bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors and outcome associated with hypomagnesemia in massive transfusion
Authors: Ho Kwok M. , Leonard Anton
Published: August 2010

BACKGROUND: Electrolyte disturbances are common in patients with critical bleeding requiring massive transfusion. The risk factors and outcome associated with the occurrence of hypomagnesemia in massive transfusion remain uncertain.

STUDY DESIGN AND METHODS: A cohort of 353 consecutive patients who required massive transfusion, defined as 10 or more units of allogeneic red blood cells or whole blood transfusion within 24 hours, between 2002 and 2008 in a quaternary health care center in Western Australia was considered. Logistic regression was used to identify risk factors and outcome associated with hypomagnesemia during massive transfusion (<0.7 mmol/L or 1.7 mg/dL).

RESULTS: Of the 353 patients requiring massive transfusion during the study period, 298 patients (84%) had serum magnesium concentrations available for analysis. Hypomagnesemia was common (172 patients, 58%), and the mean magnesium concentration was 0.68 mmol/L (1.65 mg/dL; standard deviation, 0.15 mmol/L) in these patients. The risk factors for hypomagnesemia were hypocalcemia (odds ratio [OR], 1.67 per 0.1 mmol/L decrement; 95% confidence interval [CI], 1.36‐2.01; p = 0.001) and hypofibrinogenemia (OR, 1.05 per 0.1 g/L decrement; 95% CI, 1.01‐1.09; p = 0.009). The lowest serum magnesium concentrations were associated with the lowest ionized calcium concentrations (Spearman correlation coefficient, 0.377; p = 0.001). Both magnesium concentrations (OR, 0.91 per 0.1 mmol/L increment; 95% CI 0.31‐2.69; p = 0.863) and the interaction term between magnesium and calcium concentrations were not associated with an increased risk of mortality after adjusting for other covariates.

CONCLUSIONS: Hypomagnesemia was common and associated with hypocalcemia in massive transfusion, but serum magnesium concentrations had no independent effect or interactive effect with hypocalcemia on mortality of patients requiring massive transfusion.
RhD variant caused by an in‐frame triplet duplication in the RHD gene
Authors: Pereira Janet C. , Rodrigues Maria J. , Tilley Louise , Poole Joyce , Chabert Teresa , Ribeiro Maria L.
Published: August 2010

BACKGROUND: The RHD gene is highly polymorphic and a large number of D variants have already been detected. Several mechanisms are involved in the origin of D variants. In‐frame deletions, resulting in a single‐amino‐acid deletion, have been described associated with RhD and RhCE variants. No in‐frame duplications and/or insertions have been reported in the RH genes to date.

STUDY DESIGN AND METHODS: Blood samples from a Brazilian blood donor and his sister were serologically tested with routine anti‐D reagents and anti‐D panels (ALBAclone advanced partial D typing kit, Alba Bioscience Limited; and D‐Screen, Diagast), followed by molecular biology techniques, RHD polymerase chain reaction with sequence‐specific priming and sequencing.

RESULTS: Samples tested negative with routine immunoglobulin M (IgM) anti‐D reagents and positive with IgG anti‐D, which detect weak D cells. The pattern of results with anti‐D panels did not correspond to any described before. A 3‐bp in‐frame duplication within Exon 1 (c.75_77dupTCT), resulting in the duplication of leucine 26 (p.Leu26dup), was identified in the two samples.

CONCLUSION: We report the first RhD variant associated with a 3‐bp in‐frame duplication in the RHD gene, predicted to be located within the RhD protein transmembrane domain that might be expected to result in a weak‐D–like phenotype, concordant with serologic findings.
Quality management in the transfusion service: case studies in process improvement
Authors: Goodnough Lawrence T. , Viele Maurene , Fontaine Magali , Chua Lee , Ferrer Zenaida , Jurado Christine , Quach Peter , Dunlap Marsha , Arber Daniel A.
Published: August 2010

BACKGROUND: Laboratory‐based quality improvement (QI) initiatives can improve clinical outcomes and patient safety.

STUDY DESIGN AND METHODS: We present three cases of QI that impact processes from the transfusion service (TS) laboratory to the patient's bedside.

RESULTS: Case 1 was event discovery reporting (EDR). We were able to reduce our biologic product deviation reports from 41 (17%) of 238 EDRs to only 19 (7%) of 272 (p < 0.01) EDRs after implementation of a QI workflow process. Case 2 was antibody evaluation before elective surgery. We implemented process improvement strategies: 1) surgical safety checklist with confirmation of type‐and‐screen completion and antibody evaluation before patients can proceed to surgery; 2) specimen retention policy of 30 days to allow advance testing; and 3) daily review to identify specimens needed on day of surgery. After intervention, only 7 (0.3%) of 2298 patients required antibody evaluation on day of surgery, compared to 65 (0.75%) of 8656 patients (p < 0.01) before intervention. Case 3 was wrong blood in tube (WBIT). We have a two‐specimen requirement for blood type verification before transfusion. To determine whether trauma patients should be exempted, we reviewed WBIT errors. Six WBIT errors were from the emergency department (an error rate of 1:400) and nine WBIT specimens were institution‐wide. Three patients were transfused after correction of the WBIT error. Based on this analysis, our institution agreed that no clinical units shall be exempted from our policy.

