bluuebunny/crossref_metadata_2025 huggingface dataset:
A Fracture Pain Model in the Rat
Authors: Freeman Katie T. , Koewler Nathan J. , Jimenez-Andrade Juan M. , Buus Ryan J. , Herrera Monica B. , Martin Carl D. , Ghilardi Joseph R. , Kuskowski Michael A. , Mantyh Patrick W.
Published: March 2009

Background

Because of the relative lack of understanding of the mechanisms that drive skeletal pain, the purpose of this study was to adapt a previously validated closed femur fracture model to quantitatively evaluate skeletal pain in female and male rats.

Methods

Three-month-old female and male Sprague-Dawley rats were anesthetized, and a stainless steel pin was inserted into the intramedullary space of the left femur. Three weeks later, the rats were reanesthetized, and left femoral diaphyses were fractured using a standardized impactor device. At 1-21 days after fracture, skeletal pain was measured by quantitatively assessing spontaneous guarding, spontaneous flinching, and weight bearing of the fractured hind limb.

Results

Females and males showed highly robust pain behaviors that were maximal at day 1 after fracture and returned gradually to normal nonfractured levels at days 14-21 after fracture. The magnitude of fracture pain was not significantly different at most time points between female and male rats. In both females and males, the pain-related behaviors were attenuated by subcutaneous morphine in a dose-dependent manner.

Conclusions

This model may help in developing a mechanism-based understanding of the factors that generate and maintain fracture pain in both females and males and in translating these findings into new therapies for treating fracture pain.
Isoflurane Preconditioning Decreases Myocardial Infarction in Rabbits via Up-regulation of Hypoxia Inducible Factor 1 That Is Mediated by Mammalian Target of Rapamycin
Authors: Raphael Jacob , Zuo Zhiyi , Abedat Suzan , Beeri Ronen , Gozal Yaacov
Published: March 2009

Background

Volatile anesthetics are known to protect the heart against ischemia-reperfusion injury. The authors tested whether anesthetic preconditioning with isoflurane is mediated via activation of the transcription factor hypoxia inducible factor 1 (HIF-1) and evaluated the role of mammalian target of rapamycin signaling in this process.

Methods

New Zealand White rabbits subjected to 40 min of regional myocardial ischemia, followed by 180 min of reperfusion, were assigned to the following groups: ischemia and reperfusion (I/R) only, isoflurane (1 minimal alveolar concentration) preconditioning, and isoflurane preconditioning in the presence of the mammalian target of rapamycin inhibitor rapamycin (0.25 mg/kg). Sham-operated, isoflurane + sham, rapamycin + sham, rapamycin + I/R, and dimethyl sulfoxide + I/R groups were also included. Creatine kinase-MB levels were assessed as an indicator of myocardial damage, and infarct size was evaluated by triphenyl tetrazolium chloride staining. HIF-1alpha expression and DNA binding were assessed by Western blotting and electrophoretic mobility shift analysis, respectively.

Results

Isoflurane preconditioning reduced infarct size compared with the I/R group: 26 +/- 4% versus 44 +/- 6% (P < 0.05). Creatine kinase-MB concentrations in the preconditioned animals (103 +/- 8% above baseline) were lower than in the I/R group (243 +/- 12% above baseline; P < 0.05). Rapamycin inhibited the cardioprotective effect of isoflurane: myocardial infarction increased to 44 +/- 4% and creatine kinase-MB level increased to 254 +/- 9% above baseline. HIF-1alpha protein expression and DNA binding activity increased after isoflurane preconditioning compared with the ischemia group. These effects were also inhibited by rapamycin.

Conclusions

The current results indicate that isoflurane-induced myocardial protection involves activation of the HIF-1 pathway that is mediated by the mammalian target of rapamycin.
Blood–Brain Barrier Transport Helps to Explain Discrepancies in In Vivo Potency between Oxycodone and Morphine
Authors: Boström Emma , Hammarlund-Udenaes Margareta , Simonsson Ulrika S. H.
Published: March 2009

Background

The objective of this study was to evaluate the brain pharmacokinetic-pharmacodynamic relations of unbound oxycodone and morphine to investigate the influence of blood-brain barrier transport on differences in potency between these drugs.

Methods

Microdialysis was used to obtain unbound concentrations in brain and blood. The antinociceptive effect of each drug was assessed using the hot water tail-flick method. Population pharmacokinetic modeling was used to describe the blood-brain barrier transport of morphine as the rate (CLin) and extent (Kp,uu) of equilibration, where CLin is the influx clearance across the blood-brain barrier and Kp,uu is the ratio of the unbound concentration in brain to that in blood at steady state.

Results

The six-fold difference in Kp,uu between oxycodone and morphine implies that, for the same unbound concentration in blood, the concentrations of unbound oxycodone in brain will be six times higher than those of morphine. A joint pharmacokinetic-pharmacodynamic model of oxycodone and morphine based on unbound brain concentrations was developed and used as a statistical tool to evaluate differences in the pharmacodynamic parameters of the drugs. A power model using Effect = Baseline + Slope . C best described the data. Drug-specific slope and gamma parameters made the relative potency of the drugs concentration dependent.

