bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Tibial Plateau Slope to Limb Function in Dogs Treated with a Lateral Suture Technique for Stabilization of Cranial Cruciate Ligament Deficient Stifles
Authors: HAVIG MARC E. , DYCE JONATHAN , KOWALESKI MICHAEL P. , REYNOLDS LISA R. , BUDSBERG STEVEN C.
Published: May 2007

Objective—To evaluate the effect of a lateral suture technique (LST) on tibial plateau angle (TPA) measurement and to compare TPA with functional outcome in dogs treated for cranial cruciate ligament (CrCL) rupture with LST.

Study Design—Prospective clinical study.

Sample Population—Dogs (n=34) with unilateral CrCL instability.

Methods—All dogs had lameness examination, survey stifle radiographs, and force plate analysis before and at 6, 12, 24, and 48 weeks after surgery. Radiographic osteoarthritis (OA) scores and lameness scores were assigned using previously reported methods. Preoperative radiographs were performed in all dogs, and postoperative serial radiographs were performed in 6 dogs for measurement of TPA. Differences in TPA measurements were evaluated with a random effects repeated measures model. The significance of LST on TPA measurement was established in 6 dogs and the effect of TPA on vertical impulse, peak vertical force, progression of radiographic scores, and lameness score were analyzed by general linear models in all dogs. Differences were considered significant ifP<.05.

Results—Significant differences were not noted between pre‐ and serial postoperative measurements of TPA. A significant correlation was not established between TPA and postoperative vertical impulse, peak vertical force, lameness score, or radiographic OA scores.

Conclusions—TPA values were unchanged after LST and TPA does not affect outcome measures in dogs treated with LST.

Clinical Relevance—TPA has no predictive value on clinical outcome in dogs treated with LST for stabilization of CrCL deficient stifles.
Tilt Table Recovery of Horses After Orthopedic Surgery: Fifty‐Four Cases (1994–2005)
Authors: ELMAS COLETTE R. , CRUZ ANTONIO M. , KERR CAROLYN L.
Published: May 2007

Objective— To describe an assisted anesthetic recovery technique using a tilt table for horses after high‐risk orthopedic‐related procedures and to evaluate outcome.

Study Design— Retrospective study.

Sample Population— Anesthetic recoveries (n=54) for 36 horses.

Methods— Medical records (April 1994–October 2005) for horses that had high‐risk orthopedic surgery and recovery from general anesthesia on a tilt table were reviewed. Information about the surgical procedure, anesthetic and recovery period was analyzed.

Results— Of 54 anesthetic recoveries, 1 horse (1.9%) had complete failure of internal fixation during recovery and was euthanatized. Six (11% recoveries) horses failed to adapt to the tilt table system, which necessitated transfer to a conventional recovery room. Complications without important consequences for clinical outcome (skin abrasions, myositis, cast breakage, partial implant failure) occurred during 8 (15%) recoveries.

Conclusions— A tilt table recovery system was associated with minimal incidence of serious complications. Potential disadvantages of the system are the number of personnel required, longer recovery time, and the need for a specialized table.

Clinical Relevance— A tilt table is a useful system for recovering horses believed to be at increased risk of injury during anesthetic recovery after high‐risk orthopedic‐related procedures.
Clinical Outcome of Nonnasal Chondrosarcoma in Dogs: Thirty‐One Cases (1986–2003)
Authors: WALTMAN SUZANNE SHELLY , SEGUIN BERNARD , COOPER BARRY J. , KENT MICHAEL
Published: May 2007

Objective— To evaluate metastatic rate and survival times of dogs with chondrosarcoma of nonnasal bony sites treated by wide surgical excision.

Study Design— Retrospective study.

Animals— Dogs (n=31) with chondrosarcoma.

Methods— Medical records were retrospectively reviewed to identify dogs with chondrosarcoma of bone in potentially surgically accessible sites. When complete information was not available in the medical record, owners and referring veterinarians were contacted by telephone to evaluate the course of disease and survival times. When possible, histopathologic diagnosis was confirmed by a single board certified pathologist and tumors were histologically graded.

Results— Dogs treated by wide surgical excision (n=18) had a mean survival time of 3097 days and did not reach median survival time. Dogs untreated except for diagnostic biopsy (n =13) had a median survival time of 523 days and a mean survival time of 495 days. Method of treatment and tumor grade predicted survival time (P=.016 and P=.007, respectively). Metastatic rate was 28% for treated dogs and 15% for untreated dogs, with no significant difference between the 2 groups (P=.39).

Conclusions— Wide surgical excision significantly improves survival time for dogs with chondrosarcoma of nonnasal bony sites, but does not affect the likelihood of metastasis. Grade may be prognostic for survival.

Clinical Relevance— Surgical excision benefits dogs with chondrosarcoma and can result in prolonged survival times. Metastasis still occurs in ∼1 of 4 dogs even after surgical resection.
In Vitro Elution Studies of Amikacin and Cefazolin from Polymethylmethacrylate
Authors: PHILLIPS HEIDI , BOOTHE DAWN M. , SHOFER FRANCES , DAVIDSON JEFFREY S. , BENNETT R. AVERY
Published: May 2007

Objective—To compare the in vitro elution characteristics of amikacin and cefazolin from polymethylmethacrylate (PMMA) alone and in combination.

Study Design—A prospective, controlled, experimental study.

