bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermal Characteristics of Neutralization Therapy and Water Dilution for Strong Acid Ingestion: An In‐vivo Canine Model
Authors: Homan Clark S. , Singer Adam J. , Thomajan Craig , Henry Mark C. , Thode Henry C.
Published: March 2010

Objective: To determine whether in‐vivo neutralization therapy for acid ingestions will superimpose a thermal injury upon tissue already damaged by acid.

Methods: An in‐vivo canine model was used with repeated measures of tissue and luminal temperatures. All dogs were placed under halothane general anesthesia. The stomach was exteriorized and temperature probes were placed in the lumen and mucosa. 25 mL of 0.5 N HC1 (25°C) was placed in the gastric lumen followed 5 minutes later by 75 mL of either 8% NaHCO, neutralization (25°C. n = 10) or water dilution (25°C, n = 10). Temperature measurements were recorded at specified intervals for 5 minutes post HCl acid exposure and for 30 minutes post treatment. Temperature profiles were analyzed by repeated‐measures ANOVA. Post treatment changes were evaluated using signed‐rank tests.

Results: In both treatment groups, treatment resulted in significant decreases in initial mucosa and intraluminal temperatures. Both the mucosa and intraluminal temperatures decreased immediately after treatment with HCO, by an average of 1.6°C (p = 0.05). In the water dilution treatment group, both temperatures decreased by 1.1°C (p = 0.05). Ensuing post‐treatment temperatures increased but did not reach baseline temperatures at any time up to 30 minutes post treatment.

Conclusions: In the in‐vivo setting, there is no evidence of hazardous temperature elevation when a weak alkali or dilution therapy is used to neutralize strong acid‐induced injury. Contraindication of this form of emergency treatment should not be based on the preconceived idea that a resultant exothermic reaction will cause a superimposed thermal injury. Further clinical study is needed to determine the clinical utility of this emergency therapeutic modality.
Serum Progesterone and Endovaginal Sonography by Emergency Physicians in the Evaluation of Ectopic Pregnancy
Authors: Valley Verena T. , Mateer James R. , Aiman E. James , Tkoma Margaret E. , Phelan Mary Beth
Published: March 2010

Objective: To determine a discriminatory level for serum progesterone (SP) in pregnant patients with no definite intrauterine pregnancy (IUP) on endovaginal ultrasonography (US) in the differentiation of ectopic pregnancy from normal IUPs.

Methods: A prospective observational study in a convenience sample of women at risk for ectopic pregnancy was performed at an urban teaching hospital from May 1991 until May 1994. Women aged ≥18 years presenting to the ED with a positive pregnancy test in combination with pelvic or abdominal pain, vaginal bleeding, orthostasis, adnexal mass or tenderness, or any historical risk factor for ectopic pregnancy were eligible. Hypotensive or unstable patients were excluded. Endovaginal US was performed and patients with no definite IUP had a serum 3‐hCG and SP measured.

Results: 314 patients were enrolled, with 14 excluded for lack of follow‐up or incomplete SP data, yielding 300 patients. The initial endovaginal US diagnoses included 169 definite IUP, 31 abnormal IUP, 5 definite ectopic pregnancy, and 95 no definite IUP. 68/95 had SP measured, with values of 22.8 ± 13.4 ng/mL (mean ± SD) for IUP; 4.9 ± 6.5 for spontaneous abortion, and 7.5 ± 7.2 for ectopic pregnancy. The mean values were significantly different (2‐tailed t‐test) for ectopic pregnancy vs IUP and for spontaneous abortion vs IUP. An SP of ≥11 ng/mL (sensitivity 91%; specificity 84%) was post hoc the best cutoff value for suggesting an IUP when the endovaginal US was not definite for IUP.

Conclusions: SP cannot reliably discriminate ectopic pregnancy vs spontaneous abortion in pregnant patients with no definite IUP on endovaginal US; however, a low SP (<11 ng/mL) in this sonographic category suggests an abnormal pregnancy.
Subclassification of Indeterminate Pelvic Ultrasonograms: Stratifying the Risk of Ectopic Pregnancy
Authors: Dart Robert , Howard Kristin
Published: March 2010

Objective: To determine whether the subclassification of indeterminate ultrasound readings can identify patients who are at high, intermediate, or low risk for ectopic pregnancy.

Methods: A retrospective review was made of consecutive ED patients presenting to an urban teaching hospital from August 1991 to December 1994 with abdominal pain and/or vaginal bleeding and a positive β‐hCG. Patients who had transvaginal ultrasonograms obtained during the ED visit that were read as indeterminate (no extrauterine findings of ectopic pregnancy and no intrauterine fetal pole or yolk sac) were eligible. Ultrasonograms were subclassified into 5 groups (empty uterus, nonspecific intrauterine fluid, echo‐genic debris within endometrial cavity, abnormal sac, normal sac) based on predetermined criteria. Patients were excluded if the final diagnosis could not be definitively determined.

Results: 248 patients were identified. 20 patients were excluded because a final diagnosis could not be determined. Patients with an empty uterus [25/94 = 27% (95% CI 18–36%)] had the highest frequency of ectopic pregnancy. Patients with nonspecific intrauterine fluid collections [4/30 = 13% (95% CI 4–31%)] had the next highest frequency of ectopic pregnancy. Patients with intrauterine echogenic debris [2/39 = 5% (95% CI 1–11%)], abnormal sacs [1/36 = 3% (95% CI 1–9%)], or normal‐appearing sacs [0/29 = 0% (95% CI 0 ‐8%)] had low frequencies of ectopic pregnancy.