Conclusions

For centrally acting drugs such as opioids, pharmacokinetic-pharmacodynamic relations describing the interaction with the receptor are better obtained by correlating the effects to concentrations of unbound drug in the tissue of interest rather than to blood concentrations.
High-throughput Operating Room System for Joint Arthroplasties Durably Outperforms Routine Processes
Authors: Smith Michael P. , Sandberg Warren S. , Foss Joseph , Massoli Kathleen , Kanda Mona , Barsoum Wael , Schubert Armin
Published: March 2009

Background

Recent publications have focused on increased operating room (OR) throughput without increasing total OR time. The authors hypothesized that a system of parallel processing for lower extremity joint arthroplasties sustainably reduces nonoperative time and increases throughput.

Methods

The high-throughput parallel processing strategy included neuraxial anesthesia performed in an "induction room" adjacent to the OR, patient selection, an additional circulating nurse, and end-of-case transfer of care to a recovery room nurse who transported the patient from the OR to recovery. Instruments and supplies were prepared in a dedicated sterile setup area. Data were extracted from administrative databases. Group comparisons used standard statistical methods; statistical process control was used to evaluate performance over time.

Results

There were 688 historic control cases from 299 days over 16 months, and 905 high-throughput cases from 304 days spanning 24 consecutive months starting September 1, 2004. Throughput increased from 2.6 +/- 0.7 (mean +/- SD) to 3.4 +/- 0.8 arthroplasties per day per room. Nonoperative time decreased by 36 min (or 50%) per case. Operative time also decreased by 14 min (12%) per case. The end time for the high-throughput OR day was only 16 min later than control. Nonoperative time, operative time, and throughput remained significantly improved after 2 yr of operation. Contribution margin increased 19.6%.

Conclusion

Reorganizing the perioperative work process for total joint replacements sustainably increased OR throughput. Because joint arthroplasties generated a positive margin greater than the incremental cost, the high-throughput system improved financial performance.
Early Biochemical Markers of Inflammation in a Swine Model of Endotracheal Intubation
Authors: Puyo Carlos A. , Tricomi Sally M. , Dahms Thomas E.
Published: March 2009

Background

A common complaint after endotracheal tube use is sore throat, which may be due to abrasion, ischemia-reperfusion injury, or an inflammatory reaction. Few studies have evaluated localized tracheal inflammation as part of the response to intubation.

Methods

Inflammation of the trachea due to intubation was assessed in a swine model by following indicators of inflammation over time in the tracheal lumen. Repeated tracheal lavages proximal to the endotracheal tube cuff were performed, and recovered lavage was analyzed for cells, protein, lactate dehydrogenase, and cytokines.

Results

The baseline tracheal lavage samples contained 18% polymorphonuclear cells. These cells increased rapidly to 43% by 1 h. The polymorphonuclear cell increase from baseline was significant at 1, 2, and 4 h (P < 0.01) after intubation. Tumor necrosis factor alpha, interleukin 1beta, interleukin 6, and interleukin 8 increased over time, but only interleukin 6 increased significantly (P < 0.01). Interleukin 6 was not detected at baseline or 1 h, but was detected at 2 h and increased significantly by 4 h. Neither lavage protein concentration nor lactate dehydrogenase activity increased over time.

Conclusions

These results demonstrate that inflammation does occur during tracheal intubation, even when markers suggest minimal tracheal damage. The dramatic elevation in polymorphonuclear cells, along with the increase in interleukin 6, suggests an inflammatory response to the endotracheal tube itself or to some aspect of the intubation process. A more complete understanding of the response of the tracheal tissues is important in improving the treatment of intubated patients.
Lack of Impact of Intravenous Lidocaine on Analgesia, Functional Recovery, and Nociceptive Pain Threshold after Total Hip Arthroplasty
Authors: Martin Frédéric , Cherif Kamel , Gentili Marc Emile , Enel Dominique , Abe Emuri , Alvarez Jean Claude , Mazoit Jean Xavier , Chauvin Marcel , Bouhassira Didier , Fletcher Dominique
Published: March 2009

Background

The analgesic effect of perioperative low doses of intravenous lidocaine has been demonstrated after abdominal surgery. This study aimed to evaluate whether a continuous intravenous low-dose lidocaine infusion reduced postoperative pain and modified nociceptive pain threshold after total hip arthroplasty.

Methods

Sixty patients participated in this randomized double-blinded study. Patients received lidocaine 1% (lidocaine group) with a 1.5 mg/kg intravenous bolus in 10 min followed by a 1.5 mg . kg . h intravenous infusion or saline (control group). These regimens were started 30 min before surgical incision and stopped 1h after skin closure. Lidocaine blood concentrations were measured at the end of administration. In both groups, postoperative analgesia was provided exclusively by patient-controlled intravenous morphine. Pain scores, morphine consumption, and operative hip flexion were recorded over 48 h. In addition, pressure pain thresholds and the extent of hyperalgesia around surgical incision were systematically measured at 24 and 48 h.

Results

In comparison with the placebo, lidocaine did not induce any opioid-sparing effect during the first 24 h (median [25-75% interquartile range]; 17 mg [9-28] vs. 15 mg [8-23]; P = 0.54). There was no significant difference regarding the effects of lidocaine and placebo on pain score, pressure pain thresholds, extent in the area of hyperalgesia, and maximal degree of active hip flexion tolerated. Mean plasma lidocaine concentration was 2.1 +/- 0.4 mug/ml.