Methods—Three aliquots of 6 g sterile PMMA were measured and to them added (1) 750 mg amikacin; (2) 1050 mg cefazolin; and (3) 750 mg amikacin and 1050 mg cefazolin. Ten beads of each antimicrobial/PMMA combination were placed in 5 mL phosphate‐buffered saline (PBS) at pH 7.4 and room temperature with constant agitation. PBS was sampled at 15 time points between 1 hour and 30 days. Amikacin concentrations were determined by fluorescence polarization immunoassay and cefazolin concentrations by high‐performance liquid chromatography.

Results—Amikacin and cefazolin eluted at concentrations greater than 8 and 4 times, respectively, above the minimum inhibitory concentration (MIC) for susceptible bacteria over 30 days. Co‐elution of the antibiotics resulted in a greater rate and proportion of antibiotic eluted. Concentrations of amikacin and cefazolin in the co‐eluted fluid were not maintained sufficiently above the MIC for selected bacteria over 30 days.

Conclusions—PMMA beads of only amikacin or cefazolin‐eluted concentrations greater than the MIC for selected bacteria for 30 days. Co‐elution of the antibiotics at the selected doses resulted in a significantly shorter duration of elution and may not be effective for treatment of wound infection.

Clinical Relevance—Co‐elution of amikacin and cefazolin from PMMA at the selected doses cannot be recommended for sustained treatment of infection.
Ventroaxial Luxation of the Apex of the Corniculate Process of the Arytenoid Cartilage in Resting Horses During Induced Swallowing or Nasal Occlusion
Authors: BARAKZAI S. Z. , ES Cert , MILNE E. M. , DIXON PADRAIC
Published: May 2007

Objective— To report ventroaxial luxation of the apex of the left or right corniculate process of the arytenoid cartilage under the contralateral corniculate process during resting endoscopic examination, and morphologic features of the larynx of 1 affected horse.

Study Design— Retrospective study.

Animals— Horses (n=8).

Methods— Horses had endoscopic examination as part of a survey of Clydesdale horses (n=7), or investigation of poor performance in Thoroughbred horses (1). One Clydesdale was euthanatized and the larynx examined; 4 cadaver larynges from normal horses were also examined.

Results— Ventroaxial luxation of the apex of the left or right corniculate process of the arytenoid cartilage was not detected during quiet breathing but was induced by swallowing or nasal occlusion. Prevalence in Clydesdales was 5.2% (7/133). A Thoroughbred with identical endoscopic appearance of the larynx at rest had progressive ventroaxial luxation of the apex of the arytenoid cartilage during high‐speed treadmill endoscopy, associated with abnormal respiratory noise. Necropsy examination of an affected Clydesdale larynx revealed an excessively wide (10 mm) transverse arytenoid ligament that allowed easy separation of the apices of the corniculate processes. In normal cadaver larynges, the apices could not be separated with abaxial traction.

Clinical Relevance— The clinical relevance of this laryngeal observation in resting horses is unclear. Ventroaxial luxation of the corniculate process of the arytenoid cartilage during induced swallowing or nasal occlusion in resting horses or during high‐speed treadmill exercise may be caused by an abnormally wide transverse arytenoid ligament.
Mechanical Comparison of an Interlocking Nail Locked with Conventional Bolts to Extended Bolts Connected with a Type‐Ia External Skeletal Fixator in a Tibial Fracture Model
Authors: GOETT SCOTT D. , SINNOTT MICHAEL T. , TING DENNIS , BASINGER R. RANDY , HAUT ROGER C. , DÉJARDIN LOÏC M.
Published: May 2007

Objective—To compare the structural properties of interlocking nails (ILNs) locked with bolts (ILNb) to ILN locked with extended bolts connected with a type‐IA external skeletal fixator (ILN–ESF) in a fracture gap model.

Study Design—Experimental study.

Sample Population—Synthetic tibial bone substitutes.

Methods—Custom‐made synthetic tibial bone substitutes were implanted with standard ILNs locked with either bolts or extended bolts connected to an external skeletal fixation (ESF). Constructs were tested in torsion, bending, and axial compression (n=4/testing mode). Data, consisting of construct compliance and associated deformation, were compared using t‐tests.

Results—The ILN–ESF construct compliance and deformation were significantly less than those of the ILNb construct in torsion, bending, and compression (P<.001). Slack was present in the ILNb construct under torsion and bending, but not in the ILN–ESF construct, regardless of testing mode.

Conclusions—Substitution of locking bolts with extended bolts connected to an ESF significantly reduced the construct compliance and overall deformation in torsion, bending, and compression. Furthermore, the inherent slack of the ILNb was eliminated by the use of an ESF in torsion and bending.

Clinical Relevance—The improvement in structural properties of the ILN–ESF constructs could diminish interfragmentary motion at the fracture site and potentially improve bone healing.
Rectus Abdominis Free Muscle Flap for Reconstruction in Nine Dogs
Authors: MILLER JONATHAN M. , LANZ OTTO I. , DEGNER DANIEL A.
Published: May 2007

Objective— To evaluate the clinical use and outcome of a rectus abdominis microvascular free flap for wound closure in dogs.

Study Design— Retrospective case series.

Animals— Dogs (n=9) with complex extremity or oral wounds.

Methods— Medical records (2002–2006) of dogs that had a rectus abdominis free tissue transfer to close an extremity or oral wound were reviewed.

Results— Nine dogs were identified: 5 had distal extremity wounds, 3 had oral palatal defects, and 1 had a large hygroma excised. A rectus abdominis free tissue transfer with a caudal epigastric vascular pedicle was successfully used for management of these wounds. No major complications occurred with the donor site and a good cosmetic and functional outcome occurred in all dogs.

