed for their capacity to translate a normal mRNA. Our results indicate that Upf1 plays a key role in a mechanism coupling termination and ribosome release at a PTC to subsequent ribosome reutilization for another round of translation initiation.
The surgical management of metastatic epidural compression of the spinal cord
Authors: Quraishi N. A. , Gokaslan Z. L. , Boriani S.
Published: July 2010

Metastatic epidural compression of the spinal cord is a significant source of morbidity in patients with systemic cancer. With improved oncological treatment, survival in these patients is improving and metastatic cord compression is encountered increasingly often. The treatment is mostly palliative. Surgical management involves early circumferential decompression of the cord with concomitant stabilisation of the spine. Patients with radiosensitive tumours without cord compression benefit from radiotherapy. Spinal stereotactic radiosurgery and minimally invasive techniques, such as vertebroplasty and kyphoplasty, with or without radiofrequency ablation, are promising options for treatment and are beginning to be used in selected patients with spinal metastases.

In this paper we review the surgical management of patients with metastatic epidural spinal cord compression.
Mapping the strain distribution on the proximal femur with titanium and flexible-stemmed implants using digital image correlation
Authors: Tayton E. , Evans S. , O’Doherty D.
Published: July 2010

We implanted titanium and carbon fibre-reinforced plastic (CFRP) femoral prostheses of the same dimensions into five prosthetic femora. An abductor jig was attached and a 1 kN load applied. This was repeated with five control femora. Digital image correlation was used to give a detailed two-dimensional strain map of the medial cortex of the proximal femur. Both implants caused stress shielding around the calcar. Distally, the titanium implant showed stress shielding, whereas the CFRP prosthesis did not produce a strain pattern which was statistically different from the controls. There was a reduction in strain beyond the tip of both the implants.

This investigation indicates that use of the CFRP stem should avoid stress shielding in total hip replacement.
Does diabetes affect outcome after arthroscopic repair of the rotator cuff?
Authors: Clement N. D. , Hallett A. , MacDonald D. , Howie C. , McBirnie J.
Published: July 2010

We compared the outcome of arthroscopic repair of the rotator cuff in 32 diabetic patients with the outcome in 32 non-diabetic patients matched for age, gender, size of tear and comorbidities. The Constant-Murley score improved from a mean of 49.2 (24 to 80) pre-operatively to 60.8 (34 to 95) post-operatively (p = 0.0006) in the diabetic patients, and from 46.4 (23 to 90) pre-operatively to 65.2 (25 to 100) post-operatively (p = 0.0003) in the non-diabetic patients at six months. This was significantly greater (p = 0.0002) in non-diabetic patients (18.8) than in diabetics (11.6). There was no significant change in the mean mental component of the Short-Form 12, but the mean physical component increased from 35 to 41 in non-diabetics (p = 0.0001), and from 37 to 39 (p = 0.15) in diabetics. These trends were observed at one year.

Patients with diabetes showed improvement of pain and function following arthroscopic rotator cuff repair in the short term, but less than their non-diabetic counterparts.
Capsuloligamentotaxis and definitive fixation by an ankle-spanning Ilizarov fixator in high-energy pilon fractures
Authors: Kapoor S. K. , Kataria H. , Patra S. R. , Boruah T.
Published: July 2010

Open reduction and internal fixation of high-energy pilon fractures are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. A total of 17 consecutive patients with pilon fractures of AO/OTA type 43-B3 (n = 1), type C2 (n = 12) and type C3 (n = 4) were treated by indirect reduction by capsuloligamentotaxis and stabilisation using an ankle-spanning Ilizarov fixator. The calcaneal ring was removed at a mean of 3.7 weeks (3 to 6). A total of 16 patients were available for follow-up at a mean of 29 months (23 to 43). The mean time to healing was 15.8 weeks (13 to 23). Nine patients had pin-track infections but none had deep infection or osteomyelitis. Four patients (25%) had malunion. Fair, good or excellent ankle scores were found in 14 patients. External fixation with a ring fixator achieves stable reduction of the fractured fragments without additional trauma to soft tissues.