Conclusion

Low dose perioperative intravenous lidocaine after total hip arthroplasty offers no beneficial effect on postoperative analgesia and does not modify pressure and tactile pain thresholds.
Differential Effects of α2-adrenoceptors in the Modulation of the Thermoregulatory Response in Mice Induced by Meperidine
Authors: Höcker Jan , Paris Andrea , Scholz Jens , Tonner Peter H. , Nielsen Martin , Bein Berthold
Published: March 2009

Background

Meperidine proved to be more effective in treatment of shivering than equianalgesic doses of other opioids, especially pure mu-agonists. Further, meperidine has well known nonopioid actions including agonistic effects at alpha2-adrenoceptors in vitro. Accordingly, the authors investigated nonopioid receptor-mediated effects of meperidine on thermoregulation using a mice model of nonshivering thermogenesis. To differentiate conceivable alpha2-adrenoceptor subtype specific interactions the authors analyzed wild-type mice and knock-out mice with deletion of the alpha2A-, alpha2B-, or alpha2C-adrenoceptor.

Methods

Ten mice per group (n = 60) were injected with saline, meperidine (20 mg/kg), saline plus naloxone (125 microg/kg), meperidine plus naloxone, fentanyl (50 microg/kg) plus naloxone, or meperidine plus atipamezole (2 mg/kg) intraperitoneally. Each mouse was subjected to the six different treatments. Then they were positioned into a plexiglas chamber where rectal temperature and mixed expired carbon dioxide were measured while whole body cooling was performed. Maximum response intensity and thermoregulatory threshold temperature of nonshivering thermogenesis were analyzed.

Results

Meperidine decreased the thermoregulatory threshold temperature in wild-type mice and alpha2B- and alpha2C-adrenoceptor knock-out mice. This effect ended after injection of the alpha2-adrenoceptor antagonist atipamezole. In wild-type and alpha2B-adrenoceptor knock-out mice, the decrease of thermoregulatory threshold was not reversible by administration of the opioid receptor antagonist naloxone. In contrast, in alpha2A-adrenoceptor knock-out mice, no decline of thermoregulatory threshold following meperidine injection was detectable. Maximum response intensity of nonshivering thermogenesis was comparable in all groups.

Conclusions

The authors' results suggest a major role of alpha2-adrenoceptors, especially the alpha2A subtype, in the mediation of thermoregulatory effects caused by meperidine in mice.
Randomized Placebo-controlled Study Evaluating Lateral Branch Radiofrequency Denervation for Sacroiliac Joint Pain
Authors: Cohen Steven P. , Hurley Robert W. , Buckenmaier Chester C. , Kurihara Connie , Morlando Benny , Dragovich Anthony
Published: March 2009

Background

Sacroiliac joint pain is a challenging condition accounting for approximately 20% of cases of chronic low back pain. Currently, there are no effective long-term treatment options for sacroiliac joint pain.

Methods

A randomized placebo-controlled study was conducted in 28 patients with injection-diagnosed sacroiliac joint pain. Fourteen patients received L4-L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation using cooling-probe technology after a local anesthetic block, and 14 patients received the local anesthetic block followed by placebo denervation. Patients who did not respond to placebo injections crossed over and were treated with radiofrequency denervation using conventional technology.

Results

One, 3, and 6 months after the procedure, 11 (79%), 9 (64%), and 8 (57%) radiofrequency-treated patients experienced pain relief of 50% or greater and significant functional improvement. In contrast, only 2 patients (14%) in the placebo group experienced significant improvement at their 1-month follow-up, and none experienced benefit 3 months after the procedure. In the crossover group (n = 11), 7 (64%), 6 (55%), and 4 (36%) experienced improvement 1, 3, and 6 months after the procedure. One year after treatment, only 2 patients (14%) in the treatment group continued to demonstrate persistent pain relief.

Conclusions

These results provide preliminary evidence that L4 and L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation may provide intermediate-term pain relief and functional benefit in selected patients with suspected sacroiliac joint pain. Larger studies are needed to confirm these results and to determine the optimal candidates and treatment parameters for this poorly understood disorder.
Increased Volatile Anesthetic Requirement in Short-sleeping Drosophila Mutants
Authors: Weber Bernd , Schaper Christian , Bushey Daniel , Rohlfs Marko , Steinfath Markus , Tononi Giulio , Cirelli Chiara , Scholz Jens , Bein Berthold
Published: March 2009

Background

Anesthesia and sleep share physiologic and behavioral similarities. The anesthetic requirement of the recently identified Drosophila mutant minisleeper and other Drosophila mutants was investigated.

Methods

Sleep and wakefulness were determined by measuring activity of individual wild-type and mutant flies. Based on the response of the flies at different concentrations of the volatile anesthetics isoflurane and sevoflurane, concentration-response curves were generated and EC50 values were calculated.

Results

The average amount of daily sleep in wild-type Drosophila (n = 64) was 965 +/- 15 min, and 1,022 +/- 29 in Na[har](P > 0.05; n = 32) (mean +/- SEM, all P compared to wild-type and other shaker alleles). Sh flies slept 584 +/- 13 min (n = 64, P < 0.01), Sh flies 412 +/- 22 min (n = 32, P < 0.01), and Sh flies 782 +/- 25 min (n = 32, P < 0.01). The EC50 values for isoflurane were 0.706 (95% CI 0.649 to 0.764, n = 661) and for sevoflurane 1.298 (1.180 to 1.416, n = 522) in wild-type Drosophila; 1.599 (1.527 to 1.671, n = 308) and 2.329 (2.177 to 2.482, n = 282) in Sh, 1.306 (1.212 to 1.400, n = 393) and 2.013 (1.868 to 2.158, n = 550) in Sh, 0.957 (0.860 to 1.054, n = 297) and 1.619 (1.508 to 1.731, n = 386) in Sh, and 0.6154 (0.581 to 0.649, n = 360; P < 0.05) and 0.9339 (0.823 to 1.041, n = 274) in Na[har], respectively (all P < 0.01).