Conclusion— The rectus abdominis is a versatile muscle that can be used for reconstructing cutaneous and oral defects with repeatable success.

Clinical Relevance— Free tissue transfer of the rectus abdominis muscle is a clinically useful technique for closure of a variety of difficult soft tissue wounds.
Transfusion policy: when to stop the use of extremely rare blood for an allogeneic hematopoietic progenitor cell transplant recipient with a history of red cell alloimmunization
Authors: Senzel Lisa , Boulad Farid , Wuest David , Reid Marion E.
Published: May 2007

BACKGROUND: Decisions for when to select, and when to discontinue, antigen‐negative blood in hematopoietic progenitor cell transplantation (HPCT) recipients with red blood cell (RBC) antibodies can be confusing. In HPCT performed for sickle cell anemia patients who require extremely rare antigen‐negative blood, the balance of caution and practicality is further complicated.

CASE REPORTS: Four sickle cell anemia patients with current or historic RBC antibodies underwent allogeneic HPC transplantation. One required extremely rare (group O D–, hrB–) blood. None of the antibodies caused significant hemolysis after transplant. In the case requiring rare blood, antigen‐negative blood was requested after donor RBC engraftment because of incomplete donor white blood cell (WBC) chimerism.

CONCLUSIONS: RBC antibodies derived from a recipient of allogeneic HPCT rarely cause significant hemolysis, in contrast to the more severe picture sometimes seen with donor‐derived antibodies. When donor WBC chimerism is delayed past the time of donor RBC engraftment, there can be concern for the possibility of future recipient‐type antibody production. Even 100 percent donor lymphocyte chimerism is no guarantee of total host plasma cell ablation. Immunoglobulin allotyping, when informative, can suggest chimerism for several years. Recipient‐type blood, when extremely rare, may not be available for that duration.
False‐positive pregnancy test after passive transfusion of β‐human chorionic gonadotropin from donor red blood cells during erythrocytapheresis
Authors: Shelat Suresh G. , Friedman David F. , Meny Geralyn M. , Smith‐Whitley Kim , Carlow Dean , Norris Robin
Published: May 2007

BACKGROUND: Patients transfused with blood products may passively receive soluble antibodies, proteins, and other analytes that persist during the collection, processing, and transfusion of the blood product. In this report, a female patient who received transfusion of five red blood cell (RBC) units during erythrocytapheresis later demonstrated an unexpected positive result in assays for the β‐subunit of human chorionic gonadotropin (bHCG), a screening test for pregnancy. The result caused postponement of an elective surgical procedure. A follow‐up test 1 week later was negative.

STUDY DESIGN AND METHODS: To investigate the possibility of passive transfusion of the hormone from a donor RBC unit, a sample from each of the units transfused was assayed for the level of bHCG.

RESULTS: One of the 5 units transfused to the patient had a high level of bHCG. The observed bHCG level in the recipient was found to be comparable to the predicted level, given the donor's plasma bHCG level and accounting for the dilution factors in the preparation of the RBC unit and the erythrocytapheresis procedure and the in vivo t½ of the hormone.

CONCLUSION: The donor, who was unaware of her pregnancy status at the time of donation, harbored a high bHCG level that caused the positive test result in the recipient patient's serum and urine. If an unexpected analyte or serology is detected in a recipient of a blood transfusion, it is important to consider the possibility of passive transfusion of the analyte.
Acute bleeding complications in patients after hematopoietic stem cell transplantation with prophylactic platelet transfusion triggers of 10 × 109 and 20 × 109 per L
Authors: Nevo Shoshan , Fuller Alice K. , Hartley Eric , Borinsky Mark E. , Vogelsang Georgia B.
Published: May 2007

BACKGROUND: Prophylactic platelet (PLT) transfusions are given as a standard care in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT). This retrospective analysis evaluates utilization of blood transfusions, risk of bleeding, and survival in 480 HSCT patients at 10 × 109 and 20 × 109 per L prophylactic trigger levels.

STUDY DESIGN AND METHODS: A total of 224 patients received prophylactic PLT transfusions at 20 × 109 per L threshold (1997‐1998, SP1); 256 patients had prophylaxis at 10 × 109 per L (1999‐2001, SP2). Bleeding scores were assigned daily.

RESULTS: A slight reduction in PLT transfusions per patient in SP2 compared with SP1 was not statistically significant (odds ratio, 0.82; 95% confidence interval, 0.51‐1.33; p = 0.416), yet a significantly higher proportion of patients in SP2 had PLT counts less than or equal to 10 × 109 per L compared to SP1 (p  < 0.001). In patients who bled, however, there was no excess exposure to low PLT counts before bleeding started. A substantial number of patients who bled received PLT transfusions above the goal before bleeding started (82.9% in SP2, 41.5% in SP1) because of medical complications that associated with increased risk of bleeding. Bleeding incidence was similar in both study periods (21.9% in SP1, 16.4% in SP2; p = 0.526). Bleeding was significantly associated with reduced survival in both study periods.

CONCLUSIONS: Patients who bled were usually placed on a higher threshold before the onset of their major bleeding event and were not exposed to additional risk of bleeding from thrombocytopenia. Similarity in bleeding incidence between study periods appears to associate with adjustments to high‐risk conditions and may not reflect consequences of the lower transfusion threshold.
Identification and characterization of a novel antisense RNA transcribed from the opposite strand of the human blood group ABO gene
Authors: Hata Yukiko , Kominato Yoshihiko , Takizawa Hisao
Published: May 2007

BACKGROUND: To elucidate the molecular basis of control of the ABO gene in cell type–specific expression, during normal cell differentiation, and in cancer cells lacking A/B antigen, the mechanisms responsible for regulation of human ABO gene expression have been studied. Recently, naturally occurring antisense transcriptions have been reported to regulate gene expression through a variety of biological mechanisms. Therefore, RNA transcribed from the opposite strand of the ABO gene was investigated.