CONCLUSION: Successful QI in the TS improves processes that promote efficiency, effectiveness, and patient safety.
Neonatal alloimmune neutropenia due to immunoglobulin G antibodies against human neutrophil antigen‐5a
Authors: Porcelijn Leendert , Abbink Floor , Terraneo Loes , Hoogen Laura Onderwater‐vd , Huiskes Elly , de Haas Masja
Published: August 2010

BACKGROUND: Neonatal alloimmune‐mediated neutropenia (NAIN) due to maternal alloantibodies directed against one of the human neutrophil antigens (HNAs) can cause severe infections. NAIN has been described as caused by antibodies against HNA‐1a, ‐b, ‐c, ‐2a, ‐3a, or ‐4a, but not by antibodies against HNA‐5a.

RESULTS: Blood from a 3‐week‐old newborn and from his parents was sent to our laboratory because of suspicion of NAIN. Granulocyte‐specific antibodies were present in the maternal antiserum and reactive with the paternal granulocytes. The specificity of the maternal alloantibodies was shown to be anti‐HNA‐5a by the monoclonal antibody immobilization of granulocyte antigens assay. The mother was genotyped HNA‐5a negative, and the father was genotyped homozygous HNA‐5a positive.

CONCLUSION: We identified a first case of NAIN due to maternal alloantibodies against HNA‐5a.
Thrombopoietin to replace megakaryocyte‐derived growth factor: impact on stem and progenitor cells during ex vivo expansion of CD34+ cells mobilized in peripheral blood
Authors: Duchez Pascale , Chevaleyre Jean , Vlaski Marija , Dazey Bernard , Bijou Fontanet , Lafarge Xavier , Milpied Noël , Boiron Jean‐Michel , Ivanovic Zoran
Published: August 2010

BACKGROUND: The first protocol of ex vivo expansion that enabled almost total abrogation of postmyeloablative chemotherapy neutropenia was based on a three‐cytokine cocktail (stem cell factor [SCF], granulocyte–colony‐stimulating factor [G‐CSF], pegylated‐megakaryocyte growth and development factor [PEG‐MGDF]) in a serum‐free medium. Since the clinical‐grade molecule MGDF is no longer available on the market, we evaluated its substitution by thrombopoietin (TPO).

STUDY DESIGN AND METHODS: CD34+ cells of myeloma patients were expanded for 10 days in serum‐free cultures with SCF, G‐CSF, or MGDF (100 ng/mL) or with TPO (2.5, 10, 20, 50, and 100 ng/mL) instead of MGDF. Day 10 amplifications of total nucleated cells, CD34+ cells, committed progenitors (CFCs), the capacity of engraftment of NOD/SCID mice (SCID repopulating cells [SRCs]), and the immunophenotype of cells in expansion product (CD13, CD14, CD33, CD41, CD61) were analyzed.

RESULTS: TPO in doses of 2.5 and 10 ng/mL exhibits an effect comparable to that of MGDF (100 ng/mL) on total, CD34+, and CFCs amplification. Compared to MGDF, TPO (starting at 10 ng/mL) enhances two‐ to threefold the percentage of megakaryocyte lineage cells (CD41+ and CD61+). Finally, TPO maintains or even enhances (depending on dose) SRC activity.

CONCLUSIONS: The use of TPO instead of MGDF in our protocol is feasible without any negative effect on progenitor cell expansion. Furthermore, applied in dose of 10 or 100 ng/mL it could enhance both the stem cell activity and the percentage of megakaryocyte lineage cells in expansion product.
Red blood cell microparticles show altered inflammatory chemokine binding and release ligand upon interaction with platelets
Authors: Xiong Zeyu , Cavaretta John , Qu Lirong , Stolz Donna Beer , Triulzi Darrell , Lee Janet S.
Published: August 2010

BACKGROUND: Storage of red blood cells (RBCs) under standard blood bank conditions results in reduced structural integrity leading to membrane budding and release of microparticles. Microparticles express the blood group Duffy antigen known to bind multiple inflammatory chemokines, but the functional chemokine binding properties of microparticles are not known.

STUDY DESIGN AND METHODS: We determined whether storage‐induced microparticles show inflammatory chemokine binding through the expression of the Duffy antigen, comparing the binding properties to intact RBCs, and assessed microparticle interactions with platelets (PLTs) that release chemokines upon activation.