Conclusions

A single-gene mutation in Drosophila that causes an extreme reduction in daily sleep is responsible for a significant increase in the requirement of volatile anesthetics. This suggests that a single gene mutation affects both sleep behavior and anesthesia and sedation.
Assessing Quality of Life in ALS
Authors: Bromberg Mark B
Published: March 2009

The issue of quality of life is important for the patient with amyotrophic lateral sclerosis (ALS) and his or her family. Although initial thoughts frequently are that quality of life will be poor, there are strong data to support a relatively good quality of life despite the inexorable decline in strength and loss of function with disease progression. This article discusses how quality of life can be measured in ALS patients and caregivers, the results of studies, and factors affecting quality. It ends with 10 suggestions for clinicians who care for ALS patients and their caregivers.
HIV Infection Presenting With Motor Axonal Variant of Guillain-Barré Syndrome
Authors: Wagner Jeffrey C , Bromberg Mark B
Published: March 2009

Objectives:

We present a case of acute motor axonal neuropathy in a patient with previously unrecognized human immunodeficiency virus (HIV) infection.

Methods:

A 46-year-old male graduate student from Mali, Africa presented with a 3-week history of progressive weakness that began during a visit home from Utah. The symptoms stabilized by 6 weeks and gradually improved without treatment.

Results:

Electrodiagnostic studies revealed widespread fibrillation potentials and positive sharp waves with normal sensory amplitudes and no demyelinating features. Cerebrospinal fluid pleocytosis and elevated protein prompted a test for HIV infection, which returned positive.

Conclusions:

To our knowledge, this is the first case of acute motor axonal neuropathy in HIV outside of a seroconversion reaction.
Unilateral Thigh Atrophy and Weakness in Hip Osteoarthritis
Authors: DePalma Traci B , Gilchrist James M
Published: March 2009

Osteoarthritis is a common condition that affects a significant percentage of people in the United States. The case and discussion will serve to introduce to the neurologist the issue of hip osteoarthritis causing thigh atrophy and weakness. The pathogeneses of muscular atrophy in the setting of osteoarthritis and of muscle weakness as a cause of osteoarthritis will be explored.
Glomus Tumors in Patients of Advanced Age: A Conservative Approach
Authors: Cosetti Maura , Linstrom Christopher , Alexiades George , Tessema Belachew , Parisier Simon
Published: March 2009

Objectives: Identify and discuss controversies in the management of paragangliomas in elderly patients.

Assess and evaluate a conservative treatment strategy involving limited surgical resection and vigilant monitoring of the outcome measures of tumor control, peritreatment morbidity, symptom resolution, and hearing preservation.

Study Design: Retrospective case review.

Methods: All of the patients in this study were over age 60 with temporal bone glomus tumors. Primary outcome assessment included length of hospitalization, perioperative morbidity, symptom resolution, hearing preservation, and long‐term tumor control.

Results: Twelve female patients with mean age of 74.5 years (range 61–85 years) with follow‐up from 24 months to 33 years (mean/median: 5/7.8 years) were identified. Nine (75%) of the patients presented with pulsatile tinnitus.

Seven patients (58%) underwent surgical excision of the middle ear component of the paraganglioma. Tumors extending to the jugular foramen were purposely not resected. Five patients (45%) had relative or absolute contraindications to surgical resection and were treated with observation or primary radiation therapy. Post‐treatment audiometric evaluation confirmed stable or improved hearing. Pulsatile tinnitus resolved in all patients. No patient experienced cranial nerve deficits, extended hospitalization, or blood transfusions.

All patients were followed closely with radiological imaging. The majority of patients demonstrated no disease or stable disease, while two patients demonstrated tumor growth 6 years after diagnosis.

Conclusion: A prolonged natural history and the morbidity associated with surgical intervention have led to controversies in the treatment of glomus tumors in an elderly population. Our experience supports recent limited reports advocating conservative surgical excision and vigilant long‐term monitoring in this population.
Serotonin, Inflammation, and IBS: Fitting the Jigsaw Together?
Authors: Spiller Robin
Published: March 2009

Unexplained diarrhoea is a frequent indication for gastroenterologic referral, and after full investigation the most common final diagnosis is irritable bowel syndrome (IBS). Some patients with IBS describe an acute onset of symptoms following infective gastroenteritis. Postinfective IBS affects 7% to 31% of individuals infected, and appears to be a nonspecific response to injury which has been reported following Salmonella‐, Campylobacter‐, and Shigella‐related IBS. The strongest risk factor for developing postinfective IBS is severity of the initial diarrhoea illness, but toxigenicity of the infected bacteria, age <60 years, and female sex also are important risk factors. Adverse life events, hypochondriasis, and depression are also important, as is increased enteroendocrine cell and lymphocyte numbers in rectal biopsies. Postinfective IBS and IBS with diarrhoea without an infectious onset both show increased postprandial release of serotonin, whilst constipated patients show a depressed release. Several studies suggest impairment of the serotonin transporter in IBS, which in animal studies has been shown to occur following a range of inflammatory insults. Clinical conditions with an inflammatory basis, such as coeliac and Crohn disease, also are characterised by excess postprandial serotonin release. Several studies report evidence of low‐grade inflammation in IBS with diarrhoea. However, reliable markers of low‐grade inflammation that may predict response to serotonin antagonists or other anti‐inflammatory agents remain a goal for future research.
Hyperornithinemia‐Hyperammonemia‐Homocitrullinuria Syndrome (HHH) Presenting With Acute Fulminant Hepatic Failure
Authors: Mhanni AA , Chan A , Collison M , Seifert B , Lehotay DC , Sokoro AH , Huynh HQ , Greenberg CR
Published: March 2009