Conclusion: Subclassification of indeterminate ultrasound readings identifies patients at high, intermediate, or low risk for ectopic pregnancy and should improve the diagnostic accuracy of ultrasonography in patients at risk for ectopic pregnancy. Key words: ectopic pregnancy; tubal pregnancy; intrauterine pregnancy; ultrasound; diagnosis.
Gas Exchange and Lung Mechanics during Percutaneous Transtracheal Ventilation in an Unparalyzed Canine Model
Authors: Tran T. Paul , Rhee Kenneth J. , Schultz Harold D. , Carl Michael L.
Published: March 2010

Objective: To compare the efficacy of percutaneous transtracheal ventilation (PTV) in the unparalyzed state with that in the paralyzed state using a sedated nonobstructed canine model.

Methods: Eight mongrel dogs (16.8–32 kg) were anesthetized, instrumented, and placed in a volume ple‐thysmograph. Anesthesia was achieved with pentobarbital sodium (up to 30 mg/kg). The spontaneous respiratory drive was kept intact. PTV was performed using a 13‐ga transtracheal catheter and compressed air at 45 psi at an I:E ratio of 1:3 (15 breaths/min). Each dog was sequentially ventilated in both the paralyzed and unparalyzed states. The paralyzed/unparalyzed sequence was alternated among the animals to avoid sequence bias. Paralysis was achieved with succinylcholine (0.1 mg/kg bolus and 0.01 mg/kg/min drip). Reversal of paralysis was achieved by discontinuing the succinylcholine infusion. Key variables, including arterial blood gas, tidal volume, and pulmonary mechanics, were measured and compared for the paralyzed and unparalyzed states.

Results: Gas exchanges and lung mechanics were similar between the unparalyzed and paralyzed states. There was no significant difference in mean pH, pCO2, pO2, tidal volume, or peak inspiratory transpulmonary pressure. There was also no significant difference in pulmonary resistance or pulmonary compliance.

Conclusion: In a sedated nonobstructed canine model, PTV is as efficacious in the unparalyzed state as it is in the paralyzed state. The lung mechanics are also similar in the 2 states. These data suggest that it may be unnecessary to induce paralysis when using PTV for emergency ventilation in the heavily sedated state.
Physicians in Rural West Virginia Emergency Departments: Residency Training and Board Certification Status
Authors: McGirr Joseph , Williams Janet M. , Prescott John E.
Published: March 2010

Objective: To describe the training and certification of physicians who staff small EDs in rural West Virginia.

Methods: A survey of rural hospital‐based EDs was performed. The authors chose to study all hospitals in counties with populations of <30,000 and in which the hospital was the only one in the county. Interviews were conducted with the medical director of the ED or the hospital administrator, depending on who was available at the time of interview. Data collected describing the emergency physicians (EPs) employed at each facility included: medical school and residency training, specialty board certification, and certification in a variety of life support courses. General information about each ED, such as census and hospital resources, was also obtained. Interview data were collected on a survey form and subsequently entered into a database. Descriptive analyses were performed.

Results: 20 hospitals met rural criteria for inclusion in the study and all were included. The median number of full‐time physicians per ED was 2 (IQR 2–4). 98 part‐time doctors were identified; 28 (29%) of these were residents in training. 13/40 (33%) of full‐time and 37/98 (38%) of part‐time physicians were foreign medical graduates. Only 3/40 (7.5%) of full‐time EPs completed residency training in emergency medicine (EM). Only 4/98 (4%) of part‐time EPs were residency‐trained in EM. 50% of full‐time EPs were board‐certified in a primary care specialty. Only 5/42 (12%) of full‐time EPs were board‐certified in EM. One third of full‐time and the majority of part‐time EPs were not board‐certified in any specialty whatsoever. The majority of EPs had been certified in Advanced Cardiac Life Support, but fewer had been certified in Advanced Trauma Life Support and/or Pediatric Advanced Life Support/Advanced Pediatric Life Support.

Conclusions: The majority of physicians staffing small rural EDs in West Virginia are neither residency‐trained nor board‐certified in EM. Further studies are warranted to determine the most efficient and effective way to maximize the skills and availability of emergency care providers in rural settings.
The False‐positive Rate of Thoracic Outlet Syndrome Shoulder Maneuvers in Healthy Subjects
Authors: Plewa Michael C. , Delinger Mark
Published: March 2010

Objective: To estimate the incidence of false‐positive findings of thoracic outlet syndrome (TOS) shoulder maneuvers, Adson's test (AT), costoclavicular maneuver (CCM), elevated arm stress test (EAST), and supra‐clavicular pressure (SCP) in healthy subjects.

Methods: A cross‐sectional, observational study was performed in a medical school and affiliated emergency medicine residency program setting. Participants included healthy adult volunteers without symptoms of TOS. The shoulder maneuvers AT, CCM, EAST, and SCP were performed in randomized order for 30 sec, 30 sec, 3 min, and 30 sec, respectively. Pulse quality and the presence and timing of pain or paresthesias were assessed.

Results: 53 subjects were enrolled, including 27 women, aged 29.7 ± 6.4 years (range 21–58 years). AT, CCM, EAST, and SCP resulted in an altered pulse in 11%, 11%, 62%, and 21%; pain in 0%, 0%, 21%, and 2%; and paresthesias in 11%, 15%, 36%, and 15% of cases, respectively. The following outcomes had reasonable false‐positive rates (upper 95% confidence limit): pain with the AT (7%), CCM (7%), SCP (10%), or any 2 TOS shoulder maneuvers (10%); discontinuing the EAST because of symptoms (16%); or any symptom with 3 (13%) or 4 (7%) TOS shoulder maneuvers.