RESULTS: Intact RBCs retained similar equilibrium dissociation constants for CCL2 (Kd = 7.4 ± 0.9 nmol/L), CXCL8 (Kd = 7.9 ± 1.0 nmol/L), and CXCL1 (Kd = 4.4 ± 1.0 nmol/L) throughout storage. In contrast, microparticles increased in relative counts with storage, showed higher percentages of surface phosphatidylserine, and demonstrated impaired Duffy‐dependent chemokine binding affinity with wider variability in dissociation constant for CXCL1(Kd = 362 ± 328 nmol/L; range, 0.6‐2000 nmol/L). The altered chemokine binding affinity of RBC microparticles was associated with a propensity to release ligand upon incubation with PLTs. Relative quantification of microparticles, based on criteria of glycophorin A expression and size, underestimated particle numbers with functional chemokine binding, suggesting that glycophorin A–negative particles and nanoparticles contribute to overall chemokine binding capacity.

CONCLUSION: Microparticle burden in transfusates, as determined by functional chemokine binding, is considerable. Altered membrane properties of RBC microparticles enhance PLT interactions to increase inflammatory chemokine bioavailability in vitro.
Perspectives of potential donors on cord blood and cord blood cryopreservation: a survey of highly educated, pregnant Korean women receiving active prenatal care
Authors: Shin Sue , Yoon Jong Hyun , Lee Hye Ryun , Kim Byoung Jae , Roh Eun Youn
Published: August 2010

BACKGROUND: The aim of the study was to investigate the knowledge of cord blood (CB) and attitudes toward CB banking among high‐potential donors (i.e., well‐educated pregnant Koreans) because their voluntary donation is indispensable to the success of unrelated CB transplantation.

STUDY DESIGN AND METHODS: Questionnaires examining perspectives on CB were distributed to and completed by 1001 women attending a maternity education program from April to October 2008; 863 women answered that they had heard of CB. We analyzed the 863 questionnaires to identify the sources of information, the plan for CB, the reasons for decisions, beliefs about the potential uses of CB, and knowledge about current therapeutic uses.

RESULTS: Most subjects received information from promotional materials distributed by CB banks and the media; however, minimal information was obtained from obstetricians. More than 90% of women who planned to donate cited “altruism,” and 75.0% of the “private preservation” group indicated that a desire to “safeguard for the future” was the reason for their decision. The probability of autologous CB transplantation (p = 0.001) and current usefulness were significantly overestimated in the private preservation group (p = 0.02). In addition, 56% of subjects underestimated the probability of identifying a matched CB in the public bank, and the overall rate of correct answers about current usefulness was 57.4%.

CONCLUSIONS: A considerable portion of educated pregnant Korean women has more than minimal knowledge of CB, but the levels of knowledge regarding the potency of the public bank and the current usefulness and limitations of CB are generally low; in addition, obstetricians play insignificant roles in disseminating knowledge. Providing accurate and detailed information to pregnant women not only via brochures and the media and/or Internet but also by obstetricians would encourage CB donation.
The Challenge of Degraded Environments: How Common Biases Impair Effective Policy
Authors: Berger Alan , Brown Case , Kousky Carolyn , Zeckhauser Richard
Published: August 2010

Economic activity can damage natural systems and reduce the flow of ecosystem services. The harms can be substantial, as our case studies vividly illustrate. Most degraded landscapes have at least some potential to be reclaimed. However, uncertainty plagues decision making regarding degradation and reclamation, in relation to the extent of the damage, the success of reclamation, and how exposure will change in the future. We examine how a range of observed decision biases can lead to far‐from‐optimal policies regarding how much degradation to allow and when, as well as how and how much, to reclaim degraded sites. Despite our focus on degraded landscapes, we believe these are generic biases present in a wide range of risk situations. Our three case studies show these biases at work. The first two studies are of mining operations in the United States and Canada, and the third is of climate change.
The Impact of Consumer Phase Models in Microbial Risk Analysis
Authors: Nauta Maarten , Christensen Bjarke
Published: August 2010

In quantitative microbiological risk assessment (QMRA), the consumer phase model (CPM) describes the part of the food chain between purchase of the food product at retail and exposure. Construction of a CPM is complicated by the large variation in consumer food handling practices and a limited availability of data. Therefore, several subjective (simplifying) assumptions have to be made when a CPM is constructed, but with a single CPM their impact on the QMRA results is unclear. We therefore compared the performance of eight published CPMs for Campylobacter in broiler meat in an example of a QMRA, where all the CPMs were analyzed using one single input distribution of concentrations at retail, and the same dose‐response relationship. It was found that, between CPMs, there may be a considerable difference in the estimated probability of illness per serving. However, the estimated relative risk reductions are less different for scenarios modeling the implementation of control measures. For control measures affecting the Campylobacter prevalence, the relative risk is proportional irrespective of the CPM used. However, for control measures affecting the concentration the CPMs show some difference in the estimated relative risk. This difference is largest for scenarios where the aim is to remove the highly contaminated portion from human exposure. Given these results, we conclude that for many purposes it is not necessary to develop a new detailed CPM for each new QMRA. However, more observational data on consumer food handling practices and their impact on microbial transfer and survival are needed to generalize this conclusion.
Development of a Self‐Regulated Dynamic Model for the Propagation of Salmonella Typhimurium in Pig Farms
Authors: Soumpasis Ilias , Butler Francis
Published: August 2010