We report on two Aboriginal patients with the hyperornithinemia‐hyperammonemia‐homocitrullinuria (HHH) syndrome. Both presented with acute hepatic failure with severe hypertransaminasemia and coagulopathy, prompting evaluation for emergent liver transplantation. The diagnosis of HHH syndrome was based on the presence of typical metabolic abnormalities. A protein‐restricted diet and L‐arginine or L‐citrulline supplementation were immediately started, with rapid normalization of liver function test results and other biochemical abnormalities. Molecular analysis of the SLC25A15 gene showed that the two patients were homozygous for the common French Canadian mutation (F188Δ). The diagnosis of HHH syndrome should be considered in patients with unexplained fulminant hepatic failure. There does not appear to be a genotype‐phenotype correlation for this presentation, inasmuch as the only other reported patient presenting with this picture had two different point mutations. Early identification and prompt treatment of these patients is crucial to avoid liver transplantation and can be life saving.
Effect of Enteral IGF‐1 Supplementation on Feeding Tolerance, Growth, and Gut Permeability in Enterally Fed Premature Neonates
Authors: Corpeleijn Willemijn E , van Vliet Ineke , de Gast‐Bakker Dana‐Anne H , van der Schoor Sophie RD , Alles Martine S , Hoijer Maarten , Tibboel Dick , van Goudoever Johannes B
Published: March 2009

Objectives:

The gastrointestinal tract of the premature newborn functions suboptimally with regard to digestion, absorption, and feeding tolerance. Human milk contains trophic factors, such as insulin‐like growth factor‐1 (IGF‐1), that are believed to stimulate gut growth and function. The objective of this double blind, randomized, controlled trial was to assess the effects of enteral IGF‐1 supplementation on whole body growth measured by weight gain (in grams per kilogram per day), days to regain birth weight, and anthropometrical characteristics, and gut maturation and permeability (measured by sugar absorption tests).

Patients and Methods:

The study included 60 premature infants (birth weight 750–1250 g) during the first month of life. Patients received either standard infant formula or standard infant formula supplemented with IGF‐1 in a concentration twice that of human colostrum (10 μg/100 mL of formula). Primary endpoints were days to full enteral feeding, days to regain birth weight, and growth rate. Sugar absorption tests were performed weekly to assess the secondary endpoints gut permeability and maturation.

Results:

None of the primary endpoints differed to statistical significance between groups at any point. However, gut permeability was significantly lower in the IGF‐1 supplement group on day 14 compared with the control group. At day 21, lactulose/mannitol excretion ratios were (again) comparable between the groups.

Conclusions:

Although gut permeability showed a faster decrease in the IGF‐1 supplement group, our data do not support IGF‐1 supplementation to infant formula.
Diagnosis of Helicobacter pylori Infection in a High‐prevalence Pediatric Population: A Comparison of 2 Fecal Antigen Testing Methods and Serology
Authors: Cherian Sarah , Burgner David P , Carson Christine F , Sanfilippo Frank M , Cook Angus G , Forbes David A
Published: March 2009

Objectives:

Accurate methods for diagnosing active Helicobacter pylori infection in children have been limited to invasive or time‐consuming techniques. Recently, fecal antigen testing has been used successfully for the diagnosis of H pylori infection in the pediatric population. We compared 2 monoclonal fecal antigen diagnostic methods in a population of children with a suspected high prevalence of H pylori infection. We also assessed the diagnostic performance of H pylori immunoglobulin G serology.

Materials and Methods:

In a cross‐sectional study of African refugee children (<16 years) we compared an immunochromatographic technique (ICT) and serology with a monoclonal fecal antigen enzyme immunoassay (MFAT) method for the detection of active H pylori infection. Following the manufacturer's instructions, an optical density of ≥0.190 was used as a cutoff for MFAT. Sensitivity, specificity, and positive and negative predictive values were calculated.

Results:

Of the 193 eligible children enrolled, active H pylori infection was detected in 149 of 182 (81.9%) in whom MFAT was performed. The prevalence of active infection increased with age; children with active infection were significantly older, and there were no sex differences. ICT and serology underperformed in comparison with MFAT (ICT sensitivity 74.6%, specificity 63.6%, positive predictive value 89.8%, negative predictive value 36.8%; and serology sensitivity 57.9%, specificity 77.4%, positive predictive value 92.0%, negative predictive value 29.9%).

Conclusions:

Monoclonal enzyme immunoassay fecal antigen testing is a practical and feasible alternative to traditional invasive diagnostic methods in high‐prevalence pediatric populations. Neither immunochromatography nor serology is useful for the diagnosis of active H pylori infection in these children.
Oral Delivery of L‐arginine Stimulates Prostaglandin‐dependent Secretory Diarrhea inCryptosporidium parvum–infected Neonatal Piglets
Authors: Gookin Jody L , Foster Derek M , Coccaro Maria R , Stauffer Stephen H
Published: March 2009

Objectives:

To determine if oral supplementation with L‐arginine could augment nitric oxide (NO) synthesis and promote epithelial defense in neonatal piglets infected withCryptosporidium parvum.