STUDY DESIGN AND METHODS: The presence of antisense RNA to the ABO‐coding strand in human cancer cell lines and normal tissues was examined by strand‐specific reverse transcription–polymerase chain reaction. The 5′‐ and 3′‐ends of the transcript were determined by the rapid amplification of cDNA ends (RACE) system. KATOIII cells were treated with mithramycin A, followed by quantitative analysis of both sense and antisense ABO transcripts.

RESULTS: The endogenous antisense RNA to the ABO coding strand was found to start within the first intron of the ABO gene, and the expression coincided with ABO gene expression in various cultured cells and normal tissues. This novel gene was named ABOAS. Treatment of KATOIII cells with mithramycin A repressed transcription from the ABO exon 1 promoter, while it increased the ABOAS transcript.

CONCLUSION: These results suggest that ABOAS transcribed from the opposite strand of the ABO gene might be involved in the regulation of ABO gene expression.
Synthetic glycolipid modification of red blood cell membranes
Authors: Frame Tom , Carroll Tim , Korchagina Elena , Bovin Nicolai , Henry Stephen
Published: May 2007

BACKGROUND: Glycolipids have a natural ability to insert into red cell (RBC) membranes. Based on this concept the serology of RBCs modified with synthetic analogs of blood group glycolipids (KODE technology) was developed, which entails making synthetic glycolipid constructs engineered to have specific performance criteria. Such synthetic constructs can be made to express a potentially unlimited range of carbohydrate blood group determinants.

STUDY DESIGN AND METHODS: Synthetic constructs incorporating A, B, acquired‐B, and Lea blood group determinants were constructed and used to modify RBCs. Modified cells were assessed by routine serologic methods using a range of commercially available monoclonal antibodies.

RESULTS: RBCs modified with different concentrations of synthetic glycolipids were able to give controllable serologic results. Synthetic A and B modified cells were able to be created to represent the serology of “weak” subgroups. Specialized cells such as those bearing synthetic acquired‐B antigen reacted as expected, but also exhibited extended features due to the cells bearing only specific antigen. Synthetic Lea‐modified cells reacted as expected with anti‐Lea reagents, but unexpectedly, were also able to detect the chemical anti‐Leab specificity of serologic monoclonal anti‐Leb reagents.

CONCLUSION: RBCs can be created to express normal and novel carbohydrate profiles by inserting synthetic glycolipids into them. Such cells will be useful in creating specialized antigen panels and for quality control purposes.
Parvovirus B19 DNA in Factor VIII concentrates: effects of manufacturing procedures and B19 screening by nucleic acid testing
Authors: Geng Yansheng , Wu Chuan‐ging , Bhattacharyya Siba P. , Tan De , Guo Zheng‐Ping , Yu Mei‐ying W.
Published: May 2007

BACKGROUND: Parvovirus B19 (B19) is a common contaminant, especially in coagulation factors. Because of B19 transmission by pooled plasma, solvent/detergent treated in 1999, some fractionators initiated minipool nucleic acid testing (NAT) to limit the B19 load in manufacturing pools. In this study, the extent of B19 DNA contamination in commercial Factor VIII concentrates, that is, antihemophilic factor (human) (AHF), manufactured before and after B19 NAT screening was implemented, was determined.

STUDY DESIGN AND METHODS: A total of 284 lots representing six AHF products made during 1993 to 1998 and 2001 to 2004 were assayed for B19 DNA by an in‐house NAT procedure. Anti‐B19 immunoglobulin G (IgG) was also measured.

RESULTS: Most lots made during 1993 to 1998 had detectable B19 DNA. The prevalence ranged from 56 to 100 percent and appeared to differ between manufacturers. The highest level of B19 DNA found was 106 genome equivalents (geq or international units [IU]) per mL. Forty percent of the lots tested contained 103 geq (IU) per mL. In comparison, both prevalence and levels in source plasma–derived AHF products made in 2001 to 2004 were lower. Both, however, remained unchanged in the recovered plasma‐derived product because B19 NAT screening had not been implemented. Only an intermediate‐purity AHF product was positive for the presence of anti‐B19 IgG.

CONCLUSION: The prevalence and levels of B19 DNA in AHF prepared from B19 NAT unscreened plasma were high but varied among products with different manufacturing procedures. B19 NAT screening of plasma effectively lowered the B19 DNA level in the final products and in the majority of cases rendered it undetectable and hence potentially reduced the risk of B19 transmission.
Seasonal temperature variation and the rate of donor deferral for low hematocrit in the American Red Cross
Authors: Sebok M.A. , Notari E.P. , Chambers L.A. , Benjamin R.J. , Eder A.F.
Published: May 2007

BACKGROUND: Hematocrit (Hct) values in healthy adult populations exhibit seasonal variation, with the lowest values occurring in the summer. The extent to which environmental temperature contributes to the seasonal trend in deferral rates for unacceptable Hct in the American Red Cross was further analyzed.

STUDY DESIGN AND METHODS: A centralized database of donations during 2002 to 2004, constituting 24.3 million donor presentations, was further characterized. Data on mean monthly temperature in the United States were obtained for the same period from a government agency. Multivariate regression analyses were performed to determine the relationship between Hct deferral rates among blood donors and environmental temperature and donor characteristics.

