bluuebunny/crossref_metadata_2025 huggingface dataset:
ProC® Global Assay in the Evaluation of Women with History of Severe Preeclampsia or HELLP Syndrome
Authors: Heilmann Lothar , Tempelhoff Georg-Friedrich v. , Pollow Kuhnhart
Published: June 2007

Preeclampsia/HELLP syndrome has been associated with a high incidence of defects in the protein C pathway and increased anticardiolipin-antibodies/lupus anticoagulants. It is also apparent that thrombophilia is responsible for other pregnancy complications, such as recurrent spontaneous abortion, fetal growth restriction, intrauterine fetal death, and abruptio placentae. ProC® Global is a new global clotting assay designed to evaluate the abnormalities in the protein C anticoagulant pathway. It is based on the ability of endogenous activated protein C, generated by activation of protein C by Protac®, to prolong an activated partial thromboplastin time. A total of 61 patients with a history of severe preeclampsia or HELLP syndrome and 61 normal pregnant women (controls) were evaluated, 15 of whom had factor V Leiden mutation, 12 had protein C/S deficiency, 30 had a repeated lupus anticoagulants, and 27 increased anticardiolipin antibodies (ACA). All carriers of factor V Leiden mutation (N= 15) as well as all the patients with low activated protein C (APC) resistance ratio (N= 15) had a ProC® Global normalized ratio (NR) less than 0.80 (sensitivity 100%). Twenty-four patients positive for the lupus anticoagulants (LA) and 19 patients positive for ACA (> 5.0 IgG U/mL) had a ProC® Global NR less than 0.8, while six and eight, respectively, had a ProC® Global NR greater than 0.8 (sensitivity, 70%-80%). The detection of a reduced protein C/protein S activity (<70%) was low (sensitivity, 33%-44%). In 25 cases with pathologic ProC® Global results, a thrombophilic defect (protein S/LA/ACA without APC resistance) was diagnosed in 18 women; but in 7 cases, no known thrombophilic defect was present. ProC® Global is a new screening test to identify patients with defects of the protein C system and an activated clotting system in preeclampsia but cannot correctly cover each thrombophilic component.
On the Prophylactic and Therapeutic Use of Danaparoid Sodium (Orgaran®) in Patients With Heparin-Induced Thrombocytopenia
Authors: Schenk Joachim F. , Pindur Gerhard , Stephan Bernhard , Mürsdorf Stephan , Mertzlufft Friedrich , Kroll Hartmut , Wenzel Ernst , Seyfert Ulrich T.
Published: June 2007

Heparin-induced thrombocytopenia (HIT) is a rare but dangerous complication of heparin prophylaxis or treatment. The present laboratory tests to measure heparin-associated antibodies are not specific. The diagnosis of HIT mainly depends on the decrease in platelet count and on clinical symptoms. To evaluate clinical outcome, bleeding complications and platelet counts were evaluated in 45 patients with HIT type II (HIT II) treated prophylactically (subcutaneous injections) or therapeutically (intravenous infusion) with danaparoid. Group I included 24 patients with HIT II without thromboembolic complications who received danaparoid twice daily subcutaneously (10 IU/kg) for a mean of 16 days. Group II included 21 patients with thromboembolic complications. They were treated with intravenous danaparoid (2.6 IU/kg/h ± 1.1) for a mean of 17 days. During subcutaneous prophylaxis, mean anti-Xa levels of 0.2 U/mL and during intravenous treatment, mean anti-Xa levels of 0.4 U/mL were reached. No deaths, amputations, or serious bleeding complications occurred, and no new thromboses were observed in both patient groups.Treatment with danaparoid led to a fast normalization of the platelet counts. This normalization occurred earlier and the concentration of platelets was higher in patients treated with intravenous doses. Danaparoid with subsequent vitamin K-antagonist treatment effectively prevents thromboembolic complications in patients with HIT.
Proposal of a Flow Chart for Thrombosis-Free Oral Contraceptive Therapy
Authors: Girolami Antonio , Spiezia Luca , Vianello Fabrizio
Published: June 2007

Oral contraceptive therapy (OCT) is associated with a fourfold increase in the risk for venous thromboembolism (VTE). Women with congenital defects have a much higher risk. Because it is impossible to screen all women undergoing OCT, it is advisable to adopt some guidelines in an attempt to define the group of women who may be particularly exposed to the risk of VTE. On the basis of experience and that in the literature, two flow charts are used that are simple and reliable. The two flow charts are based on an accurate family and personal history so that an extensive investigation can be carried out only for women who show a positive family or personal history for idiopathic thrombosis. The definition of idiopathic thrombosis may be difficult, particularly in the case of family members. In case of doubt the thrombotic event should be considered as idiopathic. The two flow charts are not intended to eliminate the OCT-related VTE but represent only an attempt to decrease the prevalence of this complication.
Atherosclerosis and Secondary Deep Vein Thrombosis: A Difficult Correlation
Authors: Bilora F. , Boccioletti V. , Petrobelli F. , Girolami A.
Published: June 2007

The aim of this study was to verify the degree of atherosclerosis in a group of subjects affected by secondary deep vein thrombosis and in a matched control group. Sixty-three patients were studied. Of these, 19 were cases (mean age 62.2 ± 1.2) and 16 were controls (mean age 59.3 ± 2.7). Twenty-eight were excluded because they were affected by hyperhomocysteinemia. The arterial tree was examined by means of echo color doppler, and the intima media thickness and the presence of and degree of plaques bilaterally in the carotid and femoral artery and abdominal aorta were measured with a computerized method. No difference was found in the 2 groups as concerns intima media thickness or plaques in the arterial district explored. Secondary deep vein thrombosis is not a greater risk factor for atherosclerosis.
MicroSed SR-System: New Method for Determination of ESR-Efficacy and Expected Value
Authors: Wiwanitkit Viroj , Chotekiatikul Chutamas , Tanwuttikoolt Rungnapa
Published: June 2007