Materials and Methods:

Neonatal piglets were fed a liquid milk replacer and on day 3 of age infected or not with 108C parvumoocysts and the milk replacer supplemented with L‐arginine or L‐alanine. Milk consumption, body weight, fecal consistency, and oocyst excretion were recorded daily. On day 3 postinfection, piglets were euthanized and serum concentration of NO metabolites and histological severity of villous atrophy and epithelial infection were quantified. Sheets of ileal mucosa were mounted in Ussing chambers for measurement of barrier function (transepithelial resistance and permeability) and short‐circuit current (an indirect measurement of Cl−secretion in this tissue).

Results:

C parvum–infected piglets had large numbers of epithelial parasites, villous atrophy, decreased barrier function, severe watery diarrhea, and failure to gain weight. L‐Arginine promoted synthesis of NO by infected piglets, which was unaccompanied by improvement in severity of infection but rather promoted epithelial chloride secretion and diarrhea. Epithelial secretion by infected mucosa from L‐arginine‐supplemented piglets was fully inhibited by the cyclooxygenase inhibitor indomethacin, indicating that prostaglandin synthesis was responsible for this effect.

Conclusions:

Results of these studies demonstrate that provision of additional NO substrate in the form of L‐arginine incites prostaglandin‐dependent secretory diarrhea and does not promote epithelial defense or barrier function ofC parvum–infected neonatal ileum.
Natural Evolution of Infantile Regurgitation Versus the Efficacy of Thickened Formula
Authors: Hegar Badriul , Rantos Rastra , Firmansyah Agus , De Schepper Jean , Vandenplas Yvan
Published: March 2009

Background:

Regurgitation is frequent in infants. We evaluated changes in regurgitation among patient groups fed standard formula, standard formula subsequently thickened with cereal, or formula manufactured with bean gum as a thickening agent.

Patients and Methods:

A prospective, blinded, randomised 1‐month intervention trial evaluating the efficacy of parental reassurance of the regurgitating child in combination with 3 formula interventions—standard infant formula (group A); 5 g of rice cereal added to 100 mL standard formula (group B); and formula manufactured with bean gum as a thickening agent (group C)—was performed in 60 infants presenting with more than 4 episodes of regurgitation and/or vomiting per day during the week before inclusion. Formula intake, infant comfort, stool aspects, and weight gain were evaluated. All of the infants and data recorded by parents in a diary were evaluated weekly by a blinded health care professional.

Results:

At baseline, groups A, B, and C were similar for all of the parameters. After the 1‐month intervention, regurgitation/vomiting decreased significantly in all 3 groups (P < 0.0005). Although the decrease was largest in group C (−4.2 ± 2.1 episodes/day), the incidence did not differ significantly with groups A or B. At no evaluation interval was there a difference in volume of formula intake, infant comfort, stool frequency, or aspect. After 1 month, weight gain was significantly greater in group C compared with group A (19.9% vs 16.4%; P < 0.001).

Conclusions:

Thickening of formula decreases regurgitation, but not significantly. Parental reassurance remains the cornerstone of the treatment of infant regurgitation.
Capsule Endoscopy May Reclassify Pediatric Inflammatory Bowel Disease: A Historical Analysis
Authors: Cohen Stanley A , Gralnek Ian M , Ephrath Hagit , Saripkin Larry , Meyers William , Sherrod Olga , Napier Angela , Gobin Tamara
Published: March 2009

Background:

Data are sparse on the role of capsule endoscopy (CE) in classifying disease type, affecting patient management, and altering health outcomes in pediatric inflammatory bowel disease (IBD). In a retrospective cohort analysis of symptomatic pediatric patients with previously diagnosed IBD, we evaluated whether data from CE would result in the recognition of new disease locations that could alter the current diagnosis and provide information to better manage the underlying disease.

Patients and Methods:

CE evaluation was performed in 28 patients an average of 4.2 ± 3 years after original IBD diagnosis, and was prompted by exacerbation of underlying disease, growth failure/weight loss, or presurgical evaluation. Of the patients, 7 of 28 (25%) were originally diagnosed as having ulcerative colitis (UC) (n = 5) or indeterminate colitis (IC) (n = 2), while 21 of 28 (75%) were diagnosed as having Crohn disease (CD).

Results:

Following CE examination, 4 of 5 patients with UC and 1 of 2 patients with IC (total 5 of 7, 71% of UC/IC patients) had their disease reclassified to CD based upon newly diagnosed small bowel mucosal lesions. Moreover, 13 of 21 (62%) patients with CD were found at the time of CE examination to have more extensive small bowel disease with newly diagnosed jejunal disease found in 12 of 13 (92%) patients. In the 5 newly diagnosed patients with CD, all of them had therapeutic changes made. One capsule retention occurred.

Conclusions:

Capsule endoscopy may lead to reclassification of IBD from UC/ IC to definitive CD. In addition, previously diagnosed patients with CD may be found to have a more significant burden of small bowel disease. Taken together, this information may facilitate more targeted and effective therapies and potentially lead to better patient outcomes.
Growth and Final Height After Liver Transplantation During Childhood
Authors: Scheenstra Rene , Gerver Willem Jan , Odink Roelof J , van Soest Hanneke , Peeters Paul MJG , Verkade Henkjan J , Sauer Pieter JJ
Published: March 2009

Objective:

To evaluate the effect of end‐stage pediatric liver disease and liver transplantation on growth and final height.

Patients and Methods:

We evaluated growth at 2 years (n = 101) and 5 years (n = 63) after pediatric liver transplantation (LTx). Twenty‐three children reached final height. Height was expressed as a standard deviation score of the target height (zTH score) of each patient.