RESULTS: Hct deferral rates were associated with mean monthly temperature in the United States (R2 = 0.77). The relationship between the Hct deferral rate and environmental temperature was strongest in the region of the country with the highest seasonal variation in temperature, followed by regions with intermediate and low seasonal variation in temperature, respectively. The seasonal pattern in Hct deferral rates occurred in both sexes and across all age groups, with significantly higher Hct deferral rates occurring in June through August compared to other quarters (p  < 0.0007).

CONCLUSION: There is a significant seasonal pattern in Hct deferral rates that is associated with environmental temperature. The relationship between Hct deferral rates and temperature is strongest in areas of the country with greater temperature variability. The effect of seasonality on Hct deferrals should be taken into account for donor counseling, recruitment, and retention efforts.
Seasonal influences on hemoglobin levels and deferral rates in whole‐blood and plasma donors
Authors: Hoekstra T. , Veldhuizen I. , Van Noord P.A.H. , De Kort W.L.A.M.
Published: May 2007

BACKGROUND: Indications exist that deferral rates in blood donors are highest in summer. However, a detailed quantitative analysis is not available. The association between Hb values, deferral rates, and daily temperatures was investigated in a large data set of blood donors.

STUDY DESIGN AND METHODS: The study population consisted of both plasma and whole‐blood donors from the southeast region of the Netherlands. Individual Hb levels and other examination data between January 2002 and December 2004 were extracted from the donor file. Data on daily maximum temperatures were related to Hb levels and Hb deferrals. Results are reported separately for plasma and whole‐blood donors as well as for men and women.

RESULTS: Data were available from 106,398 whole blood donors and 6983 plasma donors, resulting in data of more than 600,000 examinations. Hb levels decreased with increasing daily temperature. Highest deferral rates were observed in summer months, which were consistent over the several groups and over the three years. The highest Hb deferral of 11.1 percent was observed for female whole‐blood donors on days with a maximum temperature of 25 degrees and above. In all four donor categories a gradual increase with temperature was observed with 1.7‐2.2 times higher deferral rates on hot days (≥25°C) compared to cold days (<5°C).

CONCLUSION: A clear seasonal pattern in Hb levels and in the percentage of Hb deferrals was observed. The observed seasonal effect could not be explained by differences in donor characteristics. Our observations might have practical implications for donor management.
Fetal hemolytic anemia and intrauterine death caused by anti‐M immunization
Authors: Wikman Agneta , Edner Ann , Gryfelt Gunilla , Jonsson Baldvin , Henter Jan‐Inge
Published: May 2007

BACKGROUND:Antibodies with anti‐M specificity are detected in 10 percent of pregnant women with a positive antibody screen, but anti‐M is only rarely associated with hemolytic anemia in the fetus.

STUDY DESIGN AND METHODS:This study reports on three pregnancies in one family that all resulted in severe fetal anemia. The first fetus died in utero with hydrops fetalis during the 20th gestational week and the second child was delivered after 28 weeks of gestation with hydrops fetalis and a hemoglobin level of 16 g per L whereas the third affected child was treated with intrauterine red cell (RBC) transfusions before delivery at 28 weeks of gestation.

RESULTS:The direct antiglobulin test was negative but anti‐M in a low titer was detected through the three pregnancies, and its clinical relevance, which initially was uncertain, was confirmed by pronounced in vivo hemolysis in maternal blood of chromate (51Cr)‐labeled M+ RBCs and normal survival of51Cr labeled M– RBCs.

CONCLUSION:It is concluded that anti‐M immunization in a few cases may cause severe fetal hemolytic anemia and intrauterine death. It remains to be elucidated why a normally clinically insignificant antibody is this aggressive in a small proportion of cases. Because the condition is treatable, anti‐M must be considered as a possible cause of fetal anemia and intrauterine death.
Y‐chromosome short tandem repeats analysis to complement paternal lineage study: a single institutional experience in Taiwan
Authors: Liu Hsueng‐Mei , Chen Pei‐Shan , Chen Ying‐Ju , Lyou Jau‐Yi , Hu Hui‐Yu , Lin Jeong‐Shi , Tzeng Cheng‐Hwai
Published: May 2007

BACKGROUND: Highly polymorphic autosomal short‐tandem‐repeat (STR) analysis can be useful in most kinship testing. Y‐chromosome‐specific STRs, in contrast, have been increasingly applied for the verification of equivocal paternal genetic transmissions.

STUDY DESIGN AND METHODS: A total of 338 unrelated males were first typed for the 9‐loci Y‐STR European minimal haplotype (minHt). Samples with haplotypes that were found at least two times were subject to further study by a commercially available 17‐Y‐STR multiplex set (AmpFlSTR Yfiler). A separate clinical study for 113 various kinship identifications of male genetic transmission were then conducted by a panel consisting of 18 autosomal STRs and complemented by both Y‐STR multiplex sets and their respective results compared.