With minimum complications and good healing results, the Ilizarov apparatus is particularly useful for high-energy pilon fractures.
Custom-made endoprostheses for the femoral amputation stump
Authors: Kalson N. S. , Gikas P. D. , Aston W. , Miles J. , Blunn G. , Pollock R. , Skinner J. , Briggs T. W. R. , Cannon S. R.
Published: July 2010

Disarticulation of the hip in patients with high-grade tumours in the upper thigh results in significant morbidity. In patients with no disease of the proximal soft tissue a femoral stump may be preserved, leaving a fulcrum for movement and weight-bearing. We reviewed nine patients in whom the oncological decision would normally be to disarticulate, but who were treated by implantation of an endoprosthesis in order to create a functioning femoral stump. The surgery was undertaken for chondrosarcoma in four patients, pleomorphic sarcoma in three, osteosarcoma in one and fibrous dysplasia in one. At follow-up at a mean of 80 months (34 to 132), seven patients were alive and free from disease, one had died from lung metastases and another from a myocardial infarction. The mean functional outcome assessment was 50 (musculoskeletal tumor society), 50 and 60 (physical and mental Short-form 36 scores).

Implantation of an endoprosthesis into the stump in carefully selected patients allows fitting of an above-knee prosthesis and improves wellbeing and the functional outcome.
The normal centre-edge angle of Wiberg in the Chinese population
Authors: Shi Y. Y. , Liu T. J. , Zhao Q. , Zhang L. J. , Ji S. J. , Wang E. B.
Published: July 2010

This study was designed to provide normal reference values for the centre-edge angle of Wiberg in the Chinese population by measuring 1494 radiographs according to the criteria of Tönnis. The mean angle was 23.1° (4.7° to 46.4°) in childhood (four to nine years), increasing to 28.9° (6° to 48°) in adolescence (10 to 18 years) and reaching 32.8° (13.7° to 58.8°) in adults. The angle was positively correlated with age, increasing by a mean of 0.78° annually before adulthood and by 0.070° annually in adults. A relative upward tendency after middle age might contribute to degenerative changes. No gender difference was discovered. The change in the angle with age was similar to that observed in other ethnic groups, showing moderate differences in the average of individual age groups, but the ethnic differences are not sufficient to explain the variation of incidence of developmental dysplasia of the hip in different races.
Factors affecting the incidence of infection in hip and knee replacement
Authors: Willis-Owen C. A. , Konyves A. , Martin D. K.
Published: July 2010

Infection remains a significant and common complication after joint replacement and there is debate about which contributing factors are important. Few studies have investigated the effect of the operating time on infection.

We collected data prospectively from 5277 hip and knee replacements which included the type of procedure, the operating time, the use of drains, the operating theatre, surgeon, age and gender. In a subgroup of 3449 knee replacements further analysis was carried out using the tourniquet time in place of the operating time. These variables were assessed by the use of generalised linear modelling against superficial, deep or joint-space post-operative infection as defined by the Australian Surgical-Site Infection criteria.

The overall infection rate was 0.98%. In the replacement data set both male gender (z = 3.097, p = 0.00195) and prolonged operating time (z = 4.325, p < 0.001) were predictive of infection. In the knee subgroup male gender (z = 2.250, p = 0.02447), a longer tourniquet time (z = 2.867, p = 0.00414) and total knee replacement (versus unicompartmental knee replacement) (z = −2.052, p = 0.0420) were predictive of infection.

These findings support the view that a prolonged operating time and male gender are associated with an increased incidence of infection. Steps to minimise intra-operative delay should be instigated, and care should be exercised when introducing measures which prolong the duration of joint replacement.
Repair of a post-traumatic cartilage defect with a cell-free polymer-based cartilage implant
Authors: Patrascu J. M. , Freymann U. , Kaps C. , Poenaru D. V.
Published: July 2010

Microfracture is frequently used as the first line of treatment for the repair of traumatic cartilage defects. We present the clinical and histological results 18 months to two-years after treatment in a 26-year-old male with a post-traumatic chondral defect of the medial femoral condyle managed by microfracture covered with chondrotissue, a cell-free cartilage implant made of a resorbable polyglycolic acid felt and hyaluronic acid.
Caspofungin-Induced Toxic Epidermal Necrolysis; Acute Eosinophilic Pneumonia Secondary to Daptomycin; Catastrophic Complications of Intravenous Promethazine; Separate Episodes of Delirium Caused by Amiodarone and Levetiracetam; Fatal Hemobilia in Advanced Hepatocellular Carcinoma Caused by Sorafenib; Mania Associated with Mefloquine Prophylaxis; Inappropriate Prescribing Predicts Adverse Events in the Elderly
Authors: Shuster Joel
Published: July 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) Medwatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to Medwatch, please consider sharing the account with our readers.
Aztreonam Lysine Inhalation Solution
Authors: De Luna Kimberly , Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: July 2010