Results:

At the first 2 years after LTx, the zTH score was significantly increased from −1.7 to −1.3 SD (P < 0.05). Growth at 2 or 5 years after LTx, expressed as ΔzTH score, was positively correlated with pretransplant growth retardation (P < 0.05). In comparison with patients with noncholestatic primary liver disease, patients with cholestatic primary liver disease were more severely growth retarded before LTx (zTH score −2.0 vs −1.2 SD, P < 0.05) and had better growth in the first 2 years after LTx (ΔzTH score +0.6 vs −0.1 SD, P < 0.05). Twelve of the 23 patients had a final height below −1.3 SD of their target height.

Conclusions:

Growth retardation is common in children before LTx, particularly in children with an underlying cholestatic disease. After LTx, catch‐up growth was partial and was prominent only in cholestatic children who had been severely growth retarded before LTx. After LTx during childhood, ∼50% of patients reach a final height lower than −1.3 SD of their genetic potential
Necrotising Enterocolitis in Very Low Birth Weight Infants in Italy: Incidence and Non‐nutritional Risk Factors
Authors: Gagliardi Luigi , Bellù Roberto , Cardilli Viviana , De Curtis Mario ,   Network Neonatale Lombardo
Published: March 2009

Incidence and non‐nutritional risk factors were estimated for necrotising enterocolitis in 2035 very low birth weight infants, admitted to 14 tertiary‐level neonatal intensive care units in Lombardy, northern Italy. There were 62 necrotising enterocolitis cases, with an overall incidence of 3.1%. After adjustment for gestational age and centre, the risk factors were mechanical ventilation, patent ductus arteriosus, and late‐onset sepsis, whereas surfactant treatment was associated with decreased risk. Significant variations in necrotising enterocolitis incidence among hospitals were found.
Feeding Short-Tailed Fruit Bats (Carollia perspicillata)
Authors: Rasweiler John J. , Cretekos Chris J. , Behringer Richard R.
Published: March 2009

INTRODUCTION

The short-tailed fruit bat Carollia perspicillata is predominantly frugivorous in the wild and will therefore accept a variety of non-citrus fruits in captivity (e.g., bananas, apples, melon, and peaches). To promote cage cleanliness, however, these bats are routinely fed a fruit-based liquid diet that cannot be carried away from the food dishes. By intention, this diet is simple and inexpensive to prepare, and it can also be prepared in advance and refrigerated or frozen for later use. This protocol describes the preparation and storage of the diet, as well as the feeding of the bats.
A Nuclear Gene Encoding the Iron-Sulfur Subunit of Mitochondrial Complex II Is Regulated by B3 Domain Transcription Factors during Seed Development in Arabidopsis
Authors: Roschzttardtz Hannetz , Fuentes Ignacia , Vásquez Marcos , Corvalán Claudia , León Gabriel , Gómez Isabel , Araya Alejandro , Holuigue Loreto , Vicente-Carbajosa Jesús , Jordana Xavier
Published: March 2009

Mitochondrial complex II (succinate dehydrogenase) is part of the tricarboxylic acid cycle and the respiratory chain. Three nuclear genes encode its essential iron-sulfur subunit in Arabidopsis (Arabidopsis thaliana). One of them, SUCCINATE DEHYDROGENASE2-3 (SDH2-3), is specifically expressed in the embryo during seed maturation, suggesting that SDH2-3 may have a role as the complex II iron-sulfur subunit during embryo maturation and/or germination. Here, we present data demonstrating that three abscisic acid-responsive elements and one RY-like enhancer element, present in the SDH2-3 promoter, are involved in embryo-specific SDH2-3 transcriptional regulation. Furthermore, we show that ABSCISIC ACID INSENSITIVE3 (ABI3), FUSCA3 (FUS3), and LEAFY COTYLEDON2, three key B3 domain transcription factors involved in gene expression during seed maturation, control SDH2-3 expression. Whereas ABI3 and FUS3 interact with the RY element in the SDH2-3 promoter, the abscisic acid-responsive elements are shown to be a target for bZIP53, a member of the basic leucine zipper (bZIP) family of transcription factors. We show that group S1 bZIP53 protein binds the promoter as a heterodimer with group C bZIP10 or bZIP25. To the best of our knowledge, the SDH2-3 promoter is the first embryo-specific promoter characterized for a mitochondrial respiratory complex protein. Characterization of succinate dehydrogenase activity in embryos from two homozygous sdh2-3 mutant lines permits us to conclude that SDH2-3 is the major iron-sulfur subunit of mature embryo complex II. Finally, the absence of SDH2-3 in mutant seeds slows down their germination, pointing to a role of SDH2-3-containing complex II at an early step of germination.
Residential Segregation and the Electoral Participation of Immigrants in Australia
Authors: Bilodeau Antoine
Published: March 2009

This paper investigates whether immigrants in Australia residing in situations of residential segregation (federal constituencies with high concentrations of immigrants) participate more in electoral politics than other immigrants. The results indicate that immigrants participate more when living in federal constituencies with high concentrations of immigrants and also exhibit greater homogeneity in their partisan preferences. The analysis also indicates that the impact of residential segregation is primarily observed among immigrants from non-English-speaking countries. Immigrants from visible minority background, such as those from South East Asia as well as those from Southern and South Eastern Europe, tend to be more strongly affected by the ethnic composition of their constituencies than other immigrants such as those from the United Kingdom and Ireland.
Expression of genes encoding for proteins involved in heparan sulphate and chondroitin sulphate chain synthesis and modification in normal and malignant plasma cells
Authors: Bret Caroline , Hose Dirk , Reme Thierry , Sprynski Anne‐Catherine , Mahtouk Karène , Schved Jean‐François , Quittet Philippe , Rossi Jean‐François , Goldschmidt Hartmut , Klein Bernard
Published: March 2009