RESULTS: For the 338 individuals, a total of 270 haplotypes were identified after the minHt study, of which 234 were unique. Among the rest of the 104 samples, AmpFlSTR Yfiler identified 82 other unique haplotypes. Altogether, 324 different haplotypes were observed; 316 (97.5%) were unique whereas 8 were shared by two to seven times. The haplotype diversities for the minHt and the AmpFlSTR Yfiler were 99.75 and 99.96 percent, respectively, whereas the powers of discrimination (PDs) were 79.88 and 95.86 percent, respectively. Despite a lower PD for minHt, there was no discrepancy on the clinical setting for personal identification between the two Y‐STR sets in an allegedly true male lineage transmission involving 66 cases with 24 father‐son, 19 siblings, 9 uncle‐nephew, 8 grandfather‐grandson, 3 cousins, and 3 half‐siblings. For 47 other cases with a false allegation of paternity, exclusion was made for all without ambiguity by either Y‐STR panel.

CONCLUSION: The 9‐loci minHt Y‐STR set is adequate to complement conventional autosomal STRs for kinship studies where Y‐lineage transmission is concerned.
Managing a tissue recall in a large academic hospital
Authors: Steelman Victoria M. , Schlueter Annette J.
Published: May 2007

BACKGROUND: In October 2005, a recall of human tissue for implantation was initiated because one recovery center obtained tissues from donors who were not screened properly for infectious diseases. The Food and Drug Administration (FDA) and Centers for Disease Control (CDC) recommended notifying affected patients and offering access to infectious disease testing.

STUDY DESIGN AND METHODS: A multidisciplinary team was established to provide a framework for responding to the recall. The plan was designed to meet six goals. Steps included patient identification, surgeon and patient notification, patient education and testing, communication of test results, and information for the public.

RESULTS: The institution received 55 recalled tissues, of which 48 had been implanted into 30 patients undergoing neurosurgical, orthopedic, and general surgical procedures. Patients were identified and sent notification letters within 2 weeks of the FDA and CDC recommendations. Twenty‐seven patients underwent testing, which was performed at the convenience of the patients at no cost to them. One patient had evidence of previous (but not current) hepatitis B infection. Overall, patients were appreciative of the processes used. Media coverage was positive.

CONCLUSION: The response plan was generally successful in achieving the established goals. Potential improvements were identified in several areas, including initial patient notification and coordination of test result communication. It is critical to allow flexibility to meet each patient's needs. The plan may serve as a template for use in future tissue recalls by other hospital‐based tissue banks.
Cryopreservation of living cells: principles and practice
Authors: Meryman Harold T.
Published: May 2007

Increasingly, the cryopreservation of living cells is being attempted by researchers whose primary interest and experience is with the medical applications of those cells or tissues and whose prior experience with cryobiology may be negligible. It is therefore generally necessary to imitate some regimen used by others, perhaps with some other cell type and attempt to optimize the recovery empirically. This article makes no attempt to provide specific protocols for the many individual cell types. Rather it is a primer that may help to give such investigators an insight into the basic principles of cell freezing, cryoprotectants, and, particularly, their addition and removal. Finally, the article summarizes the five different approaches to applied cryopreservation: ultrarapid freezing and thawing, controlled‐rate freezing, freezing with nonpenetrating polymers, vitrification, and equilibrium freezing.
The Entrepreneurial Propensity of Women
Authors: Langowitz Nan , Minniti Maria
Published: May 2007

Entrepreneurship is becoming an increasingly important source of employment for women across many countries. The level of female involvement in entrepreneurial activity, however, is still significantly lower than that of men. We take a behavioral economics approach and, using a large sample of individuals in 17 countries, we investigate what variables influence the entrepreneurial propensity of women and whether those variables have a significant correlation with differences across genders. In addition to demographic and economic variables, we include a number of perceptual variables. Our results show that subjective perceptual variables have a crucial influence on the entrepreneurial propensity of women and account for much of the difference in entrepreneurial activity between the sexes. Specifically, we find that women tend to perceive themselves and the entrepreneurial environment in a less favorable light than men across all countries in our sample and regardless of entrepreneurial motivation. Our results suggest that perceptual variables may be significant universal factors influencing entrepreneurial behavior.
The Role of Gender in Opportunity Identification
Authors: DeTienne Dawn R. , Chandler Gaylen N.
Published: May 2007

Opportunity identification is rapidly becoming a key focal point of research in the entrepreneurship domain. This study is the first to explore gender differences in opportunity identification. Utilizing two distinct samples (95 senior undergraduate students, 189 entrepreneurs in two high–technology industries), we found that women and men utilize their unique stocks of human capital to identify opportunities and that they use fundamentally different processes of opportunity identification. However, we did not find any difference in the innovativeness of the opportunities identified. This research contributes both to the opportunity identification literature and to theories of social feminism by showing empirically that although women and men utilize different processes to identify opportunities, neither process is inherently superior.
Gender, Entrepreneurial Self–Efficacy, and Entrepreneurial Career Intentions: Implications for Entrepreneurship Education
Authors: Wilson Fiona , Kickul Jill , Marlino Deborah
Published: May 2007

The relationships between gender, entrepreneurial self–efficacy, and entrepreneurial intentions were examined for two sample groups: adolescents and adult master of business administration (MBA) students. Similar gender effects on entrepreneurial self–efficacy are shown for both groups and support earlier research on the relationship between self–efficacy and career intentions. Additionally, the effects of entrepreneurship education in MBA programs on entrepreneurial self–efficacy proved stronger for women than for men. Implications for educators and policy makers were discussed, and areas for future research outlined.
The Differential Effect of Men and Women Entrepreneurs’ Human Capital and Networking on Growth Expectancies in Bulgaria
Authors: Manolova Tatiana S. , Carter Nancy M. , Manev Ivan M. , Gyoshev Bojidar S.
Published: May 2007

