bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Abrasiveness of Dentifrices for Complete Dentures
Authors: Pisani Marina Xavier , Bruhn Juliana Pascotti , Paranhos Helena Freitas Oliveira , Silva‐Lovato Cláudia Helena , De Souza Raphael Freitas , Panzeri Heitor
Published: April 2010

Purpose: This study analyzed the surface roughness and weight loss in Plex Glass specimens caused by dentifrices, one conventional (Sorriso) and three specific for dentures.

Materials and Methods: Specimens (n = 6) of Plex Glass were divided into 5 groups including: negative control (water); positive control 1 (Sorriso) and 2 (Corega Brite); Experimental 1 (containing Chloramine T, antimicrobial agent); and Experimental 2 (containing Zonyl, detergent). Brushing was performed in a toothbrushing machine (Pepsodent) with a soft brush and a suspension of toothpaste and distilled water for 300 minutes, representing 6 years of brushing. Weight was measured initially and after the trial period; roughness was measured after the trial period only. The results of roughness and weight loss were analyzed using ANOVA and Tukey tests at 5%.

Results: The negative control (2.82 ± 4.41 mg) showed the lowest weight loss. Experimental 1 (13.62 ± 4.29 mg) and Experimental 2 (15.4 ± 5.80 mg) were equal statistically, and Sorriso (23.22 ± 7.23 mg) and Corega (28.83 ± 6.34 mg) produced the greatest weight loss. Concerning roughness, the negative control group (0.03 ± 0.01 μm) showed the lowest value. No significant differences were found between Corega (13.43 ± 1.65 μm), Experimental 1 (12.28 ± 0.85 μm), and Experimental 2 (10.68 ± 2.56 μm). The Sorriso toothpaste produced the greatest amount of surface roughness (19.15 ± 2.36 μm).

Conclusion: Of the tested dentifrices, the experimental preparations proved to be the least abrasive and resulted in the lowest weight loss after brushing of the acrylic. Based on these findings, the use of these experimental dentifrices is advocated. Further evaluation based on the ability of these preparations to remove biofilms is required.
Management of acute anemia in a Jehovah's Witness patient with acute lymphoblastic leukemia with polymerized bovine hemoglobin‐based oxygen carrier: a case report and review of literature
Authors: Donahue Laura L. , Shapira Iuliana , Shander Aryeh , Kolitz Jonathan , Allen Steven , Greenburg Gerson
Published: April 2010

BACKGROUND: Management of severe symptomatic anemia is exceptionally challenging when blood transfusions cannot be administered. Use of hemoglobin (Hb)‐based oxygen carriers as “bridging treatment” can be an option.

CASE REPORT: This is a report of a 36‐year‐old Jehovah's Witness diagnosed with acute lymphoblastic leukemia (ALL) who developed severe symptomatic anemia (Hb as low as 3.1 g/dL) during induction chemotherapy and refused allogeneic blood transfusions. Fifteen units of Hemopure (Biopure Corp.), an investigational polymerized bovine Hb‐derived artificial oxygen carrier, were administered over a 12‐day period after informed consent was obtained. The patient's condition improved.

RESULTS: Chart review was performed to identify relevant information about the patient's clinical status during Hemopure treatment. With the use of Hemopure the patient's total Hb level was maintained between 3.6 and 5.3 g/dL, over a 12‐day period, without any evidence of ischemia or organ dysfunction indicating that Hemopure was providing adequate tissue oxygen supply until marrow red blood cell recovery. The patient completed the chemotherapy regimen and was discharged in stable condition and has been in remission for 28 months.

CONCLUSION: This report documents the successful management of profound anemia in an acute leukemia patient who refused blood transfusion, with the use of Hemopure, to save the patient from the devastating effects of ischemia associated with severe anemia. Hemopure may represent a life‐saving intervention in patients with severe symptomatic anemia when blood transfusion is not an option.
The influence of conditions utilized to hold apheresis and whole blood–derived platelet samples before platelet enumeration with three hematology analyzers
Authors: Seetharaman Shalini , Kline Linda , Dabay Michelle , Kurtz James , Moroff Gary
Published: April 2010

BACKGROUND: The Advia 120 (Siemens Diagnostics) hematology analyzer is different from other hematology analyzers in that it requires platelets (PLTs) to be “effectively spherical” to be counted. Our study evaluated how PLT counts with this hematology analyzer and two other models were influenced by the holding of PLT product samples.

STUDY DESIGN AND METHODS: Samples were prepared from apheresis PLT products (APs) collected in ACD‐A and from whole blood–derived PLT concentrates (PCs) in CP2D or ACD‐A. Samples were stored in K2 and K3ethylenediaminetetraacetate (EDTA) tubes at room temperature (RT) and in the cold. PLT counts were determined immediately, after 1 and 4 hours, and after an overnight hold, using Advia 120, XE‐2100D, and Cell‐Dyn 3700 hematology analyzers.

RESULTS: A time‐dependent increase in PLT counts was observed with AP samples held at RT using the Advia 120, but not with the other two hematology analyzers. AP samples held in the cold did not show a substantial time‐dependent increase with any of the hematology analyzers. With the Advia 120, the PLT counts in the immediate samples were approximately 14% lower compared to those in cold or overnight‐held RT samples. PC samples with all holding conditions and hematology analyzers did not show any substantial time‐dependent increase in counts.