A self‐regulated epidemic model was developed to describe the dynamics of Salmonella Typhimurium in pig farms and predict the prevalence of different risk groups at slaughter age. The model was focused at the compartment level of the pig farms and it included two syndromes, a high and a low propagation syndrome. These two syndromes generated two different classes of pigs, the High Infectious and the Low Infectious, respectively, which have different shedding patterns. Given the two different classes and syndromes, the Infectious Equivalent concept was used, which reflected the combination of High and Low Infectious pigs needed for the high propagation syndrome to be triggered. Using the above information a new algorithm was developed that decides, depending on the Infectious Equivalent, which of the two syndromes should be triggered. Results showed that the transmission rate of S. Typhimurium for the low propagation syndrome is around 0.115, pigs in Low Infectious class contribute to the transmission of the infection by 0.61–0.80 of pigs in High Infectious class and that the Infectious Equivalent should be above 10–14% of the population in order for the high propagation syndrome to be triggered. This self‐regulated dynamic model can predict the prevalence of the classes and the risk groups of pigs at slaughter age for different starting conditions of infection.
Interpreting Null Results from Measurements with Uncertain Correlations: An Info‐Gap Approach
Authors: Ben‐Haim Yakov
Published: August 2010

Null events—not detecting a pernicious agent—are the basis for declaring the agent is absent. Repeated nulls strengthen confidence in the declaration. However, correlations between observations are difficult to assess in many situations and introduce uncertainty in interpreting repeated nulls. We quantify uncertain correlations using an info‐gap model, which is an unbounded family of nested sets of possible probabilities. An info‐gap model is nonprobabilistic and entails no assumption about a worst case. We then evaluate the robustness, to uncertain correlations, of estimates of the probability of a null event. This is then the basis for evaluating a nonprobabilistic robustness‐based confidence interval for the probability of a null.
Sleep Disordered Breathing and Arrhythmia Burden in Pacemaker Recipients
Authors: PADELETTI MARGHERITA , VIGNINI SIMONE , RICCIARDI GIUSEPPE , PIERAGNOLI PAOLO , ZACÀ VALERIO , EMDIN MICHELE , FUMAGALLI STEFANO , JELIC SANJA
Published: August 2010

Background: Sleep disordered breathing (SDB), a common condition among patients with permanent pacemaker (PM), is associated with greater incidence of cardiac arrhythmias. Scarce availability of sleep laboratories and the high costs of nocturnal‐attended polysomnography limit the routine screening of patients with PM for SDB. We investigated whether a novel PM that utilizes variations in transthoracic impedance to record the fluctuations in breathing pattern and minute ventilation could be used to screen patients for SDB.

Methods: Twenty patients who underwent dual‐chamber PM implantation were studied. The Talent 3 DR PM (SORIN Group Italy S.r.l., Milan, Italy) calculates apnea‐hypopnea index (AHI) by computing minute ventilation signal derived from transthoracic impedance measurements. Within a month after PM implantation, an in‐home respiratory monitoring was performed to evaluate the accuracy of PM‐derived AHI. Patients were followed for mean ± standard deviation, 487 ± 166 days. The PM was checked at each follow‐up visit to retrieve the information about recurrent arrhythmias.

Results: Eleven patients were diagnosed with SDB by an in‐home respiratory monitoring. An AHI derived from an in‐home respiratory monitoring was similar to pacemaker‐derived AHI (27 ± 14 vs 16 ± 13 events/hour, P = 0.15). The cumulative incidence of cardiac arrhythmias, including atrial fibrillation, extrasystolic beats, sustained and nonsustained ventricular tachycardia, and supraventricular tachycardia was similar in patients with and without SDB.

Conclusion: SDB is highly prevalent in patients with permanent pacemaker. Screening for SDB with Talent 3 DR PM may facilitate diagnosis and treatment of SDB. (PACE 2010; 33:1462–1466)
Multimodality Imaging of a Saphenous Vein Graft Aneurysm
Authors: Wallace Kerrett , Jassal Davinder S. , Kirkpatrick Iain D. C. , Hussain Farrukh
Published: August 2010

The use of multimodality cardiac imaging including echocardiography, cardiac computed tomography and cardiac catheterization for the diagnosis of a saphenous vein graft aneurysm is described. (Echocardiography 2010;27:E139‐E140)
Large Mass in Left Atrium by Transesophageal Echocardiography: An Unusual Case of Cardiac Angiosarcoma Mimicking a Cystic Mass
Authors: Toledano Francisco Javier , Mesa Dolores , Ortiz Martin Ruiz , Leon Carmen
Published: August 2010

Primary cardiac tumors are extremely rare. Among them, malignant tumors constitute approximately 15% of primary cardiac tumors. Angiosarcomas are the most frequent. They often appear as mural masses in the right atrium and completely replace the atrial wall and fill the entire cardiac chamber. We report an unusual case of angiosarcoma in a 75‐year‐old woman with a cystic appearance, located in the left atrium and causing critical mitral stenosis. (Echocardiography 2010;27:E137‐E138)
Reply
Authors: Kilic Harun , Balci Mustafa M. , Aksoy Murat N. , Bilgin Esra , Gulsoy Kevser G. , Yeter Ekrem , Acikel Sadik , Akdemir Ramazan
Published: August 2010