Conclusions: In a study of TOS shoulder maneuvers in healthy subjects, the outcomes of pulse alteration or paresthesias were unreliable in general. However, TOS shoulder maneuvers have reasonably low false‐positive rates when a positive outcome is defined as pain after AT, CCM, or SCP; discontinuation of the EAST secondary to pain; pain in the same arm with ≥2 maneuvers; or any symptom in the same arm with ≥3 maneuvers.
Apoptosis: Only the Good Die Young?
Authors: Cairns Charles B.
Published: March 2010

Despite its deadly nature, apoptosis has rapidly become a fashionable area of research in a number of areas ranging from oncology to immunology to cardilogy. The challenge for EM researchers is to convert recent developments in the field of apoptosis as outlined in the accompanying review into mechanistic insights, diagnostic modalities, and novel therapies.
Derivation of a Clinical Prediction Model for the Emergency Department Diagnosis of Ectopic Pregnancy
Authors: Buckley Robert G. , King Kerry J. , Disney Jeffrey D. , Ambroz Pamela K. , Gorman John D. , Klausen Jack H.
Published: March 2010

Abstract. Objective:To derive a clinical prediction model for estimating the pretest probability of ectopic pregnancy in ED patients with first‐trimester abdominal pain or vaginal bleeding.

Methods:All hemody‐namically stable first‐trimester patients presenting to the ED of a tertiary care military teaching hospital over a 14‐month period with a chief complaint of abdominal pain and/or vaginal bleeding had clinical data coded prior to determining outcome. They were then followed longitudinally until a criterion standard pregnancy outcome was established.

Results:Of the 486 patients enrolled, 280 (58%) had viable intrauterine pregnancies, 167 (34%) had nonviable intrauterine pregnancies, and 39 (8%) had ectopic pregnancies. Using a recursive partitioning model, a high‐risk group was derived (that was separated from intermediate and low‐risk groups), consisting of patients with abdominal peritoneal signs or definite cervical motion tenderness, with a sensitivity of 31% (95% CI: 17–48%), a specificity of 93% (95% CI: 90–95%), a positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.74. A low‐risk group, consisting of patients with either fetal heart tones or tissue at the cervical os, or the absence of pain other than midline menstrual‐like cramping and lacking any pelvic tenderness, was differentiated from an intermediate‐risk group, with a sensitivity of 96% (95% CI: 81–100%), a specificity of 22% (95% CI: 18–26%), a positive likelihood ratio of 1.2, and a negative likelihood ratio of 0.17.

Conclusion:A clinical prediction model for estimating the probability of ectopic pregnancy in ED patients has been derived. It may prove to have practical clinical application for estimating pretest probability of ectopic pregnancy as well as assisting in medical decision making when laboratory and ultrasonographic findings are nondiagnostic. Clinical application should await prospective validation in an independent sample.
Effect of Magnesium Hydroxide on Iron Absorption Following Simulated Mild Iron Overdose in Human Subjects
Authors: Wallace Kevin L. , Curry Steven C. , LoVecchio Frank , Raschke Robert A.
Published: March 2010

Abstract. Objective:To determine the effect of oral magnesium hydroxide [Mg(OH)2] on iron absorption after simulated iron overdose in human subjects.

Methods:A randomized, controlled crossover study was conducted in healthy adult male human volunteers taking no medications. Subjects received an average of 5.0 mg/kg elemental iron orally followed 1 hour later by either oral administration of 4.5 g of Mg(OH)2 per g ingested elemental iron or no treatment. Serial serum specimens were obtained over the 12 hours following iron ingestion and stored at ‐60oC until standard serum iron assay was performed. After a 2‐week washout period, the subjects were enrolled in the alternative trial arm. Individual baseline diurnal variation in serum iron levels was determined over a 12‐hour period on the day prior to each trial. Area under time‐concentration curves (AUCs) were calculated, and the AUC due to experimental iron ingestion (ΔAUC) was determined by subtracting the baseline diurnal AUC from the experimental AUC for each subject.

Results:Thirteen healthy adult male subjects were enrolled. Mean ± SEM for ΔAUC due to experimental iron ingestion followed by treatment with Mg(OH)2, 78 ± 23 |xmol(hr)/L, was significantly less than that followed by no treatment, 144 ± 33 p.mol(hr)/L (p = 0.03 by signed rank test).

Conclusions:Magnesium hydroxide, administered 1 hour post‐iron ingestion at an oral dose of 4.5 g per g elemental iron ingested, significantly reduced iron absorption during a 12‐hour period following simulated mild iron overdose in healthy adult human volunteers.
Intravenous Ketamine for Pediatric Sedation in the Emergency Department: Safety Profile with 156 Cases
Authors: Green Steven M. , Rothrock Steven G. , Harris Troy , Hopkins G. Alan , Garrett Wayne , Sherwin Thomas
Published: March 2010

Abstract. Objectives:To determine the safety of IV ketamine when administered by emergency physicians (EPs) for pediatric procedures, and to contrast the sedation characteristics of the IV and IM routes.

Methods:The study was a retrospective consecutive case series of children aged ≤15 years given IV ketamine in the EDs of a university medical center and an affiliated county hospital over a 9‐year period. A protocol for ketamine was used by treating physicians. Records were reviewed for adverse effects, indication, dosing, adjunctive drugs, inadequate sedation, and time to release. Results were contrasted with previously reported data for the IM route.

Results:During the study period IV ketamine was administered 156 times, primarily for laceration repair and fracture reduction. Transient apnea and respiratory depression occurred in one patient each; both were quickly identified and were without sequelae. Laryngospasm or aspiration was not noted in any children. There were 6 children with emesis and 2 with mild agitation during recovery. The median time from initial dose to ED release was 103 minutes (25th to 75th percentiles 76 to 146 minutes). The IV and IM routes were comparable in terms of adverse effects, inadequate sedation, and time to release.