CONCLUSIONS: With the Advia 120 hematology analyzer, the time‐dependent increase in PLT counts with RT‐held samples may be related to the need to have effectively sphered PLTs unlike that with the other two hematology analyzers. The absence of a holding effect with PC samples may indicate that only AP samples have population(s) that are slow to convert to spherical PLTs.
The detection of platelet antibodies by simultaneous analysis of specific platelet antibodies and the monoclonal antibody–specific immobilization of platelet antigens: an interlaboratory comparison
Authors: Nguyen Xuan Duc , Goebel Meike , Schober Michael , Klüter Harald , Panzer Simon
Published: April 2010

BACKGROUND: Glycoprotein (GP)‐specific platelet (PLT) antibodies can cause allo‐ or autoimmune thrombocytopenia. Their detection is of high diagnostic value. The simultaneous analysis of specific PLT antibodies (SASPA) assay is based on simultaneous detection of various PLT‐specific antibodies by flow cytometry and has entered routine use in our Mannheim institution. In this study, we performed an interlaboratory comparison investigation of PLT‐specific antibodies using SASPA versus the “gold standard,” the monoclonal antibody–specific immobilization of PLT antigen (MAIPA) assay.

STUDY DESIGN AND METHODS: Sera from 194 patients with suspected PLT allo‐ or autoantibodies were tested against GPIIb/IIIa, IX, Ia/IIa, IV, and HLA Class I by SASPA (in Mannheim) and MAIPA (in Vienna). All data were reported blinded to those from the respective other method. Sensitivity studies included dilution studies with known antibodies against HPA‐1a, ‐1b, ‐3b, ‐5b, and ‐15b and HLA Class I.

RESULTS: Overall, results were concordant in 78.9%. The specificity and sensitivity of SASPA, based on the MAIPA results, were 97.3 and 86.3%, respectively, for the detection of alloantibodies. The respective results for the detection of autoantibodies were 95.3 and 44.9%. Serial dilution experiments with sera containing anti‐HPA1a, ‐1b, ‐3b, ‐5b, and ‐15b and anti‐HLA Class I revealed a higher sensitivity of the SASPA assay with all alloantibodies.

CONCLUSION: In this first blind interlaboratory comparison, SASPA yielded similar results to those of MAIPA. The SASPA assay may be superior to the MAIPA assay for the detection of weak alloantibodies while simultaneous detection of a variety of antibody specificities or immunoglobulin classes and the need of fewer PLTs are obvious advantages.
The seroprevalence of hepatitis C virus (HCV) among 559,890 first‐time volunteer blood donors in China reflects regional heterogeneity in HCV prevalence and changes in blood donor recruitment models
Authors: Fu Yongshui , Xia Wenjie , Wang Yizhong , Tian Linwei , Pybus Oliver G. , Lu Ling , Nelson Kenrad
Published: April 2010

BACKGROUND: A decrease in the prevalence of hepatitis C virus antibody (anti‐HCV) has been reported among voluntary blood donors in some regions of China. However, the prevalence of HCV among volunteer blood donors in other regions of China has not been reported. The aim of this study was to investigate the seroprevalence of HCV among 559,890 first‐time volunteer blood donors recruited during 2004 through 2007 at the Guangzhou Blood Center, China.

STUDY DESIGN AND METHODS: Anti‐HCV was detected using two different third‐generation enzyme immunoassay kits. HCV RNA was detected using reverse transcription–polymerase chain reaction (RT‐PCR) targeting the 5′‐untranslated region of HCV.

RESULTS: Among 559,890 donors, 1877 (0.335%) were positive for anti‐HCV. The anti‐HCV+ rate was significantly higher in males than females (0.37% vs. 0.28%; p < 0.001) and significantly lower among donors living in Guangdong Province than donors who had migrated from other locations (0.30% vs. 0.40%; p < 0.001). Among the 1877 anti‐HCV+ donors, 450 were randomly selected for HCV nucleic acid amplification by RT‐PCR. Of these, 270 (60%) were HCV RNA+ and 180 (40%) were HCV RNA−.

CONCLUSIONS: Many donors from outside Guangdong Province were migrant laborers from other areas in China, suggesting that there is regional heterogenicity in HCV prevalence within China. The overall anti‐HCV+ rate reported here is among the lowest reported among blood donors in China reflecting the effect of the current recruitment of exclusively volunteer donors.
An adapted postdonation motivational interview enhances blood donor retention
Authors: Sinclair Kadian S. , Campbell Tavis S. , Carey Patricia M. , Langevin Eric , Bowser Brent , France Christopher R.
Published: April 2010

BACKGROUND: Blood donors may hold conflicting thoughts about future donation. While they may perceive the direct benefit to themselves and others, they often report compelling reasons not to give again. As a result the standard encouragements to return may not be sufficient to motivate some donors. This study examined the effects of a postdonation adapted motivational interview (AMI) on blood donor attitudes and repeat donation behavior.

STUDY DESIGN AND METHODS: Donors (n = 215) were randomly assigned to either an AMI or a no‐interview control group. Approximately 1 month after their index donation, donors in the AMI group completed a brief telephone interview to clarify individual‐specific motivations and values concerning blood donation and address potential barriers. They were then asked to complete questionnaires regarding donation attitudes, anxiety, self‐efficacy, and intention to donate. Donors in the control group were also contacted 1 month after donation and asked to complete the same series of questionnaires.

RESULTS: Donors in the AMI group reported greater intention to provide a future donation (F = 8.13, p < 0.05), more positive donation attitudes (F = 4.59, p < 0.05), and greater confidence in their ability to avoid adverse reactions (F = 10.26, p < 0.01). Further, AMI was associated with higher rates of attempted donation at 12 months (odds ratio, 2.48; 95% confidence interval, 1.27‐4.87).

CONCLUSION: Application of an AMI may be an effective strategy to increase the donor pool by enhancing retention of existing donors.
Mapping and Ablation of Frequent Post‐Infarction Premature Ventricular Complexes
Authors: SARRAZIN JEAN‐FRANCOIS , GOOD ERIC , KUHNE MICHAEL , ORAL HAKAN , PELOSI FRANK , CHUGH AMAN , JONGNARANGSIN KRIT , CRAWFORD THOMAS , EBINGER MATTHEW , MORADY FRED , BOGUN FRANK
Published: April 2010

Mapping of Post‐Infarction PVCs. Introduction: Premature ventricular complexes (PVCs) occur frequently in patients with heart disease. The sites of origin of PVCs in patients with prior myocardial infarction and the response to catheter ablation have not been systematically assessed.

Methods and Results: In 28 consecutive patients (24 men, age 60 ± 10, ejection fraction [EF] 0.37 ± 0.14) with remote myocardial infarction referred for catheter ablation of symptomatic refractory PVCs, the PVCs were mapped by activation mapping or pace mapping using an irrigated‐tip catheter in conjunction with an electroanatomic mapping system. The site of origin (SOO) was classified as being within low‐voltage (scar) tissue (amplitude ≤1.5 mV) or tissue with preserved voltage (>1.5 mV). The SOO was confined to endocardial scar tissue in 24/28 patients (86%). The SOO was outside of scar in 3 patients and could not be identified in 1 patient. At the SOO, local endocardial activation preceded the PVC by 46 ± 19 ms, and the electrogram amplitude during sinus rhythm was 0.48 ± 0.34 mV. The PVCs were effectively ablated in 25/28 patients (89%), resulting in a decrease in PVC burden on a 24‐hour Holter monitor from 15.6 ± 12.3% to 2.4 ± 4.2% (P < 0.001). The SOO most often was confined to scar tissue located in the left ventricular septum and the papillary muscles.

Conclusion: Similar to post‐infarction ventricular tachycardia, PVCs after remote myocardial infarction most often originate within scar tissue. Catheter ablation of these PVCs has a high‐success rate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1002‐1008, September 2010)
Acidosis Impairs the Protective Role of hERG K+ Channels Against Premature Stimulation
Authors: DU CHUN YUN , ADENIRAN ISMAIL , CHENG HONGWEI , ZHANG YI HONG , EL HARCHI AZIZA , MCPATE MARK J. , ZHANG HENGGUI , ORCHARD CLIVE H. , HANCOX JULES C.
Published: April 2010

Acidosis and the hERG K+ Channel. Introduction: Potassium channels encoded by human ether‐à‐go‐go‐related gene (hERG) underlie the cardiac rapid delayed rectifier K+ channel current (IKr). Acidosis occurs in a number of pathological situations and modulates a range of ionic currents including IKr. The aim of this study was to characterize effects of extracellular acidosis on hERG current (IhERG), with particular reference to quantifying effects on IhERG elicited by physiological waveforms and upon the protective role afforded by hERG against premature depolarizing stimuli.

Methods and Results: IhERG recordings were made from hERG‐expressing Chinese Hamster Ovary cells using whole‐cell patch‐clamp at 37°C. IhERG during action potential (AP) waveforms was rapidly suppressed by reducing external pH from 7.4 to 6.3. Peak repolarizing current and steady state IhERG activation were shifted by ∼+6 mV; maximal IhERG conductance was reduced. The voltage‐dependence of IhERG inactivation was little‐altered. Fast and slow time‐constants of IhERG deactivation were smaller across a range of voltages at pH 6.3 than at pH 7.4, and the contribution of fast deactivation increased. A modest acceleration of the time‐course of recovery of IhERG from inactivation was observed, but time‐course of activation was unaffected. The amplitude of outward IhERG transients elicited by premature stimuli following an AP command was significantly decreased at lower pH. Computer simulations showed that after AP repolarization a subthreshold stimulus at pH 7.4 could evoke an AP at pH 6.3.

Conclusion: During acidosis the contribution of IhERG to action potential repolarization is reduced and hERG may be less effective in counteracting proarrhythmogenic depolarizing stimuli. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1160‐1169)
Persistence of Pulmonary Vein Isolation After Robotic Remote‐Navigated Ablation for Atrial Fibrillation and its Relation to Clinical Outcome
Authors: WILLEMS STEPHAN , STEVEN DANIEL , SERVATIUS HELGE , HOFFMANN BORIS A. , DREWITZ IMKE , MÜLLERLEILE KAI , AYDIN MUHAMMET ALI , WEGSCHEIDER KARL , SALUKHE TUSHAR V. , MEINERTZ THOMAS , ROSTOCK THOMAS
Published: April 2010

Robotic Remote Ablation for AF. Aims: A robotic navigation system (RNS, Hansen™) has been developed as an alternative method of performing ablation for atrial fibrillation (AF). Despite the growing application of RNS‐guided pulmonary vein isolation (PVI), its consequences and mechanisms of subsequent AF recurrences are unknown. We investigated the acute procedural success and persistence of PVI over time after robotic PVI and its relation to clinical outcome.

Methods and Results: Sixty‐four patients (60.7 ± 9.8 years, 53 male) with paroxysmal AF underwent robotic circumferential PVI with 3‐dimensional left atrial reconstruction (NavX™). A voluntary repeat invasive electrophysiological study was performed 3 months after ablation irrespective of clinical course. Robotic PVI was successful in all patients without complication (fluoroscopy time: 23.5 [12–34], procedure time: 180 [150–225] minutes). Fluoroscopy time demonstrated a gradual decline but was significantly reduced after the 30th patient following the introduction of additional navigation software (34 [29–45] vs 12 [9–17] minutes; P < 0.001). A repeat study at 3 months was performed in 63% of patients and revealed electrical conduction recovery in 43% of all PVs. Restudied patients without AF recurrence (n = 28) showed a significantly lower number of recovered PVs (1 (0–2) vs 2 (2–3); P = 0.006) and a longer LA‐PV conduction delay than patients with AF recurrences (n = 12). Persistent block of all PVs was associated with freedom from AF in all patients. At 3 months, 67% of patients were free of AF, while reablation of recovered PVs led to an overall freedom from AF in 81% of patients after 1 year.

Conclusion: Robotic PVI for PAF is safe, effective, and requires limited fluoroscopy while yielding comparable success rates to conventional ablation approaches with PV reconduction as a common phenomenon associated with AF recurrences. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1079‐1084)
Update on the Association of Inflammation and Atrial Fibrillation
Authors: PATEL PARAG , DOKAINISH HISHAM , TSAI PETER , LAKKIS NASSER
Published: April 2010

Update on the Association of Inflammation and Atrial Fibrillation. Atrial fibrillation (AF) is a common arrhythmia and is associated with significant morbidity and mortality. The pathogenesis of AF remains incompletely understood and management remains a difficult task. Over the past decade there has been accumulating evidence implicating inflammation in the pathogenesis of AF. Inflammation appears to play a significant role in the initiation and perpetuation of AF as well as the prothrombotic state associated with AF. Inflammatory biomarkers (C‐reactive protein and interleukin‐6) have been shown to be associated with the future development, recurrence and burden of AF, and the likelihood of successful cardioversion. Therapies directed at attenuating the inflammatory burden appear promising. Animal and clinical studies have evaluated statins, angiotensin‐converting enzyme inhibitors/angiotensin‐II receptor blockers, and corticosteroids for the treatment or prevention of AF. The purpose of this review is to provide current evidence on the relationship between inflammation and AF and potential therapies available to modulate the inflammatory state in AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1064‐1070, September 2010)
Longitudinal Tissue Velocity and Deformation Imaging in Inferobasal Left Ventricular Aneurysm
Authors: Sadeghian Hakimeh , Ahmadi Farzaneh , Lotfi‐Tokaldany Masoumeh , Salehi Rezvanyieh , Zavar Reyhane , Fathollahi Mahmood Sheikh , Abbasi Seyed Hesameddin
Published: April 2010

Background: Longitudinal myocardial tissue velocity imaging (TVI) and strain rate imaging (SRI) quantify regional myocardial function. We aimed to measure TVI and SRI indices for inferobasal aneurysmal segments by echocardiography at rest. Method: Sixteen patients with inferobasal left ventricular (LV) aneurysm, LV ejection fraction (EF) ≤50%, and 14 normal coronaries with normal echocardiography (control group) were studied. In SRI, peak systolic strain (ST), strain rate (SR), and pattern of strain curves and in TVI, peak systolic inward motion (Sm) were evaluated all at rest. Ascending curve means systolic expansion and descending means shortening. Results: LVEF was significantly lower in the patient group. Mean ST, SR, and Sm of inferobasal segment showed significant difference between patient and control groups; for ST: 1.45 ± 7.18% versus −17.64 ± 7.45%, P < 0.0001; SR: −0.25 ± 0.26 versus −1.44 ± 0.64 sec−1, P < 0.0001; and Sm: 3.85 ± 1.26 versus 5.56 ± 1.28 cm/sec, P = 0.006, respectively. All inferobasal aneurysmal segments had ascending curve while normal segments showed a descending curve. In patient group, aneurysmal segments had significantly reduced ST and SR compared to normal segments. Normal functioning segments of patients showed significant reduction of ST and SR compared to normal LV segments in control subjects. The range of SR and ST for inferobasal aneurysmal segments did not overlap with that of the normal segments (−0.60, 0.19 and −3.00, −0.80 sec−1 for SR, and −8.30, 23.30 and −35.30, −10.00% for ST, respectively). Conclusion: SRI indices were significantly reduced in inferobasal aneurysmal segment in comparison with either the same segment in normal subjects or normal functioning segments in the same patients. SR and ST may be superior to Sm in the evaluation of inferobasal aneurysmal segments. (Echocardiography 2010;27:803‐808)
Potential Faces of Patent Foramen Ovale (PFO PFO)
Authors: Naqvi Tasneem Z , Rafie Reza , Daneshvar Samuel
Published: April 2010

Background: Patent foramen ovale (PFO) is diagnosed on echocardiography by saline contrast study with or without color Doppler evidence of shunting. PFO is benign except when it causes embolic events. Methods and Results: In this report, we describe unique additional manifestations related to the diagnosis and presentation of PFO. These include demonstration of PFO during the release phase of “sigh” on the ventilator in the operating room, use of a separate venipuncture to allow preparation of blood‐saline‐air mixture after multiple failed saline bubble injections, resting and stress hypoxemia related to left to right shunting across a PFO in the absence of pulmonary hypertension, presentation of quadriperesis secondary to an embolic event from a PFO and development of a thrombus on the left atrial aspect of PFO in a patient with atrial fibrillation, and on the right atrial aspect of PFO in a patient who had undergone repair of a flail mitral valve. Finally, in one patient with end‐stage renal disease, aortic valve endocarditis and periaortic abscess, PFO acted as a vent valve relieving right atrial pressure following development of aortoatrial fistula. Conclusion: PFO diagnosis can be elusive if appropriate techniques are not used during saline contrast administration. PFO can present as hypoxemia in the absence of pulmonary hypertension, can be a rare cause of quadriperesis, and can be associated with thrombus formation on either side of interatrial septum. Finally, PFO presence can be lifesaving in those with sudden increase in right atrial pressure such as with aortoatrial fistula. (Echocardiography 2010;27:897‐907)
Intellectual property and the licensing of Canadian government geospatial data: an examination of GeoConnections' recommendations for best practices and template licences
Authors: JUDGE ELIZABETH F. , SCASSA TERESA
Published: April 2010

In Canada, Crown copyright permits government to assert control over its works. These Crown rights have often been justified on the basis that government must assert intellectual property rights so as to be better able to control the accuracy, integrity and quality of any information that reaches the public through Crown works. In this article, the authors examine GeoConnections' template agreements for the licensing of government geographic data. They argue that not only is the basis and scope of claims to intellectual property rights uncertain, the objectives of quality control, data integrity and accuracy do not appear to motivate the licence terms. The uncertainty as to the legal basis of the intellectual property claims is significant, as licences of this kind may give support to otherwise weak downstream claims by third parties to copyright in data products generated through the use of geographic data provided by the Crown.
Validation of the Professional Practice Environment Scale in Australian General Practice
Authors: Halcomb Elizabeth J. , Davidson Patricia M. , Caldwell Belinda , Salamonson Yenna , Rolley John X.
Published: April 2010

Purpose: To validate the Professional Practice Environment Scale (PPE) in Australian general practice.

Methods: The PPE was modified slightly for appropriateness for the practice setting and administered to a sample of 342 Australian general practice nurses via an online survey tool. The factor structure of the 38‐item PPE was examined using principal components analysis with Varimax rotation.

Findings: An eight‐factor solution accounted for 71.6% of the variance. Low factor loading (<0.3) or cross‐component loadings were detected in eight items. A comparison of Cronbach's alpha values demonstrated little change in the deletion of eight items from four of the eight related components.

Conclusions: Findings demonstrated that a 30‐item version of the PPE was reliable and valid for use to assess the professional practice environment of nurses working in Australian general practice.

Clinical Relevance: A tool to measure the professional practice environment in general practice is important as it will assist in monitoring the impact of the work environment on the recruitment, retention, and satisfaction of nurses in this setting.
Emergency Department Information System Adoption in the United States
Authors: Landman Adam B. , Bernstein Steven L. , Hsiao Allen L. , Desai Rani A.
Published: April 2010

Objectives:  The American Recovery and Reinvestment Act of 2009 incentivizes adoption of health care information technology (HIT) based on support for specific standards, policies, and features. Limited data have been published on national emergency department information systems (EDIS) adoption, and to our knowledge, no prior studies have considered functionality measures. This study determined current national estimates of EDIS adoption using both single‐response rates of EDIS adoption and a novel feature‐based definition and also identified emergency department (ED) characteristics associated with EDIS use.

Methods:  The 2006 National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits that also surveyed participating EDs on EDIS, was used to estimate EDIS adoption. EDIS adoption rates were calculated using two definitions: 1) single‐response—response to a single survey question as to whether the EDIS was complete, partial, or none; and 2) feature‐based—based on the reported features supported by the EDIS, systems were categorized as fully functional, basic, other, or none. The relationship of EDIS adoption to specific ED characteristics such as facility type and location was also examined.

Results:  Using the single‐response classification, 16.1% of EDs had a complete EDIS, while 30.4% had a partial EDIS, and 53.5% had none. In contrast, using a feature‐based categorization, 1.7% EDs had a fully functional EDIS, 12.3% had basic, 32.1% had other, and 53.9% had none. In multivariable analysis, urban EDs were significantly more likely to have a fully functional or basic EDIS than were rural EDs. Pediatric EDs were significantly more likely than general EDs to have other EDIS.

Conclusions:  Despite more optimistic single‐response estimates, fewer than 2% of our nation’s EDs have a fully functional EDIS. EDs in urban areas and those specializing in the care of pediatric patients are more likely to support EDIS. Accurate and consistent EDIS adoption estimates are dependent on whether there are standardized EDIS definitions and classifications of features. To realize the potential value of EDIS for improved emergency care, we need to better understand the extent and correlates of the diffusion of this technology and increase emergency medicine engagement in national HIT policy‐making.

Academic Emergency Medicine 2010; 17:536–544 © 2010 by the Society for Academic Emergency Medicine
The Risk of Intra‐abdominal Injuries in Pediatric Patients with Stable Blunt Abdominal Trauma and Negative Abdominal Computed Tomography
Authors: Hom Jeffrey
Published: April 2010

Objectives:  This review examines the prevalence of intra‐abdominal injuries (IAI) and the negative predictive value (NPV) of an abdominal computed tomography (CT) in children who present with blunt abdominal trauma.

Methods:  MEDLINE, EMBASE, and Cochrane Library databases were searched. Studies were selected if they enrolled children with blunt abdominal trauma from the emergency department (ED) with significant mechanism of injury requiring an abdominal CT. The primary outcome measure was the rate of IAI in patients with negative initial abdominal CT. The secondary outcome measure was the number of laparotomies, angiographic embolizations, or repeat abdominal CTs in those with negative initial abdominal CTs.

Results:  Three studies met the inclusion criteria, comprising a total of 2,596 patients. The overall rate of IAI after a negative abdominal CT was 0.19% (95% confidence interval [CI] = 0.08% to 0.44%). The overall NPV of abdominal CT was 99.8% (95% CI = 99.6% to 99.9%). There were five patients (0.19%, 95% CI = 0.08% to 0.45%) who required additional intervention despite their initial negative CTs: one therapeutic laparotomy for bowel rupture, one diagnostic laparotomy for mesenteric hematoma and serosal tear, and three repeat abdominal CTs (one splenic and two renal injuries). None of the patients in the latter group required surgery or blood transfusion.

Conclusions:  The rate of IAI after blunt abdominal trauma with negative CT in children is low. Abdominal CT has a high NPV. The review shows that it might be safe to discharge a stable child home after a negative abdominal CT.

ACADEMIC EMERGENCY MEDICINE 2010; 17:469–475 © 2010 by the Society for Academic Emergency Medicine
Emergency Department Patient Volume and Troponin Laboratory Turnaround Time
Authors: Hwang Ula , Baumlin Kevin , Berman Jeremy , Chawla Neal K. , Handel Daniel A. , Heard Kennon , Livote Elayne , Pines Jesse M. , Valley Morgan , Yadav Kabir
Published: April 2010

Objectives:  Increases in emergency department (ED) visits may place a substantial burden on both the ED and hospital‐based laboratories. Studies have identified laboratory turnaround time (TAT) as a barrier to patient process times and lengths of stay. Prolonged laboratory study results may also result in delayed recognition of critically ill patients and initiation of appropriate therapies. The objective of this study was to determine how ED patient volume itself is associated with laboratory TAT.

Methods:  This was a retrospective cohort review of patients at five academic, tertiary care EDs in the United States. Data were collected on all adult patients seen in each ED with troponin laboratory testing during the months of January, April, July, and October 2007. Primary predictor variables were two ED patient volume measures at the time the troponin test was ordered: 1) number of all patients in the ED/number of beds (occupancy) and 2) number of admitted patients waiting for beds/beds (boarder occupancy). The outcome variable was troponin turnaround time (TTAT). Adjusted covariates included patient characteristics, triage severity, season (month of the laboratory test), and site. Multivariable adjusted quantile regression was carried out to assess the association of ED volume measures with TTAT.

Results:  At total of 9,492 troponin tests were reviewed. Median TTAT for this cohort was 107 minutes (interquartile range [IQR] = 73–148 minutes). Median occupancy for this cohort was 1.05 patients (IQR = 0.78–1.38 patients) and median boarder occupancy was 0.21 (IQR = 0.11–0.32). Adjusted quantile regression demonstrated a significant association between increased ED patient volume and longer times to TTAT. For every 100% increase in census, or number of boarders over the number of ED beds, respectively, there was a 12 (95% confidence interval [CI] = 9 to 14) or 33 (95% CI = 24 to 42)‐minute increase in TTAT.

Conclusions:  Increased ED patient volume is associated with longer hospital laboratory processing times. Prolonged laboratory TAT may delay recognition of conditions in the acutely ill, potentially affecting clinician decision‐making and the initiation of timely treatment. Use of laboratory TAT as a patient throughput measure and the study of factors associated with its prolonging should be further investigated.

ACADEMIC EMERGENCY MEDICINE 2010; 17:501–507 © 2010 by the Society for Academic Emergency Medicine
ORIGINAL ARTICLE: Epithelioid hemangioendothelioma in the right auricle of an adult, male Rhesus macaque (Macaca mulatta)
Authors: Lombardini E.D. , Virmani R. , Blanchard T.W. , Lafond J.F. , Ménard S. , Doré M.
Published: April 2010

Abstract Background  A 9‐year‐old, male castrate, Rhesus macaque was euthanized following a prolonged history of chronic renal failure.

Results  Necropsy revealed a proliferative lesion within the right cardiac auricle composed of neoplastic epithelioid cells which infiltrated the myocardium and frequently exhibited intracytoplasmic luminae. Cells multifocally exhibited strong cytoplasmic immunoreactivity for Factor VIII‐related protein (von Willebrand’s factor).

Conclusions  The histological characteristics of this tumor are consistent with a diagnosis of epithelioid hemangioendothelioma, an intermediate‐grade vasoformative neoplasm which has to our knowledge not previously been reported in the heart of a non‐human species.
Retrospective case–control study of hyperglycemia in group‐housed, mature female cynomolgus macaques (Macaca fascicularis)
Authors: Bauer S.A. , Leslie K.E. , Pearl D.L. , Fournier J. , Turner P.V.
Published: April 2010

Background  Captive cynomolgus macaques are prone to obesity, increasing their risk for developing hyperglycemia and type 2 diabetes mellitus (T2DM). Social rank may be a contributing risk factor predisposing macaques to adverse health events.

Methods  Using retrospective health records from 259 animals, a matched case–control study was conducted to assess risk factors for developing hyperglycemia in group‐housed, adult females aged 10 or older. Univariable exact and conditional logistic regression models were used to analyze the data.

Result  The odds of developing hyperglycemia were significantly greater in animals with more frequent counts of injury. Similarly, subordinate animals had higher odds of developing hyperglycemia than affiliates.

Conclusions  Subordinate social status may increase the risk of hyperglycemia in mature female cynomolgus macaques. Opportunities for subordinates to alter feeding strategies are reduced in captivity. This may be associated with increased social stress around feeding, and for animals housed long‐term could predispose them to obesity and hyperglycemia.
Mechanisms linking affective reactions to competition‐related and competition‐extraneous concerns in male martial artists
Authors: Cerin E. , Barnett A.
Published: April 2010

The main aim of this study was to examine affective linkages between competition‐related and competition‐extraneous concern domains. A secondary purpose was to establish the contributions of pre‐competition affects to post‐competition performance appraisals, independent of pre‐competition performance expectations. Thirty‐nine highly skilled male martial artists were assessed at five random times a day for a week and 1 h before a major competition on affective states and sources of concern. They also reported their performance expectations and post‐competition performance appraisals. Affective states triggered by competition‐related and competition‐extraneous concerns persisted in time. Carry‐over effects were stronger after reports of competition‐related concerns, emphasizing the subjective importance of the competitive event. Although positive (enjoyment and surprise) and negative (sadness and guilt) affective spill‐over was observed from competition‐extraneous to competition‐related concerns, the reverse held true only for disgust. These findings may be due to the athletes' ability to regulate affective reactions within a sporting setting, in particular. Spill‐over from competition‐extraneous to competition‐related concerns is indicative of a lesser degree of control over work/study and family life. Given that average weekly negative affects and anger/disgust were independent predictors of post‐competition performance appraisals, the phenomenon of spill‐over and other affective linkage mechanisms in sport warrant further investigation.
Intrinsic risk factors for acute knee injuries among male football players: a prospective cohort study
Authors: Engebretsen A. H. , Myklebust G. , Holme I. , Engebretsen L. , Bahr R.
Published: April 2010

This prospective cohort study was conducted to identify the risk factors for acute knee injuries among male football players. A total of 508 players representing 31 amateur teams were tested during the 2004 preseason for potential risk factors for knee injury through a questionnaire on previous injury, Knee Osteoarthritis Outcome Score (KOOS) and a clinical examination. Generalized estimating equations were used in univariate analyses to identify candidate risk factors, and factors with a P‐value <0.10 were then examined in a multivariate model. During the football season, 61 acute knee injuries, affecting 57 legs (53 players), were registered. Univariate analyses revealed the KOOS subscores “Pain” and “Function in daily living” (OR for a 10‐point difference in score: 1.26, 95% CI 1.03–1.55 and 1.35, 95% CI 0.98–1.85, respectively), any findings at clinical examination (OR: 2.62, 95% CI 1.03–6.68), flexion contraction in range of motion testing (OR: 0.96, 95% CI 0.93–1.00) and varus stress tests in full extension (OR: 8.50, 95% CI 1.85–39.0) and 30° flexion (OR: 5.69, 95% CI 1.73–18.8) as candidate factors. However, in a multivariate analysis, none of these factors were associated with an increased injury risk.
Directional anxiety responses in elite and sub‐elite young athletes: intensity of anxiety symptoms matters
Authors: Lundqvist C. , Kenttä G. , Raglin J. S.
Published: April 2010

The objective was to examine the differences in anxiety ratings of elite and sub‐elite athletes when the relationship between intensity and direction scores of anxiety ratings is considered in analyses. Participants were 31 junior elite (Mean age: 17.7, SD=1.1) and 53 sub‐elite (Mean age: 17.5, SD=1.1) cross country skiers and swimmers who completed the direction modified CSAI‐2R before important competitions. Results showed that elite athletes rated a higher percent of items as facilitative to their performance whereas sub‐elite athletes rated a higher percent of items as debilitative. No significant differences between the elite and sub‐elite samples were displayed regarding rated direction scores of cognitive or somatic anxiety at moderate to high‐intensity levels. A significant difference in facilitative anxiety ratings was displayed at a low anxiety intensity level (Z=−2.20, P<0.05). Outcome performance data showed no consistent congruence with athletes' anxiety direction ratings. The findings suggest that facilitative direction scores are a consequence of low anxiety intensity, possibly combined with high self‐confidence levels. Directional anxiety researchers analyzing separate total scores of intensity and direction respectively, which is the traditional approach, may draw incorrect conclusions about the importance of facilitative ratings of anxiety symptoms.
Massive subcutaneous emphysema developing before surgery for mandibular fracture: a case report
Authors: Sumida Tomoki , Kobayashi Ayumi , Oka Ryota , Yorozuya Toshihiro , Nagaro Takumi , Hamakawa Hiroyuki
Published: April 2010

Abstract –  Preoperative massive subcutaneous emphysema before intubation is extremely rare. However, this complication may be potentially lethal, depend on the condition of air spreading. Subcutaneous emphysema which occurs intra‐ or postoperative period is sometimes iatrogenic because the air is introduced into the tissue space through the hole injured by the operation. But the emphysema in this case occurred preoperatively by the pressure of the bag valve mask, because the patient had an intra‐oral wound, which reaches the submental space. In this report, we describe an extremely rare case of preoperative massive emphysema of the patient with the mandibular fracture.
Barrett’s esophagus and Cornelia de Lange Syndrome
Authors: Macchini Francesco , Fava Giorgio , Selicorni Angelo , Torricelli Maurizio , Leva Ernesto , Valadè Alberto
Published: April 2010

Aim:  To review the records of Cornelia de Lange Syndrome (CDLS) children, affected by Gastro‐oesophageal reflux disease (GERD), to detect the presence of Barrett’s Esophagus (BE).