Syndecan‐1 is a proteoglycan that concentrates heparin‐binding factors on the surface of multiple myeloma cells, and probably plays a major role in multiple myeloma biology. As heparan sulphate and chondroitin sulphate are the bioactive components of syndecan‐1, we analysed the signature of genes encoding 100 proteins involved in synthesis of these chains, i.e. from precursor uptake to post‐translational modifications, using Affymetrix microarrays. The expression of enzymes required for heparan sulphate and chondroitin sulphate biosynthesis was shown to increase in parallel with syndecan‐1 expression, throughout the differentiation of memory B cells into plasmablasts and normal bone marrow plasma cells. Sixteen genes were significantly different between normal and malignant plasma cells, nine of these genes –EXT2, CHSY3, CSGALNACT1, HS3ST2, HS2ST1, CHST11, CSGALNACT2, HPSE, SULF2 – encode proteins involved in glycosaminoglycan chain synthesis or modifications. Kaplan–Meier analysis was performed in two independent series of patients: B4GALT7, CSGALNACT1, HS2ST1 were associated with a good prognosis whereas EXT1 was linked to a bad prognosis. This study provides an overall picture of the major genes encoding for proteins involved in heparan sulphate and chondroitin sulphate synthesis and modifications that can be implicated in normal and malignant plasma cells.
Cigarette smoke suppresses in vitro allergic activation of mouse mast cells
Authors: Mortaz E. , Folkerts G. , Engels F. , Nijkamp F. P. , Redegeld F. A.
Published: March 2009

Background
Mast cells are important effector cells in innate or acquired immunity that contribute to host defence. Excessive activation of mast cells can result in the development of allergic diseases, including atopic asthma. Mast cell activation by IgE and specific antigen induces the cells to release spasmogenic, vasoactive and pro‐inflammatory mediators, which enhance airway smooth muscle contraction, vascular permeability and inflammatory cell recruitment. Recently, we have demonstrated that exposure of mast cells to cigarette smoke medium (CSM) triggered mast cells to produce chemokines. On the other hand, smoking may decrease the risk of allergic sensitization, which could be explained by a reduced IgE production or a diminished response of mast cells to activation of the IgE receptor.

Objective
In this study, we investigated the effect of CSM on the allergic activation of mast cells through IgE and antigen.

Methods
Primary cultured murine mast cells were exposed to CSM and activated with IgE and antigen or lipopolysaccharide (LPS). The release of granules, production of leukotrienes, chemokines and cytokines was determined in the supernatants by ELISA. The effect of CSM exposure on intracellular signalling, especially the nuclear factor (NF)‐κB and extracellular signal‐regulated kinase (Erk)1/2 pathways, was analysed by Western blotting.

Results
CSM suppressed IgE‐mediated degranulation and cytokine release, but no effect was observed on leukotriene release. CSM induced phosphorylation of Erk1/2 in mast cells. In CSM‐exposed mast cells, activating transcription factor (ATF)‐1 was phosphorylated after stimulation with IgE/Ag. LPS‐activated mast cells were not influenced by CSM.

Conclusion
Our study suggests that exposure to cigarette smoke may lead to a reduced allergic activation of mast cells without affecting their response to activation via e.g. bacterial‐derived LPS.
Rehabilitation nurses practices in relation to urinary incontinence following stroke: a cross‐cultural comparison
Authors: Booth Jo , Kumlien Suzanne , Zang Yuli , Gustafsson Barbro , Tolson Debbie
Published: March 2009

Aim.  To explore nurses’ practices and influences in relation to urinary incontinence following stroke, in the UK, Sweden and China.

Background.  Urinary incontinence following stroke is common, under‐recognised and poorly researched. Before appropriate rehabilitation interventions can be developed, an understanding of nurses’ current management approaches and cultural influences is required.

Design.  Qualitative.

Methods.  Semi‐structured interviews were undertaken with ten registered nurses from at least four different stroke units in three countries (n = 30). Interviews were carried out in the participants’ first language, using an agreed interview guide. Following translation, thematic analysis focusing on manifest meaning was undertaken, using an iterative approach involving electronic and face‐to‐face discussions.

Results.  The consequence of only superficial assessment was no systematic identification of types or causes of urinary incontinence and no individualised plans developed. A process model of practice, common to all three countries, was identified for stroke survivors with urinary incontinence. Routine core activities were followed by the palliative pathway (most frequently), where urinary incontinence was contained to protect the stroke survivors’ safety and ensure social continence; or the rehabilitative route (more rarely), where simple continence promoting activities were implemented with the purpose of facilitating recovery of bladder function.

Conclusions.  Nurses’ reactively manage urinary incontinence following stroke, adopting a routinised approach based on local custom and practice. Promotion of urinary continence is not a priority area of stroke rehabilitation for nurses in western or eastern countries.

Relevance to clinical practice.  The dearth of evidence‐based interventions available to rehabilitate bladder function following stroke means that stroke nursing practice is an experience‐based endeavour. This study explains the nurses’ focus on containment and social continence and highlights the need to systematically assess stroke survivors’ bladder rehabilitation needs, identify types of urinary incontinence and adopt appropriate urinary continence promoting practices.