Conclusion:IV ketamine can be administered safely by EPs to facilitate pediatric procedures when used in a defined protocol. The sedation characteristics of the IV and IM routes appear comparable.
Spinal Cord Emergencies: False Reassurance from Reflexes
Authors: Glick Thomas H. , Workman TOM P. , Gaufberg Slava V.
Published: March 2010

Emergency physicians need to understand the potential for false reassurance in the interpretation of reflex examination data. Neurologic consultation should be sought when classic signs are lacking, but other evidence causes suspicion. Changes in teaching emphasis and acute practice are needed, since the stakes may be high and time is of the essence. We have responded to the insights gained from this study by augmenting in‐service and continuing medical education teaching and by implementing guidelines to assist EPs. We have emphasized the importance of spotlighting high‐risk patients, as exemplified above, and of taking advantage of neurologic or neurosurgical consultation. Where in‐person consultation is less available, the use of guidelines and remote consultation should be able to help direct further examination, diagnostic formulation, and the need for imaging decisions. Given the potential for severe negative outcome if spinal emergencies are not optimally managed, we must give the teaching of these issues high priority.
Screening for Geriatric Problems in the Emergency Department: Reliability and Validity
Authors: McCusker Jane , Bellavance François , Cardin Sylvie , Trepanier Sylvain ,   Identification of Seniors at Risk (ISAR) Steering Committee
Published: March 2010

Abstract. Objective: lb determine the test‐retest reliability and concurrent criterion validity of a self‐report ED screening questionnaire for adverse outcomes in elders.

Methods: A cohort of 1,885 patients aged ≤ 65 years were recruited from the EDs of 4 Montreal hospitals. Patients were excluded if they could not be interviewed because of their clinical status or cognitive impairment and no informant was available. The screening questionnaire, administered in the ED, contained 27 items on social, physical, and mental risk factors, medical history, and use of hospital services, medications, and alcohol. A random sample of 404 patients were invited to participate in a clinical assessment 1–3 weeks after the ED visit, that included re‐administration of the screening questionnaire, and standardized instruments to assess disability, social resources, depression, alcohol use and abuse, and current medications.

Results: Study data were collected from 221 patients (54.7%), of whom 193 were included in the test‐retest reliability analyses and 213 in the analyses of concurrent validity. The concordance correlation coefficient for test‐retest reliability of the risk factor score was 0.78 (95% confidence interval: 0.71, 0.83; n= 193). Several screening questions showed moderately good agreement with the appropriate criterion standard, particularly those on visual and hearing impairment, depression, and use of medications. The best subset of 9 screening questions explained approximately half of the variance in the total disability score.

Conclusions: The screening questionnaire score has good test‐retest reliability, but individual screening questions have, at best, modest concurrent validity. The final set of screening questions should be selected based on their predictive validity.
Statistical Methodology: VI. Mathematical Modeling of the Electrocardiogram Using Factor Analysis
Authors: Schreck David M. , Tricarico Victor J. , Frank Joseph D. , Thielen Lawrence E. , Chhibber Parag , Brotea Cristian , Leber Ian B.
Published: March 2010

Abstract. The ECG is a 12‐lead‐vector system and is known to contain redundant information. Factor analysis (PA) is a statistical technique that improves measured data and eliminates redundancy by identifying a minimum number of factors accounting for variance in the data set. Objective: To identify the minimum number of lead‐vectors required to predict the 12‐lead ECG.

Methods: A total of 104 ECGs were obtained from 24 normal men, 22 normal women, and 28 men and 30 women with variable pathologies. Each ECG lead was simultaneously acquired and digitized, resulting in a voltage‐time data array stored for mathematical analysis. Each array was factor‐analyzed to identify the minimum number of lead‐vectors spanning the ECG data space. The 12‐lead ECG was then predicted from this minimum lead‐vector set. ANOVA was used to test for statistical significance between normal and pathologic data groups.

Results: FA revealed that 3 lead‐vectors accounted for 99.12%± 0.92% (95% CI ± 0.18%) of the variance contained in the 12‐lead ECG voltage‐time data for all 104 cases. There were no statistically significant differences between men and women (99.25%± 0.66% vs 98.98 ± 1.11%; p = 0.139). Statistically significant differences were noted between normal and acute myocardial infarction ECGs (99.5%± 0.27% vs 98.66 ± 1.25%; p = 0.00003). The measured and predicted leads were almost identical. A 3‐dimensional spatial ECG derived from the 3‐lead‐vector set resulted in variable curved surfaces that differed by pathology.

Conclusions: The 12‐lead ECG can be derived from only 3 measured leads and graphed as a 3‐D spatial ECG. This type of data processing may lead to instantaneous acquisition and may enhance the diagnostic capability of the ECG from routine bedside telemetry equipment.
Emergency Department Initiatives to Improve the Public Health
Authors: Gordon James A. , Goldfrank Lewis R. , Andrulis Dennis P. , D'Alessandri Robert M. , Kellermann Arthur L.
Published: March 2010

Each year, the Society for Academic Emergency Medicine, the American College of Emergency Physicians, and the American Board of Emergency Medicine co‐sponsor an educational session at the Association of American Medical Colleges Annual Meeting. The 1997 session was entitled “Emergency Department Initiatives to Improve the Public Health,” and included presentations by 4 invited speakers: Dr. Lewis Goldfrank, Director of Emergency Medicine at Bellevue Hospital Center and New York University Medical Center; Dr. Dennis Andrulis, Director of the Office of Urban Populations at the New York Academy of Medicine; Dr. Robert D'Alessandri, Vice President for Health Sciences and Dean of the School of Medicine at West Virginia University; and Dr. Arthur Kellermann, Acting Chief of Emergency Medicine at Emory University. Each speaker focused on a particular aspect of emergency medicine and the health of the public. The following article summarizes some of the session's ideas and themes.
β‐tricalcium phosphate in the early phase of socket healing: an experimental study in the dog
Authors: Araújo Mauricio G. , Liljenberg Birgitta , Lindhe Jan
Published: March 2010

Objectives: The aim of this experiment was to analyze processes involved in the incorporation of β‐tricalcium phospate (TCP) particles in host tissue during healing following tooth extraction and grafting.