Methods:  A total of 62 CDLS patients were investigated for GERD (1 month–35 years). In all of them a pH‐metry, an upper endoscopy with multiple biopsies and a complete radiologic digestive evaluation were carried out. BE was diagnosed in case of replacement of oesophageal mucosa by specialized intestinal‐type columnar mucosa. Anti‐reflux surgery was considered in case of persistence of BE after medical therapy. Follow‐up (mean 3.5 years) consisted in endoscopy every 6 months .

Results:  Gastro‐oesophageal reflux disease was found in 50 CDLS patients (80%) and BE in six of them (12% of the GERD group, 9.6% of the entire population, mean age 17 years, range 6–32 years). A short segment BE was observed in three patients, a long one in two patients and an infiltrating adenocarcinoma of the lower oesophagus in one patient.

Conclusions:  A higher frequency of BE in CDLS patients than in a normal population is found. A delayed diagnosis because of atypical GERD symptoms and an altered intestinal motility as a result of neurological impairment can be recognized as the main cause.
Guided Surgery and Presurgical Prosthesis: Preliminary Results of 33 Fully Edentulous Maxillae Treated in Accordance with the NobelGuide® Protocol
Authors: Gillot Luc , Noharet Renaud , Cannas Bernard
Published: April 2010

Objective: The aim of this study was to present the preliminary results of 33 edentulous maxillary patients treated using the Nobelguide® (Nobel Biocare AB, Göteborg, Sweden) technique.

Materials and Methods: Thirty‐three patients were treated according to the conventional protocol of the Nobelguide® technique in two clinical centers. This group of patients received 211 implants. Monitoring was carried out for over 12–51 months, depending on the patient. The Nobelguide® protocol was used for all patients.

Results: Of the 211 implants loaded, four were lost (1.9%). The implant survival rate was therefore 98.1%. The prosthetic survival rate was 100%. There were some per‐operative complications (four) and some postoperative complications (10 fractures of resin).

Conclusion: These preliminary results seemed rather promising. These were the first cases of experienced surgeons who needed to learn a new implant placement protocol. It was clear that analysis and understanding of the system were essential in order to obtain such a success. Only one implant was replaced without there being any impact on the prosthesis survival rate which is 100%.
The Segmental Down Fracture for Vertical Bone Augmentation: Case Report
Authors: Langer Burton
Published: April 2010

The aim of this singular case report is to describe correction of a severe vertical bone and soft tissue deficiency in the maxillary esthetic zone. The defect was corrected by using a single stage segmental down fracture technique. Treatment results were followed for 9 years, revealing stable bone, soft tissue, and bone levels adjacent to the dental implants.
Applying negative pressure therapy to deep pressure ulcers covered by soft necrotic tissue
Authors: Nakayama Mitsuyuki
Published: April 2010

Negative pressure therapy was applied to 39 deep pressure ulcers covered by soft necrotic tissue. All of the wounds were so deep that there were bones or ligaments just beneath the soft necrotic tissue. They had already received several types of conservative therapy including a necrotomy for periods ranging from 1 to 72 months. The wounds were minimally debrided and put in an adequately wet environment with negative pressure. This environment was established by the application of a suction‐dressing. All of these wounds showed clear wound beds within only 1 month. All of the wounds were successfully cured, either with or without a musculocutaneous flap. Negative pressure wound therapy is thus considered to be one of the choices for the management of non healing deep pressure ulcers covered by soft necrotic tissue.
Stenosing cancer of the ascending colon as late onset metastasis of a stage 1b gallbladder carcinoma
Authors: Bexten Tobias , Dietl Florian
Published: April 2010

Acute clinical presentation of distant metastasis from gallbladder carcinoma (GC) is rare. An English language Medline search produced no reported cases of metastasis of GC to the colon. We report a case of a 68‐year‐old man who developed colon metastasis 2 years after incidentally diagnosed stage 1b GC.
Mesh fixation in laparoscopic totally extraperitoneal inguinal hernioplasty by percutaneous subcutaneous suture technique
Authors: Tang Chun‐Kit , Wong Kenny Che‐Yung
Published: April 2010

Aim:  The method of mesh fixation remains an issue of argument in laparoscopic totally extraperitoneal inguinal hernia repair. Laparoscopic staplers, bioactive tissue glues and tacks had been used by various institutions for the same purpose. In the present article, we describe the percutaneous subcutaneous suture technique, which is an inexpensive method of mesh fixation in laparoscopic inguinal hernia repair.

Methods:  We carried out a retrospective case series review of cases with laparoscopic totally extraperitoneal inguinal hernia repair carried out in Pok Oi Hospital, Hong Kong from 19 November 2008 to 4 June 2009. Mesh fixation by percutaneous subcutaneous suture technique was carried out for patients with large hernial defects (≥ 4 cm), bilateral or recurrent hernias.

Results:  One out of 31 hernioplasties (3.2%) carried out with mesh fixation was complicated by recurrence up to 3 months of median follow up.

Conclusion:  We describe our alternative method of mesh fixation by percutaneous subcutaneous suture technique in laparoscopic totally extraperitoneal inguinal hernia repair. However, further clinical studies are required to elaborate the benefits and long‐term results of this method.