(Echocardiography 2010;27:1158)
Off‐Label Use of Drug‐Eluting versus Bare Metal Stents: A Lesion‐Specific Systematic Review of Long‐Term Outcomes
Authors: BEOHAR NIRAT , MEYERS SHERIDAN N. , ERDOGAN ATA , HARINSTEIN MATTHEW E. , PIEPER KAREN , GAGNON STEPHANIE , DAVIDSON CHARLES J.
Published: August 2010

Objective: The purpose of this systematic review was to evaluate differences in lesion‐specific outcomes with the “off‐label” use of drug‐eluting stents (DES) versus bare metal stents (BMS).

Methods: MEDLINE, PubMed, the Cochrane databases, and other Web were searched for studies evaluating off‐label use of DES and BMS with the same characteristics. Of 1,258 abstracts or manuscripts reviewed, 112 studies were included (total N = 23,438). Studies were excluded if patients received both types of stent or no stent; lesion type was unknown; lesion‐specific outcomes for ≥6 months were unavailable; or <25 patients were enrolled.

Results: Overall mortality at 6–12 months was approximately 3% for BMS and DES for off‐label use. Increase in mortality was greater from 6–12 months to 2 years with BMS than with DES (3.3%–9.1%; 2.8%–4.1%); however, rates were similar at 3 years (BMS: 18.8%; DES:15.3%). Myocardial Infarction rates were similar for both types at 6–12 months (BMS: 6.5%; DES: 6.0%). Overall rates of stent thrombosis were 1.8% and 1.7% for BMS and DES, respectively. Similar or slightly lower rates of stent thrombosis were seen for most lesion types, except higher rates for small vessels for BMS (5.2%) and true bifurcation for DES (3.3%). Rates of target lesion revascularization (TLR) were 7.5% for BMS and 19.6% for DES at 6–12 months. At 2‐years TLR remained lower than DES. When the combined group was compared to registry data alone, similar values were seen.

Conclusions: Rates of mortality, myocardial infarction (MI), and stent thrombosis were similar in patients receiving BMS or DES, while TLR rates were lower in DES patients. (J Interven Cardiol 2010;23:528–545)
Coronary Stents and the Uptake of New Medical Devices in the German System of Inpatient Reimbursement
Authors: HENSCHKE CORNELIA , BAEUMLER MICHAEL , GASKINS MATTHEW , BUSSE REINHARD
Published: August 2010

Objectives: This study aims to analyze mechanisms for facilitating the uptake of new medical devices in the German system of hospital reimbursement, focusing on the example of coronary stents, including (1) trends in their coding, (2) associated diagnosis‐related group (DRG) payments, (3) their integration in the German DRG (G‐DRG) system, and (4) their diffusion within the inpatient sector.

Methods: Published and gray literature provide the basis for analyzing the system of hospital reimbursement. Data on coronary stents were obtained from various regulatory and government bodies and examined in a longitudinal fashion.

Results: Although German Procedure Classification (Operationen‐ und Prozedurenschlüssel; OPS) codes were created for a range of stent technologies between 2004 and 2009, the regular system of G‐DRG reimbursement does not distinguish between different stents by means of unique DRGs. Instead, supplementary payments or extrabudgetary payments are used to ensure that newer technologies are reimbursed adequately. The limitations of extrabudgetary payments restrict the use of some devices to a small proportion of patients. Data on the diffusion of different stents show that factors other than the reimbursement regime likely also play a role in the frequency with which certain technologies are used. Bare metal stents currently account for most stent implantation procedures in Germany, followed by drug‐eluting stents.

Conclusion: The current system of G‐DRG reimbursement and of extrabudgetary payments ensures that even the most recently developed technologies can be used in the German inpatient sector. Nevertheless, certain technologies may not be reaching the broad patient population. (J Interven Cardiol 2010;23:546–553)
Enhanced Photochemical Reactivity at the Ferroelectric Phase Transition in Ba1−xSrxTiO3
Authors: Bhardwaj Abhilasha , Burbure Nina V. , Rohrer Gregory S.
Published: August 2010

Optical absorption and reflectance spectroscopy have been used to monitor the photochemical reactivity of Ba1−xSrxTiO3solid solutions with aqueous solutions containing methylene blue. Atomic force microscopy indicates that methylene blue is reduced on the surfaces of domains that have a positive surface polarization. The results indicated that SrTiO3and BaTiO3have similar reactivities. As the second component is added to either of the pure materials, the reactivity decreases. However, there is a sharp maximum in reactivity at the tetragonal‐to‐cubic phase boundary. This is attributed to the anomalously high dielectric constant at this composition that increases the width of the space charge region and charge carrier separation in the near surface region.
Making Bulk Ceramics from Polymeric Precursors
Authors: Jiang Tao , Hill Arnold , Fei Weifeng , Wei Yun , Tellam Mark , Xu Chengying , An Linan
Published: August 2010