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent in print and are also available online. Monographs can be customized to meet the needs of a facility. Subscribers to The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The August 2010 monograph topics are on denosumab, ketorolac tromethamine nasal spray, gatifloxacin ophthalmic solution 0.5%, naproxen/esomeprazole magnesium delayed-release, and estradiolvalerate and estradiol valerate/dienogest. The DUE/MUE is on ketorolac tromethamine.
Understanding the Implications of the Health Information Technology for Economic and Clinical Health Act's Meaningful Use Criteria
Authors: Felkey Bill G. , Fox Brent I.
Published: July 2010

Meaningful use of electronic medical records continues to dominate health information technology news. Hospitals are edging closer each day to the beginning of the first phase of required criteria implementation. This installment looks specifically at Phase 1 meaningful use criteria and what they can mean for pharmacy.
Recent Publications on Medications and Pharmacy
Authors: Russett Flint
Published: July 2010

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
Peripubertal aromatase inhibition in male rats has adverse long-term effects on bone strength and growth and induces prostatic hyperplasia
Authors: Bajpai Anurag , Simm Peter J , McPherson Stephen J , Russo Vincenzo C , Azar Walid J , Wark John D , Risbridger Gail P , Werther George A
Published: July 2010

Aromatase inhibitors have been increasingly used in boys with growth retardation to prolong the duration of growth and increase final height. Multiple important roles of oestrogen in males point to potential adverse effects of this strategy. Although the deleterious effects of aromatase deficiency in early childhood and adulthood are well documented, there is limited information about the potential long-term adverse effects of peripubertal aromatase inhibition. To address this issue, we evaluated short-term and long-term effects of peripubertal aromatase inhibition in an animal model. Peripubertal male Wistar rats were treated with aromatase inhibitor letrozole or placebo and followed until adulthood. Letrozole treatment caused sustained reduction in bone strength and alteration in skeletal geometry, lowering of IGF1 levels, inhibition of growth resulting in significantly lower weight and length of treated animals and development of focal prostatic hyperplasia. Our observation of adverse long-term effects after peripubertal male rats were exposed to aromatase inhibitors highlights the need for further characterisation of long-term adverse effects of aromatase inhibitors in peripubertal boys before further widespread use is accepted. Furthermore, this suggests the need to develop more selective oestrogen inhibition strategies in order to inhibit oestrogen action on the growth plate, while beneficial effects in other tissues are preserved.
Dynamic regulation of pituitary mRNAs for bone morphogenetic protein (BMP) 4, BMP receptors, and activin/inhibin subunits in the ewe during the estrous cycle and in cultured pituitary cells
Authors: Sallon C , Faure M O , Fontaine J , Taragnat C
Published: July 2010

Recently, bone morphogenetic protein (BMP) 4 has been shown to inhibit FSH secretion in ewe. The detection of BMP4 mRNA and BMP receptors in the pituitary suggests that BMP4 can exert paracrine actions on FSH production. This work aimed at determining whether BMP4 and/or BMP receptor mRNA as well as activin/inhibin subunit mRNA fluctuates during the estrous cycle when FSHβ mRNA and FSH release changed. The estrous cycles of ewes were synchronized with progestagen sponges. Ewes were killed in late follicular stage (n=5), before the secondary FSH surge (n=4), and in luteal phase (n=4). Using quantitative reverse transcription-PCR, we showed that the levels of mRNA for BMP4, BMP receptor, the inhibitor of differentiation 2 (Id2), a target gene of BMP4, and noggin did not change significantly across the estrous cycle. In contrast, the level of activin βB mRNA and the percentage of immunoreactive cells for activin βB-subunit were higher before the secondary surge of FSH compared to other groups. In ewe pituitary cell cultures, activin, GnRH, or estradiol-17β (E2) did not significantly affect the levels of BMP4, BMP receptor, and Id2 mRNA. E2, but not GnRH, increased the level of activin βB mRNA. Moreover, the in vitro FSH release was not modified by noggin, a BMP antagonist. In contrast, SB431542, an inhibitor of activin pathway, inhibited FSH release. Collectively, our data showed that pituitary BMP4 would not play a crucial role in the regulation of FSH production during the estrous cycle, whereas local activin B would be a major stimulus of FSH synthesis necessary for the secondary FSH surge.
Insulin treatment and high-fat diet feeding reduces the expression of three Tcf genes in rodent pancreas
Authors: Columbus Joshua , Chiang YuTing , Shao Weijuan , Zhang Nina , Wang Dingyan , Gaisano Herbert Y , Wang Qinghua , Irwin David M , Jin Tianru
Published: July 2010

Specific single-nucleotide polymorphisms in intronic regions of human TCF7L2 are associated with an elevated risk of developing type 2 diabetes. Whether Tcf7l2 is expressed in pancreatic islets of rodent species at a considerable level, however, remains controversial. We used RT-PCR and quantitative RT-PCR to examine Tcf7l2 expression in rodent gut, pancreas, isolated pancreatic islets, and cultured cell lines. The expression level of Tcf7l2 was relatively lower in the pancreas compared to the gut or the pancreatic β-cell line Ins-1. Immunostaining did not detect a Tcf7l2 signal in mouse pancreatic islets. Endogenous canonical Wnt activity was not appreciable in the pancreas of TOPGAL transgenic mice. Both Tcf7 and Tcf7l1, but not Lef1, were expressed in the pancreas. The expression of the three Tcf genes (Tcf7, Tcf7l1, and Tcf7l2) in the pancreas was reduced by treatment with insulin or high-fat diet feeding, in contrast to the stimulation of Tcf7l2 expression by insulin in the gut. We suggest that hyperinsulinemia represses Tcf gene expression in the pancreas. Whether and how this reduction alters the function of pancreatic β cells during hyperinsulinemia deserves further investigation.
Adiponectin inhibits palmitate-induced apoptosis through suppression of reactive oxygen species in endothelial cells: involvement of cAMP/protein kinase A and AMP-activated protein kinase
Authors: Kim Ji-Eun , Song Seung Eun , Kim Yong-Woon , Kim Jong-Yeon , Park Sung-Chul , Park Yoon-Ki , Baek Suk-Hwan , Lee In Kyu , Park So-Young
Published: July 2010

The present study examined whether adiponectin can inhibit palmitate-induced apoptosis, and also the associated mechanisms and signal transduction pathways in human umbilical vein endothelial cells. Cells treated with 500 μM palmitate for 48 h increased reactive oxygen species (ROS) generation and induced apoptosis. Treatment with antioxidant N-acetyl-l-cysteine (1 mM) and globular adiponectin (5 μg/ml) inhibited palmitate-induced ROS generation and apoptosis. The AMP-activated protein kinase (AMPK) activator 5-aminoimidazole-4-carboxamide-1-β-d-ribofuranoside (AICAR; 1 mM), and cAMP activators forskolin (10 μM) and cholera toxin (200 ng/ml) also displayed the same effects. The inhibitory effects of adiponectin on ROS generation and apoptosis were reversed by the AMPK inhibitor compound C (40 μM), cAMP inhibitor SQ22536 (50 μM), and protein kinase A (PKA) inhibitor H-89 (10 μM). The inhibitory effect of forskolin on palmitate-induced apoptosis was reversed by compound C, whereas the inhibitory effect of AICAR was not reversed by SQ22536 and H-89. AICAR and forskolin could not inhibit palmitate-induced apoptosis in cells treated with dominant-negative AMPK. Forskolin increased phosphorylated AMPK at both Thr-172 and Ser-485/491. These results suggest that adiponectin inhibits palmitate-induced apoptosis by suppression of ROS generation via both the cAMP/PKA and AMPK pathways. Interaction between cAMP/PKA and AMPK pathways may be involved.
Effects of adiponectin on human trophoblast invasion
Authors: Benaitreau Delphine , Dos Santos Esther , Leneveu Marie-Christine , Alfaidy Nadia , Feige Jean-Jacques , de Mazancourt Philippe , Pecquery René , Dieudonné Marie-Noëlle
Published: July 2010

Adiponectin is an adipokine with insulin-sensitizing, anti-inflammatory, anti-atherogenic, and anti-proliferative effects. The expression of specific adiponectin receptors in the placenta and in the endometrium suggests a role for this cytokine in placental development, but this role has not yet been elucidated. The invasion of trophoblast cells during the first trimester of pregnancy being crucial to placentation process, we have studied adiponectin effects on human trophoblast invasive capacities. We found that adiponectin stimulated human trophoblast cell migration in HTR-8/SVneo cells in a dose-independent manner. In addition, adiponectin also significantly enhanced invasion of HTR-8/SVneo cells and of human extravillous trophoblast from first trimester placenta. These pro-invasive effects of adiponectin in human trophoblasts seem to be mediated in part via increased matrix metalloproteinases (MMP2 and MMP9) activities and via repression of TIMP2 mRNA expression. Our results suggest that adiponectin could be a positive regulator of the early invasion process by modulating the MMP/TIMP balance. Moreover, these results provide an insight into the role of adiponectin in pathological conditions characterized by insufficient or excessive trophoblast invasion.
Altered renal FGF23-mediated activity involving MAPK and Wnt: effects of the Hyp mutation
Authors: Farrow Emily G , Summers Lelia J , Schiavi Susan C , McCormick James A , Ellison David H , White Kenneth E
Published: July 2010

Fibroblast growth factor-23 (FGF23), a hormone central to renal phosphate handling, is elevated in multiple hypophosphatemic disorders. Initial FGF23-dependent Erk1/2 activity in the kidney localizes to the distal convoluted tubule (DCT) with the co-receptor α-Klotho (KL), distinct from Npt2a in proximal tubules (PT). The Hyp mouse model of X-linked hypophosphatemic rickets (XLH) is characterized by hypophosphatemia with increased Fgf23, and patients with XLH elevate FGF23 following combination therapy of phosphate and calcitriol. The molecular signaling underlying renal FGF23 activity, and whether these pathways are altered in hypophosphatemic disorders, is unknown. To examine Npt2a in vivo, mice were injected with FGF23. Initial p-Erk1/2 activity in the DCT occurred within 10 min; however, Npt2a protein was latently reduced in the PT at 30–60 min, and was independent of Npt2a mRNA changes. KL-null mice had no DCT p-Erk1/2 staining following FGF23 delivery. Under basal conditions in Hyp mice, c-Fos and Egr1, markers of renal Fgf23 activity, were increased; however, KL mRNA was reduced 60% (P<0.05). Despite the prevailing hypophosphatemia and elevated Fgf23, FGF23 injections into Hyp mice activated p-Erk1/2 in the DCT. FGF23 injection also resulted in phospho-β-catenin (p-β-cat) co-localization with KL in wild-type mice, and Hyp mice demonstrated strong p-β-cat staining under basal conditions, indicating potential crosstalk between mitogen-activated protein kinase and Wnt signaling. Collectively, these studies refine the mechanisms for FGF23 bioactivity, and demonstrate novel suppression of Wnt signaling in a KL-dependent DCT-PT axis, which is likely altered in XLH. Finally, the current treatment of phosphate and calcitriol for hypophosphatemic disorders may increase FGF23 activity.
FDI and Domestic Investment: An Industry-Level View
Authors: Arndt Christian , Buch Claudia M , Schnitzer Monika E
Published: July 2010

Previous empirical work on the link between domestic and foreign investment has provided mixed results. This may partly be due to the level of aggregation of the data. In this paper, we argue that the impact of FDI on the domestic capital stock depends on the structure of industries. Using industry-level data on the stock of German FDI, we test our predictions. We use panel cointegration methods which address the potential endogeneity of FDI. We find evidence for a positive long-run impact of FDI on the domestic capital stock.
An optimal iteration method with application to the Thomas-Fermi equation
Authors: Marinca Vasile , Herişanu Nicolae
Published: July 2010

The aim of this paper is to introduce a new approximate method, namely the Optimal Parametric Iteration Method (OPIM) to provide an analytical approximate solution to Thomas-Fermi equation. This new iteration approach provides us with a convenient way to optimally control the convergence of the approximate solution. A good agreement between the obtained solution and some well-known results has been demonstrated. The proposed technique can be easily applied to handle other strongly nonlinear problems.
Intercellular adhesion molecule-1 gene polymorphisms in patients with familial mediterranean fever
Authors: Kobak Senol , Celebi Arzu , Oksel Fahrettin , Kabasakal Yasemin , Akarca Ulus
Published: July 2010

Familial Mediterranean fever (FMF) is a disease of unknown etiology characterized by recurrent attacks of polyserositis and fever. Intercellular adhesion molecule-1 (ICAM-1) is known to contribute inflammatory conditions by regulating leukocyte localization at inflammatory sites. The aim of this study was to evaluate the probable association of ICAM-1 G/R 241 and ICAM-1 E/K 469 polymorphisms according to susceptibility with FMF. Sixty-seven FMF patients and 83 healthy volunteers were included in the study. Genomic DNA was extracted from EDTA-preserved whole blood of whole series of patients and controls, and genotyped by polymerase chain reaction (PCR) and allele-specific oligonucleotide techniques for ICAM-1 polymorphisms G/R at codon 241 and E/K at codon 469. The ICAM-1 241 genotype and allele frequencies of FMF patients and healthy volunteers were similar. The frequency of ICAM-1 K469 homozygosity was significantly lower in FMF patients than in the controls (32.8% vs 50.7% subsequently, p=0.03). Moreover, ICAM-1 E469 allele was more frequent in FMF patients than in controls (44.8% vs 32.3%, p:0.03). Our results showed that ICAM-1 469 gene polymorphism could contribute to the pathogenesis of FMF.
Effect of pH and washing on calcium and magnesium distribution between pulp and filtrate
Authors: Gemzická Eva , Šima Jozef , Vrška Milan , Holeš Martin
Published: July 2010

The impact of pH and washing procedure on calcium and magnesium distribution between pulp and filtrate in pulp processing was investigated. Depending on media pH, the elements are present in the form of ions (Ca2+, Mg2+) and hydrated oxides (Ca(OH)2, Mg(OH)2). Distribution was monitored using binary systems of CaCl2 and MgCl2 dissolved in deionized water or Ca2+ and Mg2+ ions present in filtrates from an industrial pulp mill. Complying with the relevant standards in force, Ca and Mg contents are expressed as CaO and MgO. The study was aimed at obtaining mathematic relations between pH and calcium and magnesium, as two important non-process elements, sorption on pulp. Distribution of the elements between pulp and liquid (filtrate or water) was determined with analytical procedures and simulation of pulp washing. It was found that both pH and filtrate composition influenced sorption/desorption of the elements on/from pulp. Filtrate from a pulp mill, mainly content of organic substances in liquid phase, affects their sorption on pulp and desorption to liquid. The higher the pH value the more efficient the sorption of the elements, magnesium being sorbed on pulp in higher amounts than calcium. Prevalence of the sorbed magnesium is preserved even at lower concentrations of both elements. Distribution of the elements between pulp and solution is expressed through mathematic relations which, in turn, can be employed to purposefully modify or optimize the distribution between the solid (pulp) and liquid (filtrate) media. Moreover, rationalized exploitation of mathematical relations enables balancing the elements within a cellulose manufacture, regulating media recycling, and predicting an eventual impact on technological processes.
Isolation, Identification and Pathogenicity Assessment of a new Isolate of Entomopathogenic Fungus, Beauveria Bassiana in Iran
Authors: Safavi Seyed
Published: July 2010

Isolation, Identification and Pathogenicity Assessment of a new Isolate of Entomopathogenic Fungus, Beauveria Bassiana in Iran

A new isolate (BEH) of entomopathogenic fungus,Beauveria bassianawas isolated from soil using DOC2 selective medium. This isolate was characterized by conidiophores consisting of whorls and dense clusters of short conidiophorous cells with one-celled spherical conidia. Conidial length and width were 2.27±0.22 μm and 1.85±0.32 μm, respectively with length/width ratio of 1.23. Colonies on SDYA medium were normally white to pale yellow and sometimes red pigmented in reverse. Because of importance of this pathogen in biocontrol programs around the world and difficulties with morphological identification, a molecular technique was developed to assist complementary identification of the fungus. Pr1, a pathogenicity-related alkaline cuticle-degrading serine protease, with defined sequence inB. bassianawas amplified using PCR technique. The presence of this gene in isolated fungus (BEH) with 744 bp sequence length, as visualized on agarose gel affirmed the data from morphological studies that the new isolate (BEH) pertained to entomopathogenic fungus,B. bassiana. Pathogenicity of new isolate againstTenebrio molitorand its recovering was the other confirmation that the isolated fungus belonged toB. bassiana, using further light microscope studies.