Based on expectancy theory and social psychology perspectives, this study looks at the differential effects of men and women entrepreneurs’ human capital and networking on their growth expectancies in the context of a transitional economy. Survey data from men and women new venture owners in Bulgaria (n = 544) suggest that growth expectancy among men is significantly and positively associated with outside advice achieved through networking. Among women entrepreneurs, growth expectancy is significantly and positively associated with perceived benefits from prior experience. A Chow test for coefficient differences reveals that the determinants of growth expectancy for women entrepreneurs are significantly different than those for men, rendering support for perspectives from social psychology, which suggest that women have different socialization experiences and, as a result, conceive of their new venture growth differently. Implications for managerial practice and public policy are discussed.
Does Gender Matter? Women Business Angels and the Supply of Entrepreneurial Finance
Authors: Harrison Richard T. , Mason Colin M.
Published: May 2007

There is a substantial literature on the relationship between gender and access to finance. However, most studies have been concerned with access to debt finance. More recently, the focus of this research has broadened to examine women and venture capital. This article extends the focus further by examining the role of women in the business angel market, which is more important than the formal venture capital market in terms of both the number of ventures supported and total capital flows. Based on a detailed analysis of business angels in the U.K., the study concludes that women investors who are active in the market differ from their male counterparts in only limited respects. Future research into women business angels, and the possible existence of gender differences, needs to be based on more fully elaborated standpoint epistemologies that focus on the experience of the woman angel investor per se, and center on the examination of the role of homophily, social capital, networking, and competition in investment behavior.
Evidence for Electrical Remodeling of the Native Conduction System with Cardiac Resynchronization Therapy
Authors: HENRIKSON CHARLES A. , SPRAGG DAVID D. , CHENG ALAN , CAPPS MELISSA , DEVAUGHN KATHLEEN , MARINE JOSEPH E. , CALKINS HUGH , TOMASELLI GORDON F. , BERGER RONALD D.
Published: May 2007

Background:

Cardiac resynchronization therapy (CRT) improves hemodynamics and decreases heart failure symptoms. However, the potential of CRT to bring about electrical remodeling of the heart has not been investigated.

Methods and Results:

We studied 25 patients, of whom 17 had a nonischemic cardiomyopathy, and 8 had an ischemic cardiomyopathy; 16 had left bundle branch block (LBBB), 1 right bundle branch block (RBBB), and 8 nonspecific intraventricular conduction delay. During routine device clinic visits, patients with chronic biventricular pacing (>6 months) were reprogrammed to VVI 40 to allow for native conduction to resume. After 5 minutes of native rhythm, a surface electrocardiogram (ECG) was recorded, and then the previous device settings were restored. This ECG was compared to the preimplant ECG. Preimplant mean ejection fraction was 19% (range, 10%–35%), and follow‐up mean ejection fraction was 35% (12.5%–65%). Mean time from implant to follow‐up ECG was 14 months (range, 6–31). The QRS interval prior to CRT was 155 ± 29 ms, and shortened to 144 ± 31 ms (P = 0.0006), and the QRS axis shifted from −1 ± 59 to −26 ± 53 (P = 0.03). There was no significant change in PR or QTc interval, or in heart rate.

Conclusion:

CRT leads to a decrease in the surface QRS duration, without affecting other surface ECG parameters. The reduced electrical activation time may reflect changes in the specialized conduction system or in intramyocardial impulse transmission.
Achieving Sufficient Safety Margins with Fixed Duration Waveforms and the Use of Multiple Time Constants
Authors: KEANE DAVID , AWEH N. , HYNES BRYAN , SHEAHAN RICHARD G. , CRIPPS TIM , BASHIR YAVER , ZAIDI AMIR , FAHY GERARD , LOWE MARTIN , DOHERTY PAUL , KROLL MARK K.
Published: May 2007

Introduction:

There are several options to achieve a sufficient safety margin in a patient with a high defibrillation threshold (DFT), with varying and typically modest success. Programming fixed (millisecond) durations of both phases of a biphasic waveform in an implantable cardioverter defibrillator (ICD) has demonstrated utility.

Methods:

We established an informal multisite registry of ICD implanting facilities. Each facility agreed to attempt the use of fixed duration waveforms whenever there was an inadequate safety margin with tilt‐based waveforms. A 3.5‐ms‐based fixed duration shock was tried first. If that failed to achieve a 10‐J safety margin then a 2‐ms‐based shock was used. We also tabulated an HEDFT (high estimate DFT) as precise DFTs were not determined.

Results:

Sixteen patients (15 M, 1 F) were entered into the registry (age 58.2 ± 17.9 years) with ejection fractions of .30 ±.11. Superior vena cava coils were used in 7 patients according to physician preference. The tilt‐based HEDFTs were 35.4 ± 3.2 J delivered and 35.8 ± 3.3 J stored energy. The 3.5‐ms based shocks were evaluated on 14 patients and the HEDFT fell to 23.4 ± 6.3 J delivered (P < 0.0001) and 26.2 ± 6.9 J stored energy (P < 0.0001). The 2‐ms‐based fixed duration shocks were then evaluated on 6 patients and the delivered energy HEDFT was 22.2 ± 5.8 J (P = 0.001 vs. tilt‐based shocks) while the stored energy HEDFT was 27.9 ± 6.4 J (P = 0.01 vs. tilt‐based shocks). Using the better of the two fixed duration waveforms, the mean safety margin was improved from −1.2 ± 1.9 J to 9.5 ± 5.9 J (P < 0.00001). Multivariate predictors of the safety margin improvement were the absence of the Superior Vena Cava (SVC) coil and absence of Ventricular fibrillation (VF) presentation. Four patients still required lead repositioning after the use of the fixed duration waveforms. No additional leads were implanted.

Conclusion:

The use of a selection of directly programmed fixed duration biphasic shocks had a striking impact on the HEDFT for these difficult patients. Adequate safety margins were obtained for 12 of 16 patients with no lead manipulation or other approaches.
Elevated Estimated Pulmonary Artery Systolic Pressure is Associated with an Adverse Clinical Outcome in Patients Receiving Cardiac Resynchronization Therapy
Authors: STERN JOSHUA , HEIST E. KEVIN , MURRAY LORNE , ALABIAD CHRISFOUAD , CHUNG JEFFREY , PICARD MICHAEL H. , SEMIGRAN MARC J. , RUSKIN JEREMY N. , SINGH JAGMEET P.
Published: May 2007

Background:

A substantial percentage of patients with heart failure remain nonresponsive to cardiac resynchronization therapy (CRT). There is a paucity of information on the impact of baseline elevated pulmonary artery pressure on clinical outcome and on left ventricular reverse remodeling (LV‐RR) after CRT. We sought to investigate the impact of elevated estimated pulmonary artery systolic pressure (ePASP) on clinical outcome and LV‐RR after CRT.

Methods:

This study retrospectively analyzed data from 68 subjects with standard indications for CRT over a 12‐month period. Subjects were stratified into two groups based on the echocardiographic estimation of pulmonary artery pressure i.e., ePASP ≥ 50 mmHg (n = 27) and ePASP < 50 mmHg (n = 41). Long‐term response was measured as a combined endpoint of heart failure hospitalizations and all cause mortality at 12 months, and compared within the two groups using the Kaplan‐Meier method. Follow up echocardiograms to assess for LV‐RR were available in 51 subjects (mean duration 7.1 months). LV‐RR was defined as any improvement in global systolic function with reduction in left ventricular internal diameter.

Results:

The study population was composed of 24 women and 44 men (age, mean ± SD; 70 ± 11 years), with a decreased left ventricular ejection fraction ([25 ± 9]%) and a wide QRS (171 ± 54 ms). There were no significant differences in the clinical features between the high and low ePASP group. Subjects with ePASP ≥ 50 mmHg had a significantly worse clinical outcome (Hazard ratio (95% CI), 2.0 (1.2–5.5), P = 0.02). Baseline ePASP was not predictive of LV‐RR (P = 0.32).

Conclusion:

In patients receiving CRT, although elevated estimated pulmonary artery systolic pressure (ePASP ≥ 50 mmHg) does not significantly impact LV reverse remodeling, it is associated with an adverse long‐term outcome.
Sedation with Midazolam for Electrical Cardioversion
Authors: NOTARSTEFANO PASQUALE , PRATOLA CLAUDIO , TOSELLI TIZIANO , BALDO ELISA , FERRARI ROBERTO
Published: May 2007

Background:

Electrical cardioversion (ECV) usually requires the assistance of the anesthesiology team. To avoid this dependence, previous studies have considered the use of sedation with benzodiazepines administered by cardiologists. We describe our experience with intravenous Midazolam during cardioversion.

Methods:

We performed 280 ECV in 202 patients sedated with intravenous Midazolam, without anesthesiology supervision. In scheduled cardioversions, we tested two protocols of Midazolam administration: a bolus of 3 mg, followed by 2 mg each minute until necessary, and a loading dose of 0.09–0.1 mg/kg. In cardioversions performed during electrophysiology studies or defibrillator implant, Midazolam was administered by small repeated doses during the entire procedure.

Results:

Midazolam was effective to obtain adequate sedation in 99% of cases. All patients had amnesia with regards of the cardioversion. A loading dose of Midazolam allowed a shortening of the procedural time without serious adverse events. Intubation or the assistance of an anesthetist was never necessary.

Conclusion:

Sedation with Midazolam for ECV is effective and well tolerated, with some cautions discussed. A loading dose of Midazolam is well tolerated and further reduces the procedural time.
Strength Duration Curve for Epicardial Left Ventricular Stimulation
Authors: SCALLY MONIQUE , HESTON KAREN J. , RUDNICK ANDREW G. , DEGER FLORIN T. , GREENBERG RICHARD M.
Published: May 2007

Background:

The strength duration curve for endocardial stimulation has been extensively studied. Little information is available on the left ventricular epicardial strength duration curve. In view of the large number of patients treated with resynchronization therapy, left ventricular epicardial stimulation parameters have practical importance.

Methods:

Twelve patients who underwent implant of a biventricular defibrillator were available for at least 4 months of follow up and accurate determination of strength duration curves were studied. Strength duration curves were constructed at 30 days (subacute phase) and 4 or more months (chronic phase) after the implant for right ventricular endocardial, left ventricular epicardial unipolar, and left ventricular bipolar stimulation. The goal was to determine the chronaxie, which correlates with the most economical stimulation.

Results:

There was no significant difference between the right ventricular endocardial and left ventricular epicardial bipolar chronaxie (P = 0.57 subacute and 0.6 chronic) or right ventricular endocardial and left ventricular unipolar chronaxie (P = 0.93 subacute and 0.92 chronic). Most chronaxie values were lower than the factory default values.

Conclusion:

The left ventricular unipolar or bipolar epicardial chronaxie is not significantly different from the right ventricular endocardial chronaxie. Both values are lower than the pulse duration used as default setting in most devices as well as in clinical practice. Individual determination of the chronaxie could lead to energy savings.