Material and methods: Five beagle dogs were used. Four premolars in the maxilla (3P3, 2P2) were hemi‐sected, the distal roots were removed and the fresh extraction socket filled with TCP. The tooth extraction and grafting procedures were scheduled in such a way that biopsies representing 1 and 3 days, as well as 1, 2, and 4 weeks of healing could be obtained. Tissue elements such as cells, fibers, vessels, leukocytes and mineralized bone were determined. In deparaffinized sections structures and cells that expressed Tratarate resistant acid phosphate, alkaline phosphatase, and osteopontin were identified by the use of markers.

Results: The porosities of the TCP particles were initially filled with erythrocytes that subsequently were replaced with mineralized bone. Some of the graft material was invaded by mesenchymal and inflammatory cells and disintegrated. Thus, small membrane bound granules appeared in the granulation tissue and the provisional matrix. In the process of hard tissue formation, partly mineralized (modified) TCP particles became surrounded by ridges of woven bone.

Conclusions: It was demonstrated that the early healing of an extraction socket that had been grafted with β‐TCP involved (i) the formation of a coagulum that was (ii) replaced with granulation tissue and a provisional matrix in which (iii) woven bone could form. In this process the biomaterial was apparently involved.

To cite this article:
 Araújo MG, Liljenberg B, Lindhe J. β‐tricalcium phosphate in the early phase of socket healing: an experimental study in the dog. Clin. Oral Impl. Res. 21, 2010; 445–454. doi: 10.1111/j.1600‐0501.2009.01876.x
Modeling Flow into Horizontal Wells in a Dupuit‐Forchheimer Model
Authors: Haitjema Henk , Kuzin Sergey , Kelson Vic , Abrams Daniel
Published: March 2010

Horizontal wells or radial collector wells are used in shallow aquifers to enhance water withdrawal rates. Groundwater flow patterns near these wells are three‐dimensional (3D), but difficult to represent in a 3D numerical model because of the high degree of grid refinement needed. However, for the purpose of designing water withdrawal systems, it is sufficient to obtain the correct production rate of these wells for a given drawdown. We developed a Cauchy boundary condition along a horizontal well in a Dupuit‐Forchheimer model. Such a steady‐state 2D model is not only useful for predicting groundwater withdrawal rates but also for capture zone delineation in the context of source water protection. A comparison of our Dupuit‐Forchheimer model for a radial collector well with a 3D model yields a nearly exact production rate. Particular attention is given to horizontal wells that extend underneath a river. A comparison of our approach with a 3D solution for this case yields satisfactory results, at least for moderate‐to‐large river bottom resistances.
Early Christianity and the Discourse of Empire in the First Three Centuries CE
Authors: Frilingos Chris
Published: March 2010

Did the setting of the Roman Empire make a difference to the way that early Christian texts defined or, more precisely, invented the religion of Christianity? If so, are traces of this difference perceptible in the writings of early Christians? The scholarship assembled here, generally speaking, answers both questions affirmatively: the context of empire affected the way that early Christians talked about themselves, others, and the world they inhabited. The study of the self‐definition of early Christians, this research contends, cannot be undertaken without recognizing the distinctive kinds of knowledge (of Self and Other) engendered by the ascendancy of the Roman Empire. The work is separated out under three rubrics: spectacle, borderlines, and mimicry. These categories reflect patterns that have emerged in the study of early Christian texts as they contributed to, appropriated, refracted, and resisted the discourse of empire in the first three centuries of the Common Era.
Apoptosis‐accommodating Effect of Nitric Oxide in Photodynamically Stressed Tumor Cells
Authors: Niziolek‐Kierecka Magdalena , Pilat Anna , Korytowski Witold , Girotti Albert W.
Published: March 2010

Using a 5‐aminolevulinic acid (ALA)‐photodynamic therapy model, we have discovered a new effect of nitric oxide (NO)—the ability to accommodate apoptosis. When sensitized by disseminated ALA‐generated protoporphyrin IX, COH‐BR1 tumor cells in glucose‐containing medium died mainly by necrosis with a low level of apoptosis. Introduced before light at a nontoxic concentration, the NO donor SPNO inhibited necrosis, but supported apoptosis such that the latter became predominant in the remaining cell death. Accompanying this was a large increase in caspase‐3/7 activation. SPNO‐supported apoptosis was more pronounced when glucose‐deprived cells were compared with glucose‐replenished, SPNO‐treated counterparts. SPNO plus glucose also suppressed plasma membrane‐damaging lipid peroxidation and loss of cellular ATP under photostress. The NO effect is attributed to membrane protection with maintenance of sufficient glycolytic ATP to sustain apoptosis.
Assessing the Effect of Data Collection Mode on Measurement
Authors: Jäckle Annette , Roberts Caroline , Lynn Peter
Published: March 2010

This paper discusses the challenges in assessing the effects of mixed modes on measurement. We briefly review theories about why different modes of data collection can lead to differences in survey responses and statistical methods typically used to assess mode effects. We then discuss the challenges, including which mode effects are identified, how to test for mode effects, and whether these would affect substantive conclusions. The issues raised are illustrated with examples from the European Social Survey, which is conducting a programme of experimental research to inform decisions about whether to use mixed modes of data collection. The paper concludes with general implications for mixed modes research.
Optic disc appearance and retinal temporal vessel arcade geometry in high myopia, as based on follow‐up data over 38 years
Authors: Fledelius Hans C. , Goldschmidt Ernst
Published: March 2010

Purpose:  To discuss (i) optic disc appearance and (ii) the retinal course of the temporal vessel arcade in a longitudinal series of high myopia patients followed between the ages of 16 and 54.

Methods:  Thirty‐nine individuals from a 1948 Copenhagen birth cohort (n = 9243) who had myopia of −6 to −15 D when aged 14 years were invited for current follow‐up exams with 7–10‐year intervals. Fundus photos were available from up to five occasions over 38 years, and single eye photo collages were studied with respect to posterior pole changes over time.

Results:  Fifty‐two eyes with high myopia were available. (i) Contrary to the expected predominance of large flat optic discs in long eyes, more than half the eyes in the sample had neurodiscs that were perceived to be small; many were also oval/kinked/tilted and with minimum or absent physiological cups. Among the fellow eyes with unilateral high myopia only one out of the 10 discs appeared as small/tilted. (ii) By age, a more acute angle between upper and lower temporal retinal vessel trunks was found in 12/20 eyes with adult myopia progression (change over time 5–23°) and in 6/24 eyes with stable myopia. In the myopia‐progression subgroup, peaking of the angle was correlated with myopia degree, myopia increase and axial elongation.

Conclusion:  Contrary to clinical expectation, we found neurodiscs that appeared to be small and dense in eyes with high myopia. We further discussed the eventual peaking of the angle between the temporal vessel arcades that is sometimes observed in high myopia. Occasionally, literature on myopia reports the presence of small and tilted discs whereas no mention was found of the issue of temporal vessel arcade peaking.
Paradoxical Decrease in High‐Density Lipoprotein Cholesterol with Fenofibrate: A Quite Rare Phenomenon Indeed
Authors: Mombelli Giuliana , Pazzucconi Franco , Bondioli Alighiero , Zanaboni AnnaMaria , Gaito Sabrina , Calabresi Laura , Sirtori Cesare R.
Published: March 2010

Some recent clinical reports have suggested that paradoxical decreases in high‐density lipoprotein cholesterol (HDL‐C) levels after fenofibrate treatment may be quite common. These appear to occur mainly in patients with combined fibrate/statin therapy and possibly in those with low baseline HDL‐C. Reports on HDL‐C reductions after fenofibrate are possibly supported by the disappointing results in terms of HDL‐C responses from the recent FIELD study. A survey on 581 patients treated for 1 year or longer was carried out in our Clinical Center. This indicated that paradoxical HDL‐C reductions are a relatively uncommon phenomenon. Not more than 15.3% of the present series showed an HDL‐C reduction, mostly of a modest degree. Further, reductions of HDL‐C appear to occur mainly in individuals with significant HDL‐C elevations (>50 mg/dL), almost never in patients with low HDL‐C. Otherwise, there seems to be no impact of a previous diagnosis of diabetes or hypertension on the HDL‐C changes. From a very recent pharmacogenomic study on the apo A1/C3/A4/A5 gene cluster, genetic influences appear only to reduce the positive impact of fenofibrate on HDL‐C, but do not indicate any risk of occurrence of HDL‐C reductions. Also based on our very long experience with this drug, it appears that fenofibrate raises HDL‐C levels in the vast majority of treated patients, with a particularly dramatic effect in individuals with low HDL‐C and hypertriglyceridemia.
Identifying and overcoming the potential barriers to the adoption of natural orifice transluminal endoscopic surgery
Authors: Schwaitzberg S. D.
Published: March 2010

Natural orifice translumenal endoscopic surgery (NOTES) is an emerging innovative approach to performing minimally invasive surgical procedures. In its full potential, the concept of incisionless surgery will have mass appeal to patients. However, the barriers to adopting NOTES will have to be overcome before widespread acceptance of these techniques can occur. These potential barriers include infection, visceral leakage, difficulties in tissue manipulation, and increased cost. The history of surgical innovation has continuously overcome similar problems in other settings, and all of these potential obstacles are likely solvable. Training surgeons will be an additional barrier that will need to be overcome, but this obstacle will need to be approached differently than when laparoscopy was introduced, as standards are higher today for privileging and credentialing in most hospitals than 20 years ago. Alternative technologies that were not adopted prior to the introduction of NOTES may now appear more viable making the competitive environment more complex. Increased funding for comparative effectiveness studies and training for competency in innovation will also need original solutions, but are clearly in our patients' best interest.
Cisplatin Toxicity in Cats
Authors: Knapp Deborah W. , Richardson Ralph C. , DeNicola Dennis B. , Long Gerald G. , Blevins William E.
Published: March 2010

Cisplatin (cis‐diamminedichloroplatinum; Platinol, Bristol, Syracuse, NY) was administered to 11 cats, divided into three groups of experimental and clinical patients. In group 1, cisplatin was administered at a dose of 60 mg/m2 to four cats. In an attempt to avoid renal toxicity, saline diuresis was induced by administering 0.9% saline solution intravenously at a rate of 20 ml/kg/hr for 4 hours before and 2 hours after cisplatin administration. All four cats became dyspneic and died 48–96 hours after cisplatin administration. Postmortem findings included severe hydrothorax, pulmonary edema, and mediastinal edema. In group 2, four experimental cats entered a trial comparing the effects of saline diuresis and cisplatin (60 mg/m2) with the effects of saline diuresis and placebo (0.9% saline solution). The cats in the saline control group remained completely normal, while the cats that received cisplatin developed clinical signs and gross postmortem pulmonary changes identical to those in the first group of cats. Histopathologic examination showed that the alveolar septa were thickened and congested, and contained macrophages, occasional neutrophils, thrombi, and small foci of necrosis and fibrin. Microangiopathic changes were seen in the alveolar capillaries. In the third group, three additional cats were treated with a lower dose of cisplatin. Two cats that received 40 mg/m2 of cisplatin developed pulmonary changes similar to, but less severe than, those seen in the cats that received the higher dose of cisplatin. One cat treated with 20 mg/m2 of cisplatin showed no pulmonary changes ante mortem or post mortem. This series of 11 clinical and experimental cases identifies an apparent species‐specific, dose‐related, primary pulmonary toxicity of cisplatin in cats.
Systemic Mastocytosis in 16 Dogs
Authors: O'Keefe Deborah A. , Couto C. Guillermo , Burke‐Schwartz Cheryl , Jacobs Robert M.
Published: March 2010

The clinical and pathologic features of systemic mastocytosis in 16 dogs are reported. There was no apparent breed or sex predilection, and the median age at presentation was 9.5 years. In 14 of 16 cases there was a primary cutaneous mast cell tumor (MCT). When cutaneous tumor location was compared with previous reports, there was no association between location and systemic dissemination. The most common presenting signs associated with the cutaneous tumor were regional dissemination, edema, ulceration, and abscessation. They were present in 12 dogs (69%). Signs of systemic illness, including anorexia, vomiting, and diarrhea, were seen in eight dogs (50%). Other than the cutaneous tumors, the most consistent physical and radiographic abnormalities included lymphadenopathy, splenomegaly, and hepatomegaly. Eosinophilia and basophilia were seen in two and five dogs, respectively. Six dogs had increased numbers of mast cells in peripheral blood or buffy coat smears. Five of the nine dogs evaluated had increased numbers of mast cells in bone marrow aspirates. Bone marrow aspiration was superior to both peripheral blood and buffy coat smears in predicting mastocytosis. Coagulation abnormalities were seen in three of five dogs tested.

Using a conventional histomorphologic grading system, 10 of 13 (77%) tumors were classified as Grade III or undifferentiated and were overrepresented when compared with previous reports of cutaneous MCTs. Eighty‐eight percent of the dogs either died or were euthanatized because of their tumors. Organs commonly involved at necropsy included lymph nodes, spleen, liver, and bone marrow; four dogs had gastroduodenal ulcers.
Effect of Thyrotropin Storage on Thyroid‐Stimulating Hormone Response Testing in Normal Dogs
Authors: DVM D. S. Bruyette , Nelson R. W. , Bottoms G. D.
Published: March 2010

The stability of reconstituted, refrigerated thyrotropin was evaluated. Thyrotropin (TSH) was reconstituted at the start of the study and stored at 4C. A TSH stimulation test was performed in eight healthy, euthyroid dogs at weekly intervals for 1 month. In seven of eight dogs, there was no significant difference (P< 0.05) between the post‐TSH T3concentrations and the post‐TSH T4concentrations for the duration of the study. For one dog, the post‐TSH T4concentration was below the normal post‐TSH T4range following the administration of reconstituted TSH that had been stored 4 weeks. The T3response to the TSH, however, was normal. This dog responded normally to freshly reconstituted TSH. The results of this study suggest that reconstituted bovine TSH can be stored at 4oC for at least 3 weeks without loss of biologic activity in the dog.
The Acute Hemodynamic Effects of Milrinone in Dogs With Severe Idiopathic Myocardial Failure
Authors: Kittleson Mark D. , Johnson Lynne E. , Pion Paul D.
Published: March 2010

To examine the effects of acute oral milrinone administration (0.75 mg/kg) on dogs with severe idiopathic myocardial failure and the effect of prolonged milrinone administration on survival time, we measured hemodynamics before and 2 hours after drug administration and recorded survival time and cause of death in 13 dogs with dilated cardiomyopathy. Hemodynamics were measured using a Swan‐Ganz catheter and femoral artery puncture along with recording an M‐mode echocardiogram. Cardiac index increased from 1.92 ± 0.54 to 3.06 ± 0.81 L/min/m2, stroke volume index increased from 11.3 ± 4.3 to 16.7 ± 6.3 ml/beat/m2, and pulmonary capillary wedge pressure decreased from 23 ± 8 to 12 ± 8 mmHg. A clinically significant increase in heart rate was observed in seven dogs, resulting in a statistically significant increase in heart rate for the group from 174 ± 34 to 194 ± 44 beats/minute. Mean arterial blood pressure did not change significantly for the group but did decrease more than 20 mmHg in three dogs, suggesting a predominant primary vasodilating effect of milrinone in these dogs. An increase in contractility appeared to be the predominant reason for the improved hemodynamics in seven dogs. Eight dogs died of causes other than worsening heart failure, including four of eight Doberman pinschers that died suddenly, presumably from an acute tachyarrhythmia. Two dogs that had the greatest increase in an index of contractility are alive more than 2 years after the initiation of milrinone administration.
Serum Thyroid Hormone Concentrations Fluctuate in Cats with Hyperthyroidism
Authors: Peterson Mark E. , Graves Thomas K. , Cavanagh Irena
Published: March 2010

We measured serum thyroxine (T4) and 3,3',5‐triiodothyronine (T3) concentrations in hyperthyroid cats (hourly for 10 hours in 14 cats, and daily for 15 days in seven cats) to assess fluctuation in thyroid hormone levels. Over the 10‐hour study period the coefficient of variation (CV) for serum T4 and T3 concentrations ranged from 6.4–22.6% (mean = 12.0 ± 4.8%) and from 9.6–33.1% (mean = 17.5 ± 6.3%), respectively. During the 15‐day study period, CV for serum T4 ranged from 6.6–34.8% (mean = 18.4 ± 9.3%), while CV for serum T3 ranged from 7.8–31.0% (mean = 20.1 ± 8.6%). These CV values were significantly higher than the expected intra‐assay CVs (T4 assay, 5.1%; T3 assay, 7.7%). In addition, some of the cats with mild hyperthyroidism showed one or more normal serum T4 and T3 values during the course of the respective study periods. There was no specific time during the 10‐hour study period at which the cats consistently showed peak serum T4 or T3 concentrations. These results suggest that serum thyroid hormone concentrations are subject to a degree of fluctuation that exceeds the usual assay variation, and that cats with mild hyperthyroidism can, at a given time, exhibit normal serum T4 and T3 values. Therefore, a diagnosis of feline hyperthyroidism should not be excluded on the basis of the finding of a single normal serum T4 or T3 value in a cat with clinical signs and physical examination findings consistent with the disease.
The Influence of Castration on the Development of Prostatic Carcinoma in the Dog 43 Cases (1978–1985)
Authors: Obradovich Joyce , Walshaw Richard , Goullaud Eric
Published: March 2010

Prostatic carcinoma (PC) was diagnosed in 43 dogs at the Michigan State University Veterinary Clinical Center (MSU‐VCC) between 1978 and 1985. Of the 43 dogs with histologically confirmed PC, 19 (44.19%) had been castrated at least three years prior to the development of any prostatic disease. Seven of the castrates had been neutered at less than 12 months of age. Fourteen dogs (32.55%) were presented as intact males at the time of diagnosis. The remaining ten dogs (23.62%) had been castrated as treatment for presumptive prostatic disease prior to referral to the MSU‐VCC. Dates of castration were known in all cases. In this study, therefore, castration at any age showed no sparing effect on the risk of development of PC in the dog.

The etiology of PC in the dog may not be exclusively related to testicular hormones. Work in humans suggests that the adrenal and pituitary glands play a significant role in the disease. Preliminary work in dogs supports that nontesticular androgens exert a significant influence on the canine prostate.
Evaluation of a Test Kit for Determination of Serum Immunoglobulin G Concentration in Foals
Authors: Bertone Joseph J. , Jones Robert L. , Curtis Charles R.
Published: March 2010

The accuracy of an immunoglobulin (Ig) G test kit for the semiquantitative measurement of IgG concentration was evaluated with serum from 88 foals. Failure of passive transfer (IgG < 400 mg/dl) was correctly identified in each of 34 samples, and partial failure of passive transfer (400 ≤ IgG < 800 mg/dl) was correctly identified in each of nine samples. Evidence of adequate passive transfer (IgG ≥ 800 mg/dl) was detected in 44 of 45 samples. One sample with 800 mg/dl or more of IgG was incorrectly classified as a partial failure of passive transfer (Kendall Tau ‐b= .975). The high degree of accuracy, especially without any errors of overestimation of IgG concentrations, indicated that the IgG test kit should be a useful assay for rapidly determining the passive transfer status of foals. (Journal of Veterinary Internal Medicine 1988; 2:181–183)
The Importance of Egg Protein in Reduced Protein Diets Designed for Dogs With Renal Failure
Authors: Polzin David J. , Osborne Carl A.
Published: March 2010

The effects of two reduced‐protein diets and a canine maintenance diet on renal function, nutrition, serum and urine acid‐base and electrolyte values, and divalent ion metabolism were compared in Beagle dogs with induced chronic renal failure. Two reduced‐protein (18%) diets differed in their protein sources. One 18% protein diet was formulated using egg protein as the only protein source. The other 18% protein diet was formulated using a mixture of animal and vegetable proteins. The 42% protein diet contained a mixture of animal and vegetable protein sources. Results of this study indicate that the egg‐based and mixed protein‐based diets had similar effects on most clinical and laboratory evaluations in dogs with chronic renal failure. However, the egg protein diet appeared to promote hyperchloremic metabolic acidosis. Both reduced‐protein diets were beneficial in reducing azotemia, polyuria, hypermagnesemia, and fractional excretion of phosphorus compared with the 42% protein diet.
Effects of Castration on Peritoneal Fluid in the Horse
Authors: Schumacher John , Schumacher Jim , Spano J. S. , McGuire J. , Scrutchfield W. L. , Feldman R. G.
Published: March 2010

Twenty‐four clinically normal horses were castrated by routine methods. Peritoneal fluid was collected prior to castration and at 1, 3, 5, and 7 days postcastration. Peritoneal fluid was collected on days 9 and 11 if nucleated cell (NC) counts were still markedly elevated on day 7. Peritonitis, defined as NC counts > 10,000/μl, was evident in 15 horses following castration. Mean NC counts peaked on day 5 but were <10,000/μl for 74% of the horses by day 7, and 90% of the horses by day 9. One horse had a NC count > 60,000/μl on day 11 when sampling ended. Postcastration peritoneal fluid was obviously blood‐tinged in 21 horses. Peak RBC counts occurred on day 3 but markedly decreased by day 5. Elevated peritoneal RBC counts correlated well with elevated NC counts (P < 0.001). Horses with peritonitis tended to have fever (P < 0.05). Other clinical signs of peritonitis were not apparent.