In this paper, we report a simple technique for making bulk Si‐based ceramics from polymeric precursor. In this technique, a porous polymer preform with high porosity is used as a template. The preform is thermally decomposed before the precursor during pyrolysis to form interconnected pores for releasing gaseous species resulting from pyrolysis of precursors to avoid the formation of cracks within resultant ceramics. The thermal decomposition behavior of both template and precursor is studied for determining the proper pyrolysis procedure. The microstructure, porosity, and mechanical strength of the ceramics obtained are characterized.
Using Gas Chromatography with Ion Mobility Spectrometry to Resolve Explosive Compounds in the Presence of Interferents*
Authors: Cook Greg W. , LaPuma Peter T. , Hook Gary L. , Eckenrode Brian A.
Published: August 2010

Abstract:  Ion mobility spectrometry (IMS) is a valued field detection technology because of its speed and high sensitivity, but IMS cannot easily resolve analytes of interest within mixtures. Coupling gas chromatography (GC) to IMS adds a separation capability to resolve complex matrices. A GC‐IONSCAN® operated in IMS and GC/IMS modes was evaluated with combinations of five explosives and four interferents. In 100 explosive/interferent combinations, IMS yielded 21 false positives while GC/IMS substantially reduced the occurrence of false positives to one. In addition, the results indicate that through redesign or modification of the preconcentrator there would be significant advantages to using GC/IMS, such as enhancement of the linear dynamic range (LDR) in some situations. By balancing sensitivity with LDR, GC/IMS could prove to be a very advantageous tool when addressing real world complex mixture situations.
Contributions from Forensic Imaging to the Investigation of Upper Cervical Fractures
Authors: Uhrenholt Lars , Boel Lene W. T.
Published: August 2010

Abstract:  Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed tomography (PMCT) may contribute to the forensic investigation. This study presents PMCT in comparison with autopsy in the examination of UCS injury. Thirteen consecutive cases with UCS fracture and/or cranio‐cervical dislocation were examined with PMCT and autopsy, and the findings were correlated. Neither of the techniques identified all UCS injuries. Fractures of atlas and axis were best visualized with PMCT whereas cranio‐cervical dislocation was better identified during autopsy. Serious injuries were present after both high‐ and low‐energy trauma. Medico‐legal autopsy in combination with PMCT produced a thorough evaluation of UCS injuries. By combining these procedures detailed investigations, including accident reconstruction and injury pattern analysis, can be performed. This study supports the routine application of PMCT, as a supplement to the medico‐legal autopsy of deaths with UCS injuries.
Advanced Framework for Digital Forensic Technologies and Procedures*
Authors: Trček Denis , Abie Habtamu , Skomedal Åsmund , Starc Iztok
Published: August 2010

Abstract: Recent trends in global networks are leading toward service‐oriented architectures and sensor networks. On one hand of the spectrum, this means deployment of services from numerous providers to form new service composites, and on the other hand this means emergence of Internet of things. Both these kinds belong to a plethora of realms and can be deployed in many ways, which will pose serious problems in cases of abuse. Consequently, both trends increase the need for new approaches to digital forensics that would furnish admissible evidence for litigation. Because technology alone is clearly not sufficient, it has to be adequately supported by appropriate investigative procedures, which have yet become a subject of an international consensus. This paper therefore provides appropriate a holistic framework to foster an internationally agreed upon approach in digital forensics along with necessary improvements. It is based on a top‐down approach, starting with legal, continuing with organizational, and ending with technical issues. More precisely, the paper presents a new architectural technological solution that addresses the core forensic principles at its roots. It deploys so‐called leveled message authentication codes and digital signatures to provide data integrity in a way that significantly eases forensic investigations into attacked systems in their operational state. Further, using a top‐down approach a conceptual framework for forensics readiness is given, which provides levels of abstraction and procedural guides embellished with a process model that allow investigators perform routine investigations, without becoming overwhelmed by low‐level details. As low‐level details should not be left out, the framework is further evaluated to include these details to allow organizations to configure their systems for proactive collection and preservation of potential digital evidence in a structured manner. The main reason behind this approach is to stimulate efforts on an internationally agreed “template legislation,” similarly to model law in the area of electronic commerce, which would enable harmonized national implementations in the area of digital forensics.
Controversies and future perspectives of antiplatelet therapy in secondary stroke prevention
Authors: Weber Ralph , Diener Hans‐Christoph
Published: August 2010

Introduction

Thrombus formation and differences between ischaemic heart and brain disease

Aspirin resistance

Is there a role of combining aspirin and clopidogrel in secondary stroke prevention?

Drug interaction between clopidogrel and proton pump inhibitors

New antiplatelet agents for secondary stroke prevention

Antiplatelet agents are a cornerstone in the treatment of acute arterial thrombotic events and in the prevention of thrombus formation. However, existing antiplatelet agents (mainly aspirin, the combination of aspirin and dipyridamole and clopidogrel) reduce the risk of vascular events only by about one quarter compared with placebo. As a consequence, more efficacious antiplatelet therapies with a reduced bleeding risk are needed. We give an overview of several new antiplatelet agents that are currently investigated in secondary stroke prevention: adenosine 5′‐diphosphonate receptor antagonists, cilostazol, sarpogrelate, terutroban and SCH 530348. There are unique features in secondary stroke prevention that have to be taken into account: ischaemic stroke is a heterogeneous disease caused by multiple aetiologies and the blood–brain barrier is disturbed after stroke which may result in a higher intracerebral bleeding risk. Several small randomized trials indicated that the combination of aspirin and clopidogrel might be superior to antiplatelet monotherapy in the acute and early post‐ischaemic phase. There is an ongoing debate about antiplatelet resistance. Decreasing response to aspirin is correlated independently with an increased risk of cardiovascular events. However, there is still no evidence from randomized trials linking aspirin resistance and recurrent ischaemic events. Similarly, randomized trials have not demonstrated a clinical significantly decreased antiplatelet effect by the concomitant use of clopidogrel and proton pump inhibitors. Nevertheless, a routine use of this drug combination is not recommended.
Antiplatelet therapy in secondary stroke prevention – state of the art
Authors: Diener Hans‐Christoph , Weimar Christian , Weber Ralph
Published: August 2010

Introduction

Prevention of recurrent stroke using antiplatelets in patients with acute ischaemic stroke

Long‐term secondary stroke prevention in non‐cardioembolic stroke

The role of antiplatelets in cardioembolic stroke prevention

Antiplatelets in patients with symptomatic intracranial stenosis

Antiplatelets in stroke patients with patent foramen ovale

Disclosures

Our objective is to provide the reader with an overview as well as an update on current antiplatelet therapy for secondary stroke prevention. Relevant journals were hand‐searched by the authors to compile a broad but by far not comprehensive summary of innovative and clinically relevant studies. Aspirin, clopidogrel and the combination of dipyridamole plus aspirin are the cornerstone therapy in secondary prevention after non‐cardio‐embolic stroke or transient ischaemic attack. A head‐to‐head comparison showed no difference in the prevention of recurrent stroke between dipyridamole plus aspirin and clopidogrel. More potent antiplatelet drugs or the combination of aspirin and clopidogrel prevent more ischaemic events, but also lead to more bleeding complications. For secondary stroke prevention in patients with atrial fibrillation, oral anticoagulation is more effective than aspirin or the combination of aspirin and clopidogrel.
Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury
Authors: Andriessen Teuntje M. J. C. , Jacobs Bram , Vos Pieter E.
Published: August 2010

Introduction

Classifying TBI

Clinical characteristics

Pathophysiological mechanisms of focal injury

Pathophysiological mechanisms of diffuse injury

Conclusions

Traumatic brain injury (TBI) is a frequent and clinically highly heterogeneous neurological disorder with large socioeconomic consequences. TBI severity classification, based on the hospital admission Glasgow Coma Scale (GCS) score, ranges from mild (GCS 13–15) and moderate (GCS 9–12) to severe (GCS ≤ 8). The GCS reflects the risk of dying from TBI, which is low after mild (∼1%), intermediate after moderate (up to 15%) and high (up to 40%) after severe TBI. Intracranial damage can be focal, such as epidural and subdural haematomas and parenchymal contusions, or diffuse, for example traumatic axonal injury and diffuse cerebral oedema, although this distinction is somewhat arbitrary. Study of the cellular and molecular post‐traumatic processes is essential for the understanding of TBI pathophysiology but even more to find therapeutic targets for the development of neuroprotective drugs to be eventually used in human beings. To date, studies in vitro and in vivo, mainly in animals but also in human beings, are unravelling the pathological TBI mechanisms at high pace. Nevertheless, TBI pathophysiology is all but completely elucidated. Neuroprotective treatment studies in human beings have been disappointing thus far and have not resulted in commonly accepted drugs. This review presents an overview on the clinical aspects and the pathophysiology of focal and diffuse TBI, and it highlights several acknowledged important events that occur on molecular and cellular level after TBI.
Azithromycin as an adjunct to scaling and root planing in the treatment of Porphyromonas gingivalis‐associated periodontitis: a pilot study
Authors: Oteo Alfonso , Herrera David , Figuero Elena , O'Connor Ana , González Itziar , Sanz Mariano
Published: August 2010

Oteo A, Herrera D, Figuero E, O'Connor A, González I, Sanz M. Azithromycin as an adjunct to scaling and root planing in the treatment of Porphyromonas gingivalis‐associated periodontitis: a pilot study. J Clin Peridontol 2010; 37: 1005–1015. doi: 10.1111/j.1600‐051X.2010.01607.x.

Objective: To evaluate the clinical and microbiological effects of systemic azithromycin as an adjunct to scaling and root planing (SRP) in the treatment of Porphyromonas gingivalis‐associated chronic periodontitis.

Methods: Twenty‐nine patients harbouring P. gingivalis were randomized into test and placebo groups. Test patients received SRP plus 500 mg of azithromycin per day (3 days), and control patients received SRP plus placebo. Clinical [plaque and bleeding indexes, probing pocket depth (PPD), clinical attachment level (CAL)] and microbiological data (four‐sites pooled samples, processed by culture) were collected at baseline, and 1, 3 and 6 months, post‐therapy. Clinical variables were compared by anova, and microbiological variables by chi‐square, signed‐rank and Wilcoxon tests.

Results: Fifteen test and 11 placebo patients completed the study. Mean PPD decreased 0.34 mm [95% confidence interval (CI) 0.19–0.49] in the placebo and 0.80 mm (CI 0.57–1.04) in the test group after 6 months. For mean CAL gain, the correspondent figures were 0.29 (CI 0.08–0.49) and 0.76 (CI 0.46–1.05), respectively. The frequency of detection of P. gingivalis decreased significantly (p0.01) in the test group after 1, 3 and 6 months.

Conclusions: Within the limitations of this study, the adjunctive use of systemic azithromycin in the treatment of P. gingivalis periodontitis demonstrated significant clinical and microbiological benefits when compared with SRP plus placebo.
Osteotome sinus floor elevation technique without grafting: a 5‐year prospective study
Authors: Nedir Rabah , Nurdin Nathalie , Vazquez Lydia , Szmukler‐Moncler Serge , Bischof Mark , Bernard Jean‐Pierre
Published: August 2010

Nedir R, Nurdin N, Vazquez L, Szmukler‐Moncler S, Bischof M, Bernard J‐P. Osteotome sinus floor elevation technique without grafting: a 5‐year prospective study. J Clin Peridontol 2010; 37: 1023–1028. doi: 10.1111/j.1600‐051X.2010.01610.x.

Aim: To evaluate the long‐term stability of peri‐implant bone formation following implant placement without grafting into resorbed posterior maxillae.

Materials and Methods: Twenty‐five implants of 10 mm were placed in 17 patients to rehabilitate atrophic maxillae by means of an osteotome sinus floor elevation (OSFE) procedure without grafting. Mean residual bone height was 5.4±2.3 mm. Bone levels were evaluated at 1, 3 and 5 years using periapical radiographs.

Results: All implants fulfilled survival criteria and gained peri‐implant bone (mean increase 3.2±1.3 mm). Implant protrusion into the sinus decreased from 4.9±1.9 mm after surgery to 1.5±0.9 mm after 5 years. Mean crestal bone loss amounting to 0.8±0.8 mm stabilized over the 5‐year observation interval. Twenty implants showed additional peri‐implant bone gain following the 1‐year control.

Conclusions: Implant rehabilitation of atrophic maxillae may be greatly simplified using implants 10 mm and the OSFE technique without grafting. Grafting material is not needed to gain at least 3 mm of bone in the atrophic maxilla. The procedure appears predictable with favourable long‐term results.
Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24‐month randomized clinical trial
Authors: Casarin Renato Corrêa Viana , Del Peloso Ribeiro Érica , Nociti Francisco Humberto , Sallum Antônio Wilson , Ambrosano Gláucia Maria Bovi , Sallum Enilson Antônio , Casati Márcio Zaffalon
Published: August 2010

Casarin RCV, Ribeiro ÉDP, Nociti Jr FH, Sallum AW, Ambrosano GMB, Sallum EA, Casati MZ: Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24‐month randomized clinical trial. J Clin Periodontol 2010; doi: 10.1111/j.1600‐051X.2010.01614.x.

Objective: This study aimed to evaluate the response of proximal furcations treated with enamel matrix derivative proteins (EMD) in a 24‐month follow‐up.

Materials and Methods: Twelve patients presenting bilateral class II proximal furcation with vertical probing depth (PD)5 mm and bleeding on probing were selected. The furcations were assigned to: a control group (n=12), open flap debridement (OFD)+EDTA and a test group (n=12) – OFD+EDTA+EMD. The gingival margin position, PD, relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated before treatment and after 6, 12 and 24 months.

Results: After follow‐up, no statistical difference could be seen between groups. At 24 months, the test group showed 1.9 ± 1.6 mm PD reduction whereas the control group showed 1.0 ± 1.3 mm PD reduction. RHCAL gains of the control and the test group were 0.7 ± 1.3 and 1.4 ± 0.9 mm, respectively. However, at 24 months, the test group only presented five remaining class II furcations versus 10 furcations in the control group (p<0.05).

Conclusion: It could be concluded that EMD therapy promoted a reduction in the number of proximal furcations presenting a diagnosis of class II after 24 months of treatment compared with OFD therapy.
Public awareness of oral cancer, of oral potentially malignant disorders and of their risk factors in some rural populations in Sri Lanka
Authors: Amarasinghe Hemantha K. , Usgodaarachchi Udaya S. , Johnson Newell W. , Lalloo Ratilal , Warnakulasuriya Saman
Published: August 2010

Amarasinghe HK, Usgodaarachchi US, Johnson NW, Lalloo R, