bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal Serum Progesterone-Induced Blocking Factor at 11–13 Weeks’ Gestation in Spontaneous Early Preterm Delivery
Authors: Beta Jarek , Szekeres-Bartho Julia , Skyfta Evdoxia , Akolekar Ranjit , Nicolaides Kypros H.
Published: April 2011

Objective: Progesterone-induced blocking factor (PIBF) may be the mediator of the pregnancy maintenance effects of progesterone. The aim of this study is to investigate the potential value of measuring the maternal serum concentration of PIBF at 11–13 weeks’ gestation in the prediction of spontaneous early preterm delivery. Method: The maternal serum concentration of PIBF at 11–13 weeks was measured by enzyme-linked immunosorbent assay in 25 singleton pregnancies which subsequently delivered spontaneously before 34 weeks, and 75 controls who delivered at or after 37 weeks. The values in the 2 groups were compared by the Mann-Whitney U test. Results: The median maternal serum concentration of PIBF in women who subsequently delivered before 34 weeks (157.5, interquartile range 99.5–208.8 ng/ml) was not significantly different from the control group delivering at term (167.5, interquartile range 105.0–212.0 ng/ml; p = 0.519). Conclusions: In women who have a spontaneous early preterm delivery, the maternal serum levels of PIBF are not altered at 11–13 weeks of gestation.
Relating Function to Branching Geometry: A Micro-CT Study of the Hepatic Artery, Portal Vein, and Biliary Tree
Authors: Kline Timothy L. , Zamir Mair , Ritman Erik L.
Published: April 2011

Utilizing micro-computed tomography images, the hierarchical structure, interbranch segment lengths and diameters of a hepatic artery, a portal vein, and two biliary trees from intact rat liver lobes were characterized. The data were investigated by analyzing the geometric properties of the vascular structures, such as how interbranch segment diameters change at bifurcation points. In the case of the hepatic artery and portal vein trees (in which the flow rate is high by comparison with that in the biliary tree), the vascular geometry is consistent with a fluid transport system which aims to simultaneously minimize both the power loss of laminar flow, and a cost function proportional to the total volume of material needed to maintain the system (lumenal contents). In comparison, the biliary tree (which has a low flow rate and an opposite flow direction to that of the hepatic artery and portal vein) was found to have a geometry in which the lumen cross-sectional area is maintained at bifurcations. These findings imply that the histological makeup and therefore the pathophysiology of biliary tree vasculature are likely very different from that of the vasculature within the systemic arterial tree. The extent to which the characteristic variability/scatter in the data may have resulted from imaging and/or measurement errors was examined by simulating such errors in a theoretical tree model and comparing the results with the measured data.
Current Serum Lipoprotein Levels and fMRI Response to Working Memory in Midlife
Authors: Gonzales Mitzi M. , Tarumi Takashi , Eagan Danielle E. , Tanaka Hirofumi , Biney Fedora O. , Haley Andreana P.
Published: April 2011

Aims: Given that high cholesterol levels at midlife are a risk factor for future cognitive decline, the goal of the current study was to determine if cholesterol-related alterations in the cerebrovascular response to cognition could be detected at midlife. Methods: Forty adults, aged 40–60 years, performed a 2-Back working memory task during fMRI. The associations between serum total cholesterol, HDL-cholesterol, and total cholesterol/HDL-cholesterol concentrations to task-related activation intensity were modeled using multivariate multiple regression (two-tailed p < 0.02). Results: Higher levels of total cholesterol/HDL-cholesterol related to reduced working memory-related activation intensity in the left inferior parietal lobe, right superior frontal gyrus, and right middle frontal gyrus. Conclusion: These data provide preliminary support for a deleterious effect of elevated total cholesterol/HDL-cholesterol ratio on cerebrovascular support for cognition in midlife.
The Effect of Storage Time on Adipose-Derived Stem Cell Recovery from Human Lipoaspirates
Authors: Carvalho Pedro P. , Wu Xiying , Yu Gang , Dias Isabel R. , Gomes Manuela E. , Reis Rui L. , Gimble Jeffrey M.
Published: April 2011

Multipotent adipose-derived stromal/stem cells (ASCs) can be isolated with high yield from human subcutaneous lipoaspirates. This study reports our experience isolating, expanding, differentiating and immunophenotypically characterizing ASCs over a period of 4 days after having surgically obtained the lipoaspirate samples. The ultimate goal is to understand how to optimize the consistent isolation of ASCs from lipoaspirates. The length of time between adipose tissue harvest and processing will need to be systematically evaluated with respect to cell yield, viability, and function since some distance is likely to exist between the plastic surgeon’s office where lipoaspiration is performed and the current Good Manufacturing Practices (cGMP) laboratory where the ASCs are isolated. The objective of this study was to determine the effect of time delays on the yield and function of ASCs after collagenase digestion. We were able to isolate ASCs from lipoaspirates up to 72 h after the surgical procedure. The ASCs isolated on sequential days after the original tissue harvest proliferated, differentiated and maintained cell surface markers. We found that the initial 24-hour period is optimal for isolating ASCs with respect to cell yield and that there was no significant difference between ASC cell proliferation and differentiation ability within this period of time. In contrast, each of these parameters declined significantly for tissues maintained at room temperature for 48 or 72 h prior to isolation. These findings should be considered in the future development of standard operating procedures for cGMP processing of clinical-grade human ASCs.
Location and Size of Ruptured Intracranial Aneurysm and Serious Clinical Outcomes Early after Subarachnoid Hemorrhage: A Population-Based Study in Australasia
Authors: Shiue Ivy , Arima Hisatomi , Hankey Graeme J. , Anderson Craig S. ,   for the ACROSS Group
Published: April 2011

Background: It is uncertain whether the location and size of a ruptured intracranial aneurysm (IA) independently influences the outcome of subarachnoid hemorrhage (SAH). Objective: To determine the independent relationship of location and size of a ruptured IA with serious clinical outcomes after SAH in an Australasian population-based study. Methods: From 432 first-ever cases of primary SAH registered prospectively over 12 months in 4 Australasian cities between 1995 and 1998, the demographics, clinical features, risk factors and results of investigations were obtained, including the location and size of any ruptured IA as assessed by cerebral angiography, computed tomography and/or magnetic resonance imaging. Location was classified as either anterior (i.e. anterior communicating artery, internal carotid artery and middle cerebral artery) or posterior circulation (i.e. posterior communicating artery, posterior inferior cerebellar artery, basilar artery and vertebral artery), and size was classified as <5, 5–9 and ≧10 mm. Outcomes recorded during hospitalization were rebleeding, delayed ischemia, hydrocephalus, residual neurological impairment and in-hospital death. Logistic regression analysis was used to evaluate the effects of IA location and size on outcome, independent of other potential prognostic factors. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). Results: IA location and size were confirmed separately in 299 and 252 patients, respectively. Patients with a posterior circulation IA had a lower rate of rebleeding than those with an anterior circulation IA (adjusted OR: 0.11; 95% CI: 0.02–0.87), but otherwise there was no significant relationship between IA location and outcome. Patients with a larger ruptured IA had higher risks of rebleeding (p = 0.02 for trend) and in-hospital death (p = 0.001) after controlling for age, sex, ethnicity, location of the ruptured IA and neurosurgical intervention. Conclusion: IA location in the posterior circulation was associated with a lower risk of rebleeding than IA in the anterior circulation. A larger IA size was associated with higher risks of rebleeding and in-hospital death.
Failed Recovery from Thrombolysis Is Predicted by the Initial Diffusion Weighted Imaging Lesion
Authors: Seitz Rüdiger J. , Oberstrass Hagen , Ringelstein Adrian , Wittsack Hans-Jörg , Siebler Mario
Published: April 2011

Background: The clinical response to systemic thrombolysis with recombinant tissue plasminogen activator (rtPA) is thought to depend on an early recanalization. We sought to investigate the effect of early recanalization on stroke lesion development as assessed with magnetic resonance imaging (MRI). Methods: Thirty-seven consecutive stroke patients (66 ± 13 years) treated with systemic thrombolysis with rtPA and tirofiban were grouped according to successful or failed recanalization as assessed on angiographic imaging. Infarct lesions were determined volumetrically in MRI prior to treatment and after 4 days. Results: Patients were severely affected (median National Institutes of Health Stroke Scale 14) and had significantly larger perfusion (PWI) than diffusion weighted imaging (DWI) lesion volumes. Ten patients with failed recanalization of the internal carotid or the middle cerebral artery did not improve. Their PWI and DWI lesion volumes were larger and the apparent diffusion coefficient more depressed than in the 27 patients with significant improvement and successful recanalization (p < 0.001). The DWI lesion volumes increased profoundly in the patients with failed recanalization (p < 0.001) but only little in the patients with successful recanalization. Multivariate regression analysis showed a relation of the initial DWI lesion volumes to the DWI lesion volumes at follow-up and the neurological recovery. Conclusions: The ischemic brain damage was particularly severe in patients with no recanalization already before systemic thrombolysis and predicted further lesion growth and failed recovery.
Patients with Moderate to Severe Plaque Psoriasis: One Year after the European Medicines Agency Recommendation of Efalizumab Suspension
Authors: Talamonti M. , Teoli M. , Botti E. , Spallone G. , Chimenti S. , Costanzo A.
Published: April 2011

Background: In February 19, 2009, the European Medicines Agency (EMA) had recommended the suspension of the marketing authorization for efalizumab after the occurrence of cases of progressive multifocal leukoencephalopathy. Objective: To explore the efficacy of alternative therapies for psoriasis and the health status of patients who discontinued efalizumab. Methods: An observational study was performed on 101 patients. After the EMA communication, efalizumab was discontinued in the following 2–3 months. In agreement with the patients, we decided to either prescribe other treatments or none at all. Results: After 1 year, 11 patients are still not treated, 63 patients are treated with biologics, and 9 patients are treated with systemic conventional therapies. Conclusion: In order to prevent rebound or relapse, various approaches are available, including cyclosporine, methotrexate and biologic therapies. Interestingly, in 11 out of 31 patients who did not receive any systemic drug, psoriasis is still under control, suggesting a long-term effect of efalizumab.
Introduction of Potentially Allergenic Foods in the Infant’s Diet during the First Year of Life in Five European Countries
Authors: Schiess Sonia A. , Grote Veit , Scaglioni Silvia , Luque Veronica , Martin Francoise , Stolarczyk Anna , Vecchi Fiammetta , Koletzko Berthold ,   for the European Childhood Obesity Project
Published: April 2011

Background: Little information is available on infants’ age at first introduction of potentially allergenic foods as part of complementary feeding. We aimed to analyze age at the introduction of potentially allergenic foods in healthy term infants relative to recommendations in 5 European countries. Method: Recruitment was conducted from October 2002 to June 2004. A total of 1,678 infants [588 breastfed (BF) and 1,090 formula-fed (FF) infants] were studied. In 1,368 infants, at least one 3-day weighed food diary at the age of 1–9 and 12 completed months was available. Results: Six percent of BF infants and 13% of FF infants consumed some potentially allergenic food already prior to the recommended minimum age of 4 months, and 4% of BF infants and 11% of FF infants had already received gluten. There were significant differences in the timing of the introduction of potentially allergenic foods between the countries at the age of 4–6 months (p < 0.001). Conclusion: The time of first introduction of potentially allergenic foods in infants differed significantly between countries, and they were introduced much earlier than recommended in some countries. FF infants received potentially allergenic foods earlier than BF infants. Better information and counseling of parents is desirable.
Immunohistochemical Expression and Prognostic Value of ER, PR and HER2/neu in Pancreatic and Small Intestinal Neuroendocrine Tumors
Authors: Arnason Thomas , Sapp Heidi L. , Barnes Penelope J. , Drewniak Magdalena , Abdolell Mohamed , Rayson Daniel
Published: April 2011

Background and Aims: There has been limited study of estrogen and progesterone receptor (ER/PR) expression in gastrointestinal neuroendocrine tumors (GINETs) despite emerging evidence of hormone receptor regulation of pancreatic islet cells. Beta cells express PR and progesterone has been implicated in the pathogenesis of gestational diabetes. There is conflicting information regarding HER2/neu protein overexpression in GINETs. Investigation of ER, PR and HER2/neu expression in GINETs is therefore warranted. Methods: A pathology database search identified 77 patients with primary pancreatic (40) or small intestinal (37) NETs diagnosed from 1991 to 2009. Ki67, ER, PR and HER2/neu were assessed via immunohistochemistry. ER and PR were interpreted as negative (0), 1+ (Allred score 3–7/8) or 2+ (Allred score 8/8), and HER2/neu was assessed according to ASCO/CAP guidelines for breast carcinoma. Clinical correlation and survival outcomes were ascertained by a retrospective clinical chart review. Results: 2+ PR staining was observed more often in pancreatic compared to small intestinal cases (55 vs. 8%; p < 0.001). All small intestinal NETs with 2+ PR were duodenal primaries. Cases with 2+ PR presented significantly less often with nodal or distant metastases compared to cases with 0/1+ PR (13 vs. 61.5%; p < 0.001) and had significantly improved disease-free survival (median 155 vs. 38 months; p = 0.037). Only one case demonstrated 2+ ER staining and all were negative for HER2/neu. Conclusion: GINETs with strong (2+) PR expression are associated with pancreatic/duodenal origin, lower stage disease, and more favorable clinical prognosis. Further study is needed to determine the clinical utility of PR expression in GINETs.
Cytophagic Histiocytic Panniculitis after H1N1 Vaccination: A Case Report and Review of the Cutaneous Side Effects of Influenza Vaccines
Authors: Pauwels C. , Bulai Livideanu C. , Maza A. , Lamant L. , Paul C.
Published: April 2011

Cytophagic histiocytic panniculitis (CHP) is a rare disease mostly caused by viral infections and/or lymphoproliferative diseases. We describe a case of CHP associated with H1N1 vaccine during the winter 2009–2010 vaccination campaign and discuss the cutaneous side effects of influenza vaccines. A 6-year-old child presented with inflammatory subcutaneous nodules, which had appeared 1 month after the first injection of H1N1 vaccine and 1 week after the second injection. There was no history of recent infection. The skin lesions spontaneously disappeared without scarring. In CHP the abnormal cytokine secretion from neoplastic or reactive T cells promotes monocyte-macrophage activation and haemophagocytosis. Vaccination is not a common cause of CHP, but it seems possible that, as in infectious diseases, reactive T cells to the vaccine antigen could trigger CHP.
Impetigo Herpetiformis with Gestational Hypertension: A Case Report and Literature Review
Authors: Huang Y.H. , Chen Y.P. , Liang C.C. , Chang Y.L. , Hsieh C.C.
Published: April 2011

Background: Impetigo herpetiformis (IH) is a rare skin disorder that occurs during pregnancy. It was previously associated with high maternal and fetal mortality and morbidity, but now has a better prognosis. Case Report: We report a case of a pregnant woman with IH who presented with generalized erythematous pustular eruptions in the 32nd week of gestation. The IH progressed rapidly, and gestational hypertension was observed in the 36th week. The lesions did not subside, despite treatment with corticosteroids and phototherapy. She delivered a healthy male baby via cesarean section in the 37th week. One month after her delivery, her skin returned to normal, except for residual pigmentation, with complete recovery 3 months postpartum. Conclusion: An experienced medical team comprising obstetricians, dermatologists, perinatologists and neonatologists is critical to aggressively treat this life-threatening specific dermatosis of pregnancy and to prevent ensuing complications, such as fluid and electrolyte imbalance, secondary infection and placental insufficiency.
A Six-Week Course of Bacillus Calmette-Guérin Prophylaxis Is Insufficient to Prevent Tumor Recurrence in Nonmuscle Invasive Bladder Cancer with Strong-Positive Expression of p53
Authors: Oh Jong Jin , Ji Sang Hyun , Choi Don Kyoung , Gong In Hyuk , Kim Tae Heon , Park Dong Soo
Published: April 2011

Objective: To determine the impact of p53 overexpression on tumor recurrence after bacillus Calmette-Guérin (BCG) intravesical therapy in patients with nonmuscle invasive bladder cancer (NMIBC). Methods: Between January 1999 and December 2008, 275 patients who received six BCG intravesical instillations for NMIBC (transitional cell carcinoma) after transurethral resection were assessed for differences in outcomes according to the level of p53 overexpression. A multivariate logistic regression model was applied to assess the predictive capacity of variables for recurrence. Overexpression of p53 was determined using monoclonal p53-DO7 antibody. Results: In 275 subjects, the recurrence rate was higher based on the level of p53 expression (p = 0.019). Based on multivariate analysis, a strong-positive p53 >60% (p = 0.031) and tumor grade (p = 0.015) were significant predictors for recurrence. Patients with a strong-positive p53 >60% had a much lower 5-year biochemical recurrence-free survival rate than patients with p53 ≤60% (72.1 vs. 31.5%, p < 0.001). Conclusions: Strong overexpression of p53 was predictive of recurrence in patients with NMIBC undergoing intravesical BCG treatment. A 6-week induction course of BCG alone is not sufficient to prevent recurrence in patients with NMIBC with high p53 expression; additional prophylactic strategies are needed for these patients.
The Missing Brother in Psalm 133
Authors: Rochester Kathleen
Published: April 2011

Instead of reading this psalm as expressing a merely sentimental ideal of sibling harmony, this article shows how a cohesive reading of the more difficult middle section can illuminate a way through the tensions of sibling rivalry and betrayal. Here the central images are taken to evoke the parallel relationships between brother mountains (Hermon and Zion) and the brothers involved in priestly anointing (Moses, the missing but implied brother, and Aaron).
Global Oral Health Inequalities
Authors: Pitts N. , Amaechi B. , Niederman R. , Acevedo A.-M. , Vianna R. , Ganss C. , Ismail A. , Honkala E.
Published: April 2011

The IADR Global Oral Health Inequalities Task Group on Dental Caries has synthesized current evidence and opinion to identify a five-year implementation and research agenda which should lead to improvements in global oral health, with particular reference to the implementation of current best evidence as well as integrated action to reduce caries and health inequalities between and within countries. The Group determined that research should: integrate health and oral health wherever possible, using common risk factors; be able to respond to and influence international developments in health, healthcare, and health payment systems as well as dental prevention and materials; and exploit the potential for novel funding partnerships with industry and foundations. More effective communication between and among the basic science, clinical science, and health promotion/public health research communities is needed. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. Recommendations are made for both clinical and public health implementation of existing research and for caries-related research agendas in clinical science, health promotion/public health, and basic science.
Strengthening grief support for children with developmental disabilities
Authors: Sormanti Mary , Ballan Michelle S.
Published: April 2011

Although a sizable literature investigates and describes children’s grief, the majority of information focuses on typically developing children. Far less has been published about the loss and grief of children with developmental disabilities (DD), even though this population experiences significant and multiple losses, increasing their vulnerability to negative outcomes. Addressing this gap in scholarship, this article explicates common losses and important grief-related challenges experienced by children with DD. An overview of practice guidelines is provided to enhance the efforts of school-based mental health professionals in supporting this vulnerable population.
Acidic buffer or plus cyclosporine A post-conditioning protects isolated rat hearts against ischemia-reperfusion injury
Authors: Xin Duan  , Bingyang Ji  , Kun Yu  , Feilong Hei  , Jinping Liu  , Cun Long
Published: April 2011

Background: It is well documented that transient acidosis during reperfusion is protective. The aim of this study was to evaluate the cardioprotection of acidic buffer or plus cyclosporine A in isolated rat hearts after cardioplegic arrest.

Methods: Langendorff-perfused Sprague—Dawley rat hearts were perfused for 20 min with Krebs—Henseleit (K-H) buffer followed by 30 min of crystalloid cardioplegia and 60 min of reperfusion. Control hearts were perfused with Krebs—Henseleit buffer. Acidic buffer post-conditioning hearts were perfused with acidic K-H buffer (pH 6.8) for the first 3 min of reperfusion. Acidic buffer plus cyclosporine A hearts were perfused with K-H acidic buffer (pH 6.8) containing cyclosporine A (0.2 μmol/L) for the first 3 min of reperfusion.

Results: Compared with the control group, acidic buffer or plus cyclosporine A post-conditioning significantly improved myocardial performance, decreased cytochrome C release into the cytosol, increased Bcl-2 expression and decreased Bax expression, decreased sensitivity of mPTP-opening to [Ca2+] and the rate of apoptosis after reperfusion.

Conclusion: These findings suggested that acidic buffer or plus cyclosporine A post-conditioning prevented apoptosis-related mitochondrial permeabilization and provided the myocardial protection after cardioplegic arrest.
Globalizing Writing Studies: The Case of U.S. Technical Communication Textbooks
Authors: Matsuda Aya , Kei Matsuda Paul
Published: April 2011

In an increasingly globalized world, writing courses, situated as they are in local institutional and rhetorical contexts, need to prepare writers for global writing situations. Taking introductory technical communication in the United States as a case study, this article describes how and to what extent global perspectives are incorporated into writing. Based on an analysis of eight textbooks and a closer analysis of four of them, we illustrate the representation of technical communication and communicators as well as multiculturalism and multilingualism in these textbooks and point out the limitations vis-à-vis the cultural and linguistic complexity of global technical communication in today’s world. We conclude by considering implications for U.S. college composition as it continues to contribute to the international discourse of writing studies.
Occult Genres and the Certification of Madness in a 19th-Century Lunatic Asylum
Authors: Berkenkotter Carol , Hanganu-Bresch Cristina
Published: April 2011

Using archival admissions records and case histories of patients at a British asylum from the 1860s to the 1870s, the authors examine the medical certification process leading to the asylum confinement of individuals judged to be “of unsound mind.” These institutional texts are, the authors suggest, “occult genres” that function as complex acts of argumentation, whose illocutionary force depends on the success of their felicity conditions. Through the lens of Austin’s concept of “uptake,” the authors analyze the role of medical certification in the admissions history of two patients at Ticehurst House Asylum in the 1860s-1870s. The authors contend that historical genre analysis plays an important role in the rhetoric of medicine and health, shedding light on the performative power of medical certification, an act essential to the practice of psychiatry.
I’ll race you to the top: Othering from within - attitudes among Pontian children in Cyprus towards other immigrant classmates
Authors: Theodorou Eleni
Published: April 2011

Drawing on data from a larger ethnographic study, this article explores processes of othering among immigrant children of different ethnic and racial backgrounds at a public elementary school in Cyprus. Immigrant children of Pontian background internalized and reproduced racial and Eurocentric stereotypes against their non-European immigrant classmates, despite the shared experience of marginalization by the Greek-Cypriot majority. Such examinations of children’s negotiations of selfing and othering widen our understandings of how children make meaning of, are influenced by but also shape their worlds, and carry implications for the anthropology of childhood and intercultural education.
Forgetting and remembering alienation theory
Authors: Yuill Chris
Published: April 2011

Alienation theory has acted as the stimulus for a great deal of research and writing in the history of sociology. It has formed the basis of many sociological ‘classics’ focused on the workplace and the experiences of workers, and has also been mobilized to chart wider social malaise and individual troubles. Alienation theory usage has, however, declined significantly since its heyday of the 1960s and 1970s. Here, the reasons why alienation theory was ‘forgotten’ and what can be gained by ‘remembering’ alienation theory are explored. To realize this ambition this article proceeds by (1) briefly visiting differing definitions of alienation theory, before charting its high point, and the various debates and tensions of the time, during the 1960s and 1970s; (2) analysing the reasons why alienation theory fell from grace from the 1980s onwards; (3) elaborating how and why alienation theory is still relevant for sociology and the wider social sciences today.
Nephropathy associated with antiphospholipid antibodies in patients with systemic lupus erythematosus
Authors: Silvariño R , Sant F , Espinosa G , Pons-Estel G , Solé M , Cervera R , Arrizabalaga P
Published: April 2011

Abstract: Background. Nephropathy associated with antiphospholipid antibodies (aPL) has been proposed as a risk factor of worse renal prognosis in patients with systemic lupus erythematosus (SLE). The purpose of the current study was to evaluate the prevalence of aPL-associated nephropathy (aPLN) among patients with lupus nephritis and to describe their functional renal outcome. Methods. A total of 79 renal biopsies from 77 patients followed at the Hospital Clinic, Spain were analysed. Each renal biopsy was evaluated by a pathologist who was blinded to the aPL status. Thrombotic microangiopathy (TMA), fibrous intimal hyperplasia (FIH), fibrocellular arterial occlusion (FAO), focal cortical atrophy (FCA), and tubular thyroidization as lesions suggestive of aPLN were identified. Results: aPLN was found in nine (11.4%) biopsies. TMA was found in three (33.3%) cases whereas chronic aPLN, represented by FIH and FCA, was found in four (44.4%) and three (33.3%) cases, respectively. A significant association between the presence of aPL and aPLN was found ( p = 0.003). Patients with lupus anticoagulant (LA) plus IgG anticardiolipin antibodies (aCL) showed an increased prevalence of aPLN (OR: 3.61, 95% CI 1.28–5.14; p = 0.002). Creatinine levels were significantly increased in patients with aPLN compared with those with aPL without aPLN ( p = 0.038). However, no significant difference in complete remission, partial remission, not response, and established renal damage between groups was observed at the end of follow-up. Conclusions: The aPL have an important role in the pathogenesis of renal lesions in SLE patients. Prospective studies are needed to address the role of aPLN in the long-term outcome of SLE patients with positive aPL.
The English Church at the Frontier of Early Modern Catholicism
Authors: Powell Raymond A.
Published: April 2011

The Restoration of English Catholicism in the mid-1550s came at a fateful moment—familiar currents of medieval religion as partially reshaped by Humanist reform had begun to fade, but Early Modern Catholicism was only beginning to take form, and had not yet been given its ultimate Tridentine direction. The English Church under Mary I was post-Protestant, but pre-Catholic reform. In this difficult environment of sweeping religious change, popular Catholic writers created a new English Catholic identity intended to consolidate the recent Catholic Restoration, support widely held religious values and make sense of ordinary people’s religious experience. This identity arose through a creative synthesis of several disparate themes important to Marian Catholics (Catholic unity, English heritage and traditionalism). The English Catholic identity of popular Marian literature de-emphasised contemporary, international Catholicism, stressing instead the historic component of Catholic unity through shared commitment to the beliefs and practices of the Early Church, which allowed English people to celebrate their own national identity as Catholics while coming to terms with the recent heterodox past.
Exploring the self-directed anger of the stigmatized
Authors: Hansen Nina , Sassenberg Kai
Published: April 2011

Does social identification protect or harm targets of discrimination? Two studies ( N = 52, N = 94) tested the prediction that perceived legitimacy moderates the impact of social identification on negative responses to discrimination. Results confirm that when discrimination is perceived as illegitimate, identification is negatively related to self-directed anger ( buffering effect) because identification provides a feeling of in-group support. However, when discrimination is perceived as legitimate, identification is positively related to self-directed anger ( exacerbating effect) because the internalized social identity is perceived as legitimate target for the negative treatment. Legitimacy is measured and manipulated among different low-status groups. The legitimization and internalization of discrimination driven by self-directed anger are discussed.
The Carryover Effect Does Not Influence Football Results
Authors: Goossens Dries R. , Spieksma Frits C.R.
Published: April 2011

In a round robin tournament, it is often believed that each team has an effect on its opponent, which carries over to the next game of that opponent. Indeed, if team A plays against team B, and subsequently against team C, A’s performance against C may have been affected by B, and we say that team C receives a carryover effect from B. For instance, if team B is a very strong team, then team A could be exhausted and discouraged after this game, which could benefit its next opponent, team C. Clearly, any schedule will lead to carryover effects. In practice, the perceived influence of carryover effects has been used as an argument when producing a schedule. In this work, we develop an approach to measure whether carryover effects have an influence on the outcome of football matches. The authors apply this method on the highest division in Belgium, using data from over 30 seasons, amounting over 10,000 matches. In our data set, we find no evidence to support the claim that carryover effects affect the results, which has major implications for the sporting community with respect to generating fixtures.
Ultra-Large-Volume Paracentesis
Authors: Ault Mark J. , Lamba Rajneet , Rosen Bradley T.
Published: April 2011

Total paracentesis with albumin replacement has become the mainstay of treatment for refractory ascites in patients with decompensated hepatic cirrhosis. The authors report one of the largest volume single-tap paracenteses in the literature (38.8 L), discuss issues surrounding the safety of this procedure, and review the challenges inherent to managing these complex patients.
Acute Care Nurse Practitioners in an Academic Multidisciplinary ICU
Authors: Shimabukuro David
Published: April 2011

The need for acute care nurse practitioners (ACNPs) in the intensive care unit (ICU) has steadily increased over the years. This is in part because of an increase in hospital admissions from an aging population that is living longer from advances in health care, especially in the critical care arena. Another factor involves recommendations by the Leapfrog Group that include fundamental critical care support be readily available to the patient’s bedside within 5 minutes. However, the largest driving force is the human resources shortage in critical care medicine. More and more patients are requiring critical care services, whereas physician numbers are not keeping pace with the growth. In addition, duty hour restrictions implemented by the Accreditation Council for Graduate Medical Education that limits residents’ work hours is contributing to the shortage. As a medium-to-large public tertiary academic medical center that serves all of northern California and part of the Central Valley, we have not been spared from the increase in workload in addition to the decrease in house staff support. The purpose of this article is to describe our experience with the use and integration of ACNPs into our multidisciplinary ICU teams.
Gene Therapy for Cartilage Repair
Authors: Madry Henning , Orth Patrick , Cucchiarini Magali
Published: April 2011

The concept of using gene transfer strategies for cartilage repair originates from the idea of transferring genes encoding therapeutic factors into the repair tissue, resulting in a temporarily and spatially defined delivery of therapeutic molecules to sites of cartilage damage. This review focuses on the potential benefits of using gene therapy approaches for the repair of articular cartilage and meniscal fibrocartilage, including articular cartilage defects resulting from acute trauma, osteochondritis dissecans, osteonecrosis, and osteoarthritis. Possible applications for meniscal repair comprise meniscal lesions, meniscal sutures, and meniscal transplantation. Recent studies in both small and large animal models have demonstrated the applicability of gene-based approaches for cartilage repair. Chondrogenic pathways were stimulated in the repair tissue and in osteoarthritic cartilage using genes for polypeptide growth factors and transcription factors. Although encouraging data have been generated, a successful translation of gene therapy for cartilage repair will require an ongoing combined effort of orthopedic surgeons and of basic scientists.
Preoperative Measurement of Cartilage Defects by MRI Underestimates Lesion Size
Authors: Gomoll Andreas H. , Yoshioka Hiroshi , Watanabe Atsuya , Dunn John C. , Minas Tom
Published: April 2011

Objective:

Anecdotal evidence suggests that MRI frequently underestimates the size of cartilage defects when compared with final lesion size after debridement of all degenerated tissue. This has potential implications for the choice of cartilage repair technique since most treatment algorithms are primarily driven by defect size. We conducted an investigation comparing size estimates based on preoperative MRI with final defect size after debridement. Our aim was to provide surgeons with more objective data to assist in predicting true defect size based on MRI scanning.

Design:

Patients were included in this retrospective study if they had undergone preoperative MRI and open cartilage repair within 12 months to minimize potential confounding by defect progression on MRI. Defect sizes measured after debridement were obtained from surgical notes and compared with MRI size estimates by 2 musculoskeletal radiologists.

Results:

Thirty-eight patients were enrolled with a median age of 37 years, median number of 1.7 defects, and a total median defect area of 6 cm2 per knee. Preoperative MRI scanning had predicted a median defect area of 3.6 cm2. This reflected a difference of 65% ( P < 0.001) between MRI and final defect area after debridement when 85% of all individual defects were larger than predicted by preoperative MRI.

Conclusions:

Our study compared the size of cartilage defects measured by preoperative MRI with surgical measurements after debridement. On average, the final total defect area per knee was 65% larger than estimated preoperatively by MRI. Individual defects were larger than predicted by 47% to 377%, depending on defect location.
Right Aortic Arch With Aberrant Left Subclavian Artery and Anomalous Origin of Right Pulmonary Artery From Ascending Aorta
Authors: Hamzeh G. , Crespo A. , Rey E. , Blanco R. , Luis M. , Rodríguez M. A. , Aramendi J.
Published: April 2011

The authors report a case of a neonate that was operated on with the diagnosis of right aortic arch and aberrant left subclavian artery and anomalous origin of right pulmonary artery from ascending aorta. Computed tomography (CT) scan suggested double aortic arch and cardiac catheterization suggested anomalous origin of right pulmonary artery from ascending aorta versus aorto-pulmonary window. The final diagnosis was made at the operation. There was a right aortic arch and aberrant left subclavian artery and persistent ductus arteriosus. Surgical repair consisted of section of the ductus arteriosus and reimplantation of the right pulmonary artery in the main pulmonary artery.
Bilateral Ductus Arteriosus With Isolated Right Pulmonary Artery
Authors: Hawkins John A. , Cleveland Jeanne H. , Erickson Brian , Puchalski Michael D. , Tani Lloyd Y.
Published: April 2011

Bilateral patent ductus arteriosus and isolated right pulmonary artery (RPA) is a rare anomaly often interpreted as congenital absence of the RPA. Recognized early, continuity between the main pulmonary artery and distal RPA can be established and long-term sequelae avoided. We report 2 patients who underwent neonatal repair using a nonvalved pulmonary artery allograft conduit placed anterior to the aorta to establish continuity between the main pulmonary artery and RPA. Both patients continue to do well 10 and 15 years postoperatively with good growth of the distal RPA and good exercise tolerance. This approach offers good long-term palliation.
Two-Stage Repair of Truncus Arteriosus Associated With Interrupted Aortic Arch in Critically Ill Patients
Authors: Sernich Steffan , Pettitt Timothy W. , Caspi Joseph
Published: April 2011

This report describes 2 newborns with truncus arteriosus associated with an interrupted aortic arch who underwent a 2-stage repair due to poor preoperative condition. A repair of the interrupted aortic arch and ventricular-to-pulmonary artery conduit with a 6-mm Gore-Tex tube was performed as a first stage. Closure of a ventricular septal defect and placement of a right ventricular-to-pulmonary artery homograft conduit were performed electively at 8 months of age.
Pediatric Cardiopulmonary Bypass
Authors: Talor Jonathan J. , Ündar Akif
Published: April 2011

This current review describes how components of the cardiopulmonary bypass (CPB) circuit are selected and examines the benefits of pulsatile perfusion for use during CPB. Pulsatile flow generates significantly greater surplus hemodynamic energy (SHE) than nonpulsatile flow; higher SHE values have been associated with better microcirculation perfusion, lower rates of systemic inflammatory response, and better vital organ protection. Pulsatile perfusion may have a positive effect on clinical outcomes, play a role in preserving homeostasis, and help to decrease morbidity associated with CPB.
Sustainable Knowledge Transfer in Pediatric Cardiac Surgery
Authors: Baliulis Giedrius , Lipnevičius Artūras , Sudikiene Rita , Lebetkevičius Virgilijus , Versockas Kęstutis , Lankutis Kęstutis , Nogienė Giedrė , Žilinskas Vidmantas , Sirvydis Vytautas , Haw Marcus P. , Tarutis Virgilijus
Published: April 2011

The study assesses the impact of a program using a model of knowledge transfer on the long-term development of a pediatric cardiac service in Lithuania. A team from the United Kingdom evaluated Lithuanian pediatric cardiac services and provided support in areas targeted for improvement. The total number of infant operations performed in Lithuania from 1990 to 2008, together with in-hospital mortality rates, was broken down into 3 time periods and analyzed to estimate the efficacy of the program: (1) 1990-1998, before the program; (2) 1999-2002, during the program; (3) 2003-2008, following the end of the program. Lithuanian results in children older than 1 year were comparable with other European centers. However, only 315 infant and neonatal cardiac procedures were performed between 1990 and 1998, and there was an in-hospital mortality of 34.2%. Between 1999 and 2002, the UK team performed 23 highly complex demonstration procedures (in-hospital mortality, 13%). During the same period the Lithuanian team performed 305 additional operations in neonates and infants, and in-hospital mortality decreased to 18.7%. From 2003 to 2008 results continued to improve—559 infant operations were performed, with in-hospital mortality of 11.3% ( P < .0001). Knowledge transfer has led to substantial and sustainable long-term improvement in the results of infant cardiac surgery in Lithuania. Demonstrating techniques and care on a limited number of more complex cases is an efficient way of transferring knowledge and skills to the developing pediatric cardiac centers.
Challenges of Univentricular Physiology in Heterotaxy
Authors: Jacobs Marshall L. , Mavroudis Constantine
Published: April 2011

Patients with heterotaxy syndrome exhibit an extensive constellation of congenital cardiac malformations, making these patients a challenging group to manage surgically. Many of these patients' hearts do not lend themselves to separation of the pulmonary and systemic circulations except by some modification of the Fontan procedure. Palliative procedures early in life are directed at creating a satisfactory balance of pulmonary and systemic blood flow and at the same time ensuring unobstructed pulmonary venous return. Early conversion from parallel pulmonary and systemic circulations to superior cavopulmonary connections is important, to reduce volume work of the systemic ventricle. Heterotaxy patients are generally considered a high-risk population with respect to eventual Fontan procedure. It is important to appreciate the unique and variable anatomy of the sinus node and conduction system and the potential for occult pulmonary venous obstruction, atrioventricular valve regurgitation, and recurrent cyanosis, which may be related to the development of pulmonary arteriovenous malformations.
Surgical Management of the Neonate With Heterotaxy and Long-Term Outcomes of Heterotaxy
Authors: Jonas Richard A.
Published: April 2011

A review of the many challenges facing the neonate with heterotaxy has identified total anomalous pulmonary venous connection, atrioventricular valve abnormalities, pulmonary atresia, and arrhythmias including heart block as particular risk factors for the child who will pursue a single-ventricle pathway. Experience varies widely between different centers as to the percentage of patients who are suitable for biventricular repair, ranging from less than 20% to greater than 50%. Biventricular repair may only require simple baffling of anomalous systemic or pulmonary veins or may involve complex intraventricular baffle repair of double-outlet right ventricle with common atrioventricular valve. The long-term complications of heterotaxy include accelerated development of pulmonary arteriovenous malformations after the Kawashima procedure, high mortality and morbidity for the Fontan procedure (although improving results have been reported more recently), and the development of late arrhythmias. Extracardiac problems include a high risk of volvulus if malrotation is present, suggesting the need for an elective Ladd procedure. The presence of associated ciliary dyskinesia appears to be associated with an increased risk of postoperative morbidity, particularly ventilator dependence and other respiratory complications. The child with heterotaxy faces many challenges that are often underappreciated by both caregivers and families.
Inadvertent Screw Stripping During Ankle Fracture Fixation in Elderly Bone
Authors: Feroz Dinah A. , Mears Simon C. , Knight Trevor A. , Soin Sandeep P. , Campbell John T. , Belkoff Stephen M.
Published: April 2011

Poor screw purchase because of osteoporosis presents difficulties in ankle fracture fixation. The aim of our study was to determine if cortical thickness, unicortical versus bicortical purchase, and bone mineral density are predictors of inadvertent screw stripping and overtightening. Ten paired cadaver ankles (average donor age, 81.7 years; range, 50-97 years) were used for the study. Computed tomography scanning with phantoms of known density was used to determine the bone density along the distal fibula. A standard small-fragment, 7-hole, one-third tubular plate was applied to the lateral surface of the fibula, with 3 proximal bicortical cortical screws and 2 distal unicortical cancellous screws. A posterior plate, in which all 5 screws were cortical and achieved bicortical purchase, was subsequently applied to the same bones and positioned so that the screw holes did not overlap. A torque sensor was used to measure the torque of each screw during insertion (Ti) and then stripping (Ts). The effect of bone density, screw location, cortical thickness, and unicortical versus bicortical purchase on Ti and Ts was checked for significance ( P < .05) using a general linearized latent and mixed model. We found that 9% of the screws were inadvertently stripped and 12% were overtightened. Despite 21% of the screws being stripped or being at risk for stripping, we found no significant predictors to warn of impending screw stripping. Additional work is needed to identify clinically useful predictors of screw stripping.