This study was undertaken to examine the efficacy of a new erythrocyte sedimentation determination (ESR) method, MicroSed SR-system, and study the expected value of the ESR obtained with this method among the healthy Thai population aged 17 to 50 years old. This was a comparative study between standard Westergren and the MicroSed SR-system for ESR on 100 individual subjects. In addition, the expected range was calculated based on ESRs of 50 males and 50 females. From the study, the comparison-ofmethods plot the comparison-of-methods plot MicroSed SR-system (Y) VS Westergren method (X) gave the least square linear regression equation of Y = 0.1.371 X + 0.842 (r = 0.904). The expected range of ESRs for males and females are 0 to 25.6 mm/hr and 0 to 37.5 mm/hr, respectively. Based on study results, the MicroSed SR-system method ESR result correlates well with the standard Westergren method. The derived expected range of ESR was similar to the standard references. The MicroSed SR-system can be used as an alternative method for ESR determination.
Decreased Protein Z Concentrations Complicating the Hypercoagulable State of Behqet's Disease
Authors: Öztüirk M. Akif , Özbalkan Zeynep , Onat A. Mesut , Ertenli Ihsan , Kiraz Sedat , Aytemir Kudret , Ureten Kemal , Abali Gulcan , Çalgüineri Meral , Kirazli Şerafettin , Haznedaroglu Ibrahim C.
Published: June 2007

Protein Z is a vitamin-K-dependent plasma protein that serves as a cofactor for the inhibition of factor Xa. Although the precise physiologic function of protein Z is still unknown, abnornal plasma protein Z concentrations have been associated with a number of thrombotic disease states. There is the evidence of universal activation of the hemostatic system in Behqet's disease (BD), which represents a hypercoagulable/prothrombotic state. Circulating protein Z levels in patients with BD were evaluated. Plasma protein Z concentrations were assayed in 24 patients with BD (male/female: 13/11, mean age 35.4 years) and in 24 healthy controls (males/females: 14/10, mean age 59.8 years). The disease duration was 10.6 years (range, 1-30 years). None of the subjects in either group had received anticoagulants within 3 weeks before the study, and none of them had liver dysfunction. Patients complicated with vascular disease were also excluded from the study. Mean plasma concentrations of protein Z were 141 ng/mL (range, 56.8-257) in healthy controls and 107.8 ng/mL (range, 21.2-202) in BD patients (p<0.05). There was a positive correlation between the disease duration and protein Z levels in the study group (p<0.05, r=0.448). Alterations of protein Z concentrations could complicate the pathobiology of the prothrombotic state of BD. Furthermore, the tendency of increment in the protein Z with the passage of time may reflect the diminution of the disease activity.
The PAI-I gene 4G/5G Polymorphism and Deep Vein Thrombosis in Patients with Inherited Thrombophilia
Authors: Sartori Maria Teresa , Danesin Cristina , Saggiorato Graziella , Tormene Daniela , Simioni Paolo , Spiezia Luca , Patrassi Giovanni Maurizio , Girolami Antonio
Published: June 2007

Genetic and acquired factors may influence phenotypic expression of inherited thrombophilia. Hypofibrinolysis due to excess PAI-I can be found in patients with deep vein thrombosis (DVT) and 4G/5G polymorphism of the PAI-1 gene may modulate the inhibitor's synthesis. In 149 patients with inherited thrombophilia, the possible thrombotic contribution of both 4G/5G polymorphism and PAI-1 plasma levels was evaluated. Sixty-seven patients with idiopathic DVT and 98 normal subjects were also studied. By comparison with controls, a significantly higher prevalence of 4G/4G genotype was seen in idiopathic DVT and in thrombophilia patients, although in this latter group the difference only remained significant in cases symptomatic for thrombosis (p=0.01). The 4G/4G genotype was associated with a greater risk of thrombosis both in symptomatic thrombophilia patients (OR 2.85, 95% CI 1.26-6.46) and in idiopathic DVT patients (OR 3.1, 95% CI 1.26-7.59). The greater frequency of 4G allele in symptomatic thrombophilia patients with respect to controls was statistically significant (p=0.04). Compared to healthy subjects, PAI-i:Ag levels were higher in symptomatic thrombophilia patients and related to the 4G/5G polymorphism, with significantly higher values in the 4G/4G carriers. In conclusion, PAI-1 4G/5G polymorphism may influence PAI-i expression and thrombotic risk in patients with inherited thrombophilia.
A New Mutation (Arg251 Trp) in the Ca2+ Binding Site of Factor X Protease Domain Appears to be Responsible for the Defect in the Extrinsic Pathway Activation of Factor X Padua
Authors: Girolami Antonio , Vianello Fabrizio , Cabrio Laura , Lombardi Anna Maria
Published: June 2007

Factor X Padua, first described a few years ago, is characterized by a defect only in the extrinsic system. In this present paper, the molecular basis for this peculiar defect is investigated. Polymerase chain reaction amplification and direct sequencing of the entire FX coding sequence and of exon-intron junctions detected in the proposita a C-to-T translocation in exon 8 of nucleotide 875 at the homozygous level. This resulted in the substitution of tryptophan for arginine 251. A niece of the proposita was shown to be heterozygous for the abnormality. Molecular modeling suggested that the mutation does not alter significantly folding and stability of the protein but may be involved in the Ca2+ binding site.
Activated Partial Thromboplastin Time Abnormality in Patients with Cholangiocarcinoma
Authors: Wiwanitkit Viroj
Published: June 2007

Cholangiocarcinoma can be detected worldwide, but is most common in tropical areas where crowded living conditions and poor sanitation exist. This infection can demonstrate a wide spectrum of clinical presentations from no complaints to arrest. Similar to the other liver diseases, the activated partial thromboplastin time abnormality can be seen in the patients with cholangiocarcinoma. The activated partial thromboplastin times among 33 Thai hospitalized patients with cholangiocarcinoma are studied. The correlation between the activated partial thromboplastin time and the other characteristics of the patients is studied. Most characteristics of the patients show no significant correlation with activated partial thromboplastin time (p > 0.05). The only two parameters that showed significant correlation are alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p < 0.05). Because the activated partial thromboplastin times shows significant relation to AST and ALT but not to serum bilirubin and alkaline phosphatase, this might mention that the prolonged activated partial thromboplastin time seems to relate with the process of hepatic parenchyma damage than the biliary tract obstruction. Hence, as a hypothesis, the prolonged activated partial thromboplastin time might be a useful indication for excessive parenchymal involvement in cholangiocarcinoma. However, because the total number of cases in this study is rather small, a larger study to answer this question is necessary. In addition, the more systematic evaluations are required to answer the raised hypothesis.
Thrombotic Complications in Three Hemodialysis Patients With Heparin-Induced Thrombocytopenia Type I
Authors: Suzuki Shunji , Sakamoto Susumu , Matsuo Miyako , Shimano Chikako , Kuroda Tatsumi , Matsuo Takefumi
Published: June 2007

Although unfractionated heparin is the most commonly used anticoagulant for hemodialysis and has been associated with bleeding episodes, a more devastating complication that can occur is heparin-induced thrombocytopenia (HIT). It is believed that HIT type II is much more dangerous than type I, because HIT type II is associated with thromboembolic complications whereas there are no such complications in HIT type I. However, increased clot formation in the extracorporeal circuit during hemodialysis with unfractionated heparin is sometimes experienced by not only patients with HIT type II but also those with HIT type I. Three patients with HIT type I are presented who suffered from clot formation during hemodialysis, and in whom 81 mg of aspirin and/or cessation of heparin was prescribed. All three patients had received recombinant human erythropoietin (rHuEpo). Both heparin and rHuEpo induce enhanced platelet aggregation; therefore, it is possible that even HIT type I patients may suffer clot formation in the extracorporeal circuit due to platelet activation via the synergistic effects of unfractionated heparin and rHuEpo.
Frequency of Abnormal Biphasic aPTT Clot Waveforms in Patients with Underlying Disorders Associated with Disseminated Intravascular Coagulation
Authors: Matsumoto Takeshi , Wada Hideo , Nishioka Yukiko , Nishio Midori , Abe Yasunori , Nishioka Junji , Kamikura Yuko , Sase Tomohiro , Kaneko Toshihiro , Houdijk Wim P. M. , Nobori Tsutomu , Shiku Hiroshi
Published: June 2007

Abnormal biphasic waveform (BPW) patterns were previously reported when the activated partial thromboplastin time (aPTT) was performed in plasma from patients with disseminated intravascular coagulation (DIC). In this study, the prevalence of the BPW was examined in a cohort of 508 hospitalized patients with elevated fibrinogen degradation products (FDP) levels (>10 μg/mL). The presence of a BPW was automatically flagged by the MDA® analyzer when the slope of the precoagulation phase in the waveform exceeded a threshold value of -0.25%T/sec. In our cohort, 76 patients (15%) were diagnosed with overt DIC according to the criteria recently proposed by the International Society of Thrombosis and Haemostasis (ISTH), whereas 96 patients (18.9%) were diagnosed with DIC following the criteria of the Japanese Ministry of Health and Welfare (JMHW). The JMHW and ISTH criteria agreed in 93% of cases (kappa coefficient 0.76). The concordance between both scoring systems was high in patients with infection but low in solid cancer. The BPW appeared in 65 patients (12.8%), with the highest prevalence (23.6%) in patients with infection. The BPW was more prevalent in the subgroup of patients with DIC: 59.2% and 47.9% for DIC diagnosed by ISTH and JMWH scores, respectively. The prevalence of the BPW was particularly high in patients with DIC and infection: 86.4% and 75.0% for DIC diagnosed by ISTH and JMWH scores, respectively. For the total cohort, the presence of the BPW was significantly associated with DIC. Odds ratios were 29.9 and 19.0 for ISTH and JMWH scores, respectively (p<0.0001). The BPW showed a moderate sensitivity (59.2% for the ISTH score; 47.9% for the JMWH score), but a high specificity (95.4% for both scores). Waveform analysis of the aPTT potentially provides a practical tool in risk assessment of critical care patients, in whom development of DIC is known to worsen the prognosis.
Monitoring of Plasmin and Plasminogen Activator Activity in Blood of Patients under Fibrinolytic Treatment by Reteplase
Authors: Stief T. W. , Richter A. , Bünder R. , Maisch B. , Renz H.
Published: June 2007

There are no reliable data on plasmin or plasminogen activator (PA) activities in blood of patients receiving fibrinolytic treatment. This is due to continuing in vitro action of PA after blood withdrawal. These artefactual changes of PA or plasmin activities have been prevented by arginine stabilization of blood samples of myocardial infarction patients treated with plasminogen activators. Twelve patients with myocardial infarction were treated with reteplase 2 × 10,000,000 units in bolus application; one patient was treated with 100 mg t-PA in continuous infusion. Blood was immediately stabilized with EDTA and arginine. The plasma was analyzed with newly developed assays for plasmin and PA. Maximal plasmin activities in blood were obtained at 40 to 60 minutes reteplase treatment time (0.1-0.6 U/mL = approximately 0.05-0.3 μmol/L plasmin). The 50% clearance rate for plasmatic Pli was greater than 30 minutes. The plasmatic reteplase concentration peaked at approximately 2000 U/mL after the first bolus infusion and at approximately 1500-3500 U/mL after the second bolus infusion. Reteplase was cleared to 50% within less than 30 minutes, also with great inter-individual variation. Arginine stabilization of blood allows reliable determinations of activities of plasmin and PA in blood of patients under fibrinolytic treatment: substantial plasmin activities occur in patients treated by reteplase. Therapeutic thrombolysis might be improved, imitating the physiologic cellular thrombolysis; i.e., polymorphonuclear phagocytes (PMN) that can be activated by singlet oxygen (1O2). PMN might be superior to PA in selective lysis of pathologic thrombi.
Pharmacogenomic Effect of Cytochrome P450 2C9 Polymorphisms in Different Populations
Authors: Wiwanitkit Viroj
Published: June 2007

Presently, warfarin sodium or coumadin is the therapeutic drug of choice for maintenance anticoagualtion therapy. One of several factors underlying the variability in warfarin dose response in the patients receiving this oral anticoagulant is a genetic predisposition, especially the CYP2C9 polymorphisms. The pharmacogenomic effect of CYP2C9 polymorphisms is assessed in different racial populations. A retrospective review was performed with an electronic search engine on this topic to get the data for further meta-analysis. A significant correlation between population ethnicity and gene frequencies was detected in this study. A significant low frequency of CYP2C9 variants among the Asian can be demonstrated. The clinical correlation between CYP2C9 polymorphism and warfarin metabolism was also assessed. Four available case-control reports were selected for this meta-analysis. CYP2C9 variants are strongly associated with low-dose warfarin requirement. In summary, the CYP2C9 variants strongly affect the warfarin dose requirement. This phenomenon is ethnically dependent. Due to the high variant frequency among whites in the West, the investigation for CYP2C9 might be useful for this population, not the Asians, whose variant frequency is very low.
Successful Treatment of Life-threatening Bleeding after Cesarean Section with Recombinant Activated Factor VII
Authors: Heilmann L. , Wild C. , Hojnacki B. , Pollow K.
Published: June 2007

Hemorrhagic shock developed in a 29-year-old nullipara without coagulopathy after emergency caesarean section. Treatment with uterotonic drugs, prostaglandins, and conservative procedures with transfusion of packed red cells and fresh-frozen plasma failed to control the diffuse vaginal and uterine bleeding. Finally an intravenous bolus injection of 90 μg/kg recombinant activated factor VII (rFVIIa, NovoSeven®, Novo Nordisk A/S, Bagsvaerd, Denmark), was given and showed success within 20 minutes after administration, without any side effects.
Diagnostic and Therapeutic Difficulties in Type 2A von Willebrand Disease: Resolution
Authors: Thomas M. R. , Cutler J. A. , Savidge G. F.
Published: June 2007

A patient with type 2A von Willebrand disease and a long history of gastrointestinal (GI) bleeding is presented, in whom no abnormality was found on sequencing the von Willebrand factor gene at the DNA level. Subsequent RNA analysis revealed him to be heterozygous for a T-C substitution at nucleotide 4883, a mutation previously described and associated with type 2A von Willebrand disease. This illustrates the value of a dual DNA/RNA approach to genetic investigations of highly polymorphic genes. GI bleeding from angiodysplasia is a feature of von Willebrand disease, particularly type 2A. Proactive management with definitive diagnosis of angiodysplasia and ablative treatment where feasible is recommended to stop bleeding symptoms and minimize exposure to blood products.
A New Clinical Model in Pulmonary Embolism and Its Correlation With V/P Scan Results
Authors: Hatipoglu Osman N. , Hanci Emel , Tabakoglu Erhan , Altiay Gundeniz , Cermik Tevfik Fikret , Caglar Tuncay
Published: June 2007

The study was prospectively designed to assess the correlation between a new clinical model empirically developed for acute pulmonary embolism (PE) and ventilation/perfusion (V/P) scan results. One hundred sixty consecutive patients with suspected acute PE underwent clinical evaluation before V/P scintigraphy. The clinical probability of PE was categorized according to a structured clinical model empirically developed as low, intermediate, or high, and the results were compared with those of V/P scintigraphy. Forty, 61, and 59 patients were classified as low, intermediate, and high clinical probability, respectively. Seventy-five percent (30/40) of the patients with low clinical probability were also of low scintigraphic probability or had a normal result (rs: 0.39, p=0.000); 28% (17/61) of the patients with intermediate clinical probability demonstrated intermediate scintigraphic probability (rs: 0.20, p=0.012); and 68% (40/59) of the patients with high clinical probability were also of high scintigraphic probability (rs: 0.43, p=0.000). Overall, the correlation of two scoring systems was statistically significant (rs: 0.39, p=0.000). Unilateral leg swelling (p=0.027), syncope or near syncope (p=0.002), amputation of a hilar artery (p=0.007), and electrocardiographic signs of right ventricular overload (p=0.000) prevailed in patients with high scintigraphic probability. “Syncope-near syncope or hemodynamic collapse” PLUS “electrocardiographic signs of right ventricular overload or hypoxemia” combination had the most significant correlation with a high scintigraphic probability (rs: 0.31; p=0.000). In conclusion, the new clinical model empirically developed was significantly successful to provide comparable results with V/P scan. This consistency was particularly prominent in patients with low or high clinical probability for PE.
Characterization of Recessive Severe Type 1 and 3 von Willebrand Disease (VWD), Asymptomatic Heterozygous Carriers Versus Bloodgroup O-Related von Willebrand Factor Deficiency, and Dominant Type 1 VWD
Authors: Michiels Jan Jacques , Berneman Zwi , Gadisseur Alain , van der Planken Marc , Schroyens Wilfried , van de Velde Ann , van Vliet Huub
Published: June 2007

Recessive type 3 von Willebrand disease (VWD) is caused by homozygosity or double heterozygosity for two non-sense mutations (null alleles). Type 3 VWD is easy to diagnose by the combination of a strongly prolonged bleeding time (BT), absence of ristocetine-induced platelet aggregation (RIPA), absence of von Willebrand factor (VWF) protein, and prolonged activated partial thromboplastin time (aPTT) due to factor VIII:coagulant (FVIII:C) deficiency. VWD type 3 is associated with a pronounced tendency to mucocutaneous and musculoskeletal bleedings since early childhood. Carriers of one null allele are usually asymptomatic at VWF levels of 50% of normal. Recessive severe type 1 VWD is caused by homozygosity or double heterozygosity for a missense mutation. Recessive type 1 VWD differs from type 3 VWD by the presence of detectable von Willebrand factor: antigen VWF:Ag and FVIII:C levels between 0.09 and 0.40 U/mL. Patients with recessive type 1 VWD show an abnormal VWF multimeric pattern in plasma and/or platelets consistent with severe type 2 VWD. Carriers of a missense mutation may have mild bleeding and mild VWF deficiency and can be diagnosed by a double VWF peak on cross immunoelectrophoresis (CIE). There will be cases of mild and moderate recessive type 1 VWD due to double heterozygosity of two missense mutations, or with the combination of one missense mutation with a non-sense or bloodgroup O. Mild deficiency of VWF in the range of 0.20 to 0.60 U/mL, with normal ratios of von Willebrand factor: ristocetine cofactor/antigen VWF:RCo/Ag and VWF:collagen binding/antigen (VWF:CB/Ag), normal VWF multimers, and a completely normal response to desmopressin acetate (DDAVP) with VWF level rising from below to above 1.00 U/mL are very likely cases of so-called pseudo-VWF defienciecy in individuals with normal VWF protein and gene. Autosomal dominant type 1 VWD variants are in fact type 2 variants caused by a heterozygous missense mutation in the VWF gene that produces a mutant VWF protein that has a dominant effect on normal VWF protein produced by the normal VWF allele with regard to the synthesis, processing, storage, secretion, and/or proteolysis of VWF in endothelial cells. A DDAVP challenge test clearly differentiates between dominant type 1 VWD phenotype and dominant type 2 M VWD.
Unfractionated Heparin Reduces the Anti-Platelet Effects of Abciximab but not Eptifibatide During PCI
Authors: Deliargyris Efthymios N. , Upadhya Bharathi , Melton Laura G. , Thompson Cheryl , Fisher Melrose , Gabriel Don A. , Dehmer Gregory J. , Sane David C.
Published: June 2007

In 29 patients undergoing percutaneous coronary intervention (PCI), we obtained blood samples at baseline, 10 minutes after standard weight-based abciximab (n=15) or double-bolus eptifibatide (n=14) and 5 minutes after unfractionated heparin (UFH; 70 U/kg bolus). The median percent inhibition was significantly higher in the eptifibatide group compared with the abciximab group both before (96.5% [94-100] vs. 85% [77-89.5] [adenosine diphosphate; ADP]; 89.5% [84-95] vs. 59% [37.5-76.5] [thrombin receptor agonist peptide; TRAP], p<0.001 for both) and after UFH (95% [93-100] vs. 79% [68.8-87.5] [ADP]; 82% [77-93] vs. 51% [34.5-71.3] [TRAP], p<0.001 for both). Addition of UFH significantly reduced platelet inhibition in the abciximab group (85% [77-89.5] vs. 79% [68.8-87.5] [ADP]; 59% [37.5-76.5] vs. 51% [34.5-71.3] [TRAP], p<0.05 for both) but not in the eptifibatide group (96.5% [94-100] vs. 95% [93-100] [ADP]; 89.5% [84-95] vs. 82% [77-93] [TRAP], p=ns for both). Eptifibatide achieved superior platelet inhibition before but especially after UFH compared with abciximab.
Estimated Annual Costs of Prophylaxis and Treatment of Venous Thromboembolic Events Associated With Major Orthopedic Surgery in France
Authors: Tilleul Patrick , LaFuma Antoine , Colin Xavier , Ozier Yves
Published: June 2007

Venous Thromboembolism (VTE) remains a major complication following orthopedic surgery despite heparin prophylaxis. Clinical consequences associated with this complication are deep vein thrombosis (DVT), pulmonary embolism, and long-term consequences of DVT, especially Postthrombotic syndrome (PTS). The purpose of the present study was to estimate the annual direct costs of VTE following major orthopedic surgery of the lower limb in France. This cost of illness study was performed by using available information from health system databases (1999) and literature and specific surveys (2002). Direct costs were calculated by using estimates of the number of patients with major orthopedic surgery in France during one year. Patients presenting with VTE were identified from the national disease-related group inpatient database. Additional resource consumption was identified by comparison with disease-related groups without the VTE complications. Ambulatory care costs after hospitalization, for recurrences and PTS, were estimated from specific surveys of general practitioners and venous disease specialists. Total annual costs of VTE associated with major orthopedic surgery for the French Sickness Fund were estimated to be approximately 60 million euros over 1 year with 28 million euros for inpatient care and 30 million euros for recurrences and PTS.
Amaurosis Fugax Caused by Heritable Thrombophilia-Hypofibrinolysis in Cases Without Carotid Atherosclerosis
Authors: Glueck Charles J. , Golnik Karl , Ping Wang
Published: June 2007

Nineteen patients (age 60 ± 14) with amaurosis fugax associated with heritable thrombophilia-hypofibrinolysis without ipsilateral atherosclerotic carotid plaque or other causes of amaurosis fugax were studied. Our hypothesis was that case-specific thromboprophylaxis would prevent subsequent amaurosis fugax episodes. Prospective treatment data were available for 13 cases. Thrombophilic disorders included high Factors VIII and XI, G20210A prothrombin heterozygosity, low proteins C and S, MTHFR mutations, and the PL A1/A2 mutation. Hypofibrinolytic disorders included plasminogen activator inhibitor-1 4G4G, and high lipoprotein (a). Treatments included Coumadin; Lovenox, folic acid-vitamin B6-vitamin B12, discontinuation of estrogens-selective estrogen receptor modulators, Glucophage, and aspirin, as appropriate. Usually within 1 month on therapy, patients became asymptomatic and have remained asymptomatic for ≥ 1 year on therapy, without adverse treatment side effects. When amaurosis fugax occurs without carotid artery atherosclerosis or other known causes, thrombophilia or hypofibrinolysis, or both are nearly universal, safely treatable, reversible pathoetiologies.
Heparin-induced Thrombocytopenia in a Uremic Patient Requiring Hemodialysis
Authors: Matsuo Takefumi , Kusano Hitoshi , Wanaka Keiko , Ishihara Misa , Oyama Atsushi
Published: June 2007

Heparin-induced thrombocytopenia (HIT) is an uncommon but potentially serious complication of hemodialysis, and subsequent reexposure to heparin after the disappearance of antiheparin-PF4 complex antibodies (HIT antibody) has been controversial. We report a 60-year-old woman who was sensitized to unfractionated heparin (heparin) as anticoagulant during hemodialysis (HD) and heparin flush on a nonsession day. The patient suddenly developed acute systemic reactions with acute pulmonary embolism a few minutes after manipulation with heparin flush on day 9, a nonsession day. Although there was no evidence of pulmonary embolism on a pulmonary scintigram on the next day, the fifth HD session was discontinued owing to recurrence of acute systemic reactions and massive clots in the dialyzer 30 min into the session. After confirmation of the presence of HIT antibody and maturation of vascular access fistula, a sixth HD session was carried out with argatroban, a synthetic direct thrombin inhibitor, with a bolus of 10 mg and continuous infusion of 0.5 mg/kg/hr as an alternative to heparin. Optimal dose adjustment of argatroban through activated partial thromboplastin time (APTT) monitoring led to a bolus of 5 mg and continuous infusion of 0.15 mg/kg/hr. The patient's HD treatment at the same doses 3 times a week followed an uneventful course over 6 months. HIT antibody was seronegative about 40 days after the cessation of heparin treatment. Reexposure to heparin was attempted with the monitoring of HIT antibody and platelet counts before and after the sessions on day 210. The titers of HIT antibody compared with before the level of reexposure showed a transient insignificantly small peak, and dialysis with heparin has been maintained to date with no recurrence of HIT. The measurement of HIT antibody titer could be useful in assessing not only the effect of argatroban to replace heparin but also in predicting the recurrence of HIT due to reexposure.
An Exact Solution for the Natural Frequencies of Flexible Beams Undergoing Overall Motions
Authors: Nayfeh Ali H , Emam S.A. , Preidikman Sergio , Mook D.T.
Published: June 2007

We investigate the free vibrations of a flexible beam undergoing an overall two-dimensional motion. The beam is modeled using the Euler-Bernoulli beam theory. An exact solution for the natural frequencies and corresponding mode shapes of the beam is obtained. The model can be extended to beams undergoing three-dimensional motions.
Constrained Kalman Filter for Nonlinear Structural Identification
Authors: Yang Yongmin , Ma Fai
Published: June 2007

It is well known that hysteresis is a principal source of internal energy dissipation in structural systems. One of the widely accepted hysteretic models for structures is a differential model, called the modified Bouc-Wen model. In this paper, a constrained Kalman filter with a global weighted iteration strategy has been used to estimate the parameters in the modified Bouc-Wen model. An actual seismic signal was used to excite a nonlinear structural system described by the modified Bouc-Wen model that has both degradation and pinching characteristics. The convergence results show that, for both clean and noise-corrupted data, this algorithm is effective in estimating all the 11 parameters with satisfactory precision and fast convergence. As this algorithm has modest computing requirements, it should be acceptable as a basic tool for estimating hysteretic parameters in engineering design.
The Role of Disease Management in Pay-for-Performance Programs for Improving the Care of Chronically Ill Patients
Authors: Beich Jeff , Scanlon Dennis P. , Ulbrecht Jan , Ford Eric W. , Ibrahim Ibrahim A.
Published: June 2007

To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health’s eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association betweenRFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.
thinking narrative (on the Vancouver Island ferry)
Authors: Prendergast Monica
Published: June 2007

This is a hybrid poem, a grafting together of narrative research, qualitative methods, and poetic representation. “The offspring of genetically dissimilar parents” (www.answers.com), the poem attempts to exist in the rarely seen intergeneric worlds of poetry and inquiry. It is inspired in part by the poetic inquiry found in Qualitative Inquiry by poets and researchers such as Corinne Glesne, Ivan Brady, Donald Blumenfeld-Jones, Miles Richardson, Mary Weems, and others. This poem is dedicated to Dr. Antoinette Oberg, Department of Curriculum & Instruction, Faculty of Education, University of Victoria, a wondrous mentor who retired in December 2005.
Death by Document: Tracing the Agency of a Text
Authors: Brummans Boris H. J. M.
Published: June 2007

This nonanthropological poetry was brought to life by tracing the agency of my father's euthanasia declaration through a reconstruction of its confessions. I follow the poetry with reflections on the role of this textual agent in the unfolding of my father's last days.
Audiologic Management of Older Adults With Hearing Loss and Compromised Cognitive/Psychoacoustic Auditory Processing Capabilities
Authors: Kricos Patricia B.
Published: June 2007

The number and proportion of older adults in the United States population is increasing, and more clinical audiologists will be called upon to deliver hearing care to the approximately 35% to 50% of them who experience hearing difficulties. In recent years, the characteristics and sources of receptive communication difficulties in older individuals have been investigated by hearing scientists, cognitive psychologists, and audiologists. It is becoming increasingly apparent that cognitive compromises and psychoacoustic auditory processing disorders associated with aging may contribute to communication difficulties in this population. This paper presents an overview of best practices, based on our current knowledge base, for clinical management of older individuals with limitations in cognitive or psychoacoustic auditory processing capabilities, or both, that accompany aging.
A Peer Mentor Training Program for Aural Rehabilitation
Authors: Bally Scott J. , Bakke Matthew H.
Published: June 2007

This article describes a new training program at Gallaudet University that aims to prepare peer mentors to work under the supervision of hearing-health professionals in the area of aural rehabilitation (AR). The paucity of AR programs for consumers with hearing loss in the United States has been documented. The peer mentor training program is an attempt to harness the energies, skills, and knowledge of people with hearing loss; to expand them through a program of academic and experiential learning; and to put them to work in audiologic practices and other hearing-health care settings in order to improve the quality and quantity of AR available to consumers. A peer mentor training curriculum is described, and the current status of the educational program is reported. Initial anecdotal evidence suggests that the program has the potential to contribute to the development of a more comprehensive model of AR service delivery.
What is Private-Duty Home Care? An Industry Overview
Authors: McMackin Sheila
Published: June 2007

This article examines the private-duty model of care. It explains the types of home care and reviews payment sources, and how long-term-care insurance covers private-pay home care. The article covers the various models within private-pay home care, examines how the care is directed and managed, and gives information about who provides the care within the various models. Finally, the article reviews the troubling issues within the private-duty industry and reflects on the pitfalls of home care.
The Accidental Employer: Obligations of Trusts and/or Trustees When Using Placement Agencies to Meet Trust Obligations
Authors: Milligan Jennifer S.
Published: June 2007

This article addresses the obligations and the liabilities to consumers hiring care providers through placement agencies or registries. The article discusses briefly the primary issues that potentially arise as a result of this type of care-giver provision. Facts and actual examples are presented relative to these obligations and relationships.
A friendship intervention for children with Attention-Deficit/Hyperactivity Disorder: Preliminary findings
Authors: Hoza B. , Mrug S. , Pelham W. E. , Greiner A. R. , Gnagy E. M.
Published: June 2007

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are known to experience difficulty in peer relationships. Neither standard interventions for ADHD nor peer acceptance-oriented interventions fully remedy this problem.

We propose that interventions targeting ADHD children’s dyadic friendships may be more realistic strategies for improving peer relationships. Hence, a friendship intervention, implemented within the context of an intensive behavioral treatment program with 209 ADHD children, is described. A model is proposed in which the friend’s antisocial behavior relates to parental compliance with the friendship intervention, and both the friend’s antisocial behavior and parental compliance predict friendship quality and treatment response.

Results indicate that children paired with peers lower on antisocial behavior and children whose parents had higher levels of compliance with the friendship intervention achieved higher quality friendships and were rated by teachers as more improved.
Underlying processes in the poor response inhibition of children with Attention-Deficit/Hyperactivity Disorder
Authors: Gomez Rapson
Published: June 2007

This study evaluated the effects of reward, punishment, and reward + punishment on the impulsive responses of ADHD children. The impulsive responses of ADHD and normal control boys (30 per group) were compared during performance of a go/no-go task, administered under reward-only, punishment-only, and reward + punishment conditions.

When differences in aggression, anxiety, and IQ between these groups were controlled for, results indicated that the impulsivity levels of the ADHD group were higher than the control group in all three reinforcement conditions. Also, the ADHD group was more impulsive in the reward + punishment condition, compared to the reward-only and punishment-only conditions, and there was no difference between the reward-only and punishment-only conditions.

The control groups showed no difference across the three reinforcement conditions. These findings raise the possibility that the poor response inhibition of ADHD children may be related to both a generalized inhibitory deficit and a response modulation deficit.
Differences in heterosocial behavior and outcomes of ADHD-symptomatic subtypes in a college sample
Authors: Canu Will H. , Carlson Garyn L.
Published: June 2007

The purpose of this study was to explore heterosocial relational outcomes in a college-aged sample showing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Using questionnaires and a behavioral observation task, dating, sexual, and social outcomes were examined in three groups: 24 non-ADHD controls, 27 ADHD-combined (ADHD/C) Type, and 13 ADHD-Primarily Inattentive (ADHD/IA) Type.

The ADHD/IA group shoed a consistent pattern of passivity and inexperience and was perceived relatively negatively by female confederates, whereas the ADHD/C group reported increased sexual drive and early dating experience. The effects of externalizing comorbidity differed by DSM-IV ADHD subtype.

These findidngs indicate that ADHD-symptomatic adults differ by DSM-IV subtype in the manifestation of heterosocial deficits. Results suggest specific and divergent types of psychosocial intervention with ADHD/C versus ADHD/IA clients
Diagnostic utility of DSM-IV-TR symptoms in the prediction of DSM-IV-TR ADHD subtypes and ODD
Authors: Owens J. , Hoza B.
Published: June 2007

Objective: Examined the diagnostic utility of DSM-IV-TR symptoms in the prediction of DSM-IV-TR ADHD subtypes and ODD to: (a) Assess the relative utility of parent and teacher ratings, and (b) Examine the utility of individual symptoms as inclusion and exclusion criteria.

Method: Parent and teacher versions of the Disruptive Behavior Disorders Rating Scale were completed for 440 children (217 boys; 223 girls) ranging in age from 9 to 13 years and were used to classify children into groups. Individual symptoms were used to compute corrected conditional probability statistics.

Results: Corrected positive predictive power (cPPP) statistics indicated that parent and teacher ratings had similar diagnostic utility in the prediction of the presence of ADHD, Inattentive Type and ADHD, Hyperactive/Impulsive Type, and that their combination did not provide incremental utility over either informant alone. However, cPPP statistics for ADHD, Combined Type, and ODD indicated that teacher ratings, and the use of combined parent and teacher ratings, provided an advantage over parent ratings alone. Results support the use of a multi-method, multi-informant assessment approach.
Reactive vs. proactive antisocial behavior: Differential correlates of child ADHD symptoms?
Authors: Bennett David S. , Pitale Maria , Vora Vaishali , Rheingold Alyssa A.
Published: June 2007

This study examines the relation between proactive and reactive antisocial behavior with Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. Caregivers of children aged 8 to 15 ( n = 84) being evaluated at a child psychiatry outpatient clinic served as participants.

Given the conceptual similarity between reactive antisocial behavior (ASB) and particular ADHD symptoms, we hypothesized that ADHD symptoms would be more closely related to reactive than to proactive ASB. Based on peer deviancy training models of ASB, we also hypothesized that the relation between ADHD symptoms and proactive ASB would increase from middle childhood to adolescence.

Both hypotheses were supported. These findings suggest that reactive ASB is relatively specific to ADHD symptoms, and that intervening before early adolescence may be critical to prevent the onset of comorbid proactive ASB.
Differences between low and high trait impulsivity are not associated with differences in inhibitory motor control
Authors: Lijffijt M. , Bekker E. M. , Quik E. H. , Bakker J. , Kenemans J. L. , Verbaten M. N.
Published: June 2007

Objective: The present study investigates whether there is an association between trait impulsivity in the normal population and inhibitory motor control as assessed by the stop task.

Method: Low- and high-impulsive participants (as assessed by the I7 questionnaire; both groups n = 31) performed the stop task. Differences in performance were analyzed by an independent samples t-test. Furthermore, a short meta-analysis was performed on this study and three previous studies with a similar aim.

Results: The low- and high-impulsive groups did not differ on the speed to stop the response (SSRT). However, the meta-analysis revealed that high-impulsives are marginally slower in stopping than low-impulsives (effect size = -0.26, p = 0.06).

Conclusions: There is only minor evidence that impulsivity in the common population is associated with poor inhibitory motor control.
Diagnostic performance of the CBCL-Attention Problem Scale as a screening measure in a sample of Brazilian children with ADHD
Authors: Lampert T. L. , Polanczyk G. , Tramontina S. , Mardini V. , Rohde L. A.
Published: June 2007

Objective: To evaluate the diagnostic performance of the Attention Problem Scale of the Child Behavior Checklist (CBCL-APS) for the screening of Attention-Deficit/Hyperactivity Disorder (ADHD) in a sample of Brazilian children and adolescents.

Methods: The CBCL-APS was given to 763 children and adolescents. Child psychiatrists using DSM-IV criteria confirmed the clinical diagnoses. Diagnostic performance was evaluated through Receiver-Operating Characteristic (ROC) curves.

Results: Only moderate areas under the curve (AUC) were found for the general sample (AUC = 0.79; 95%CI = 0.76-0.82), and for the subsample of referred patients (AUC = 0.78; 95%CI = 0.74-0.82). The subsample of patients with ADHD of the combined type presented the largest AUC (AUC = 0.85; 95%CI = 0.82-0.88).

Conclusion: Our findings concur with previous studies of different cultures demonstrating adequate diagnostic performance of the CBCL-APS for the screening of ADHD, especially of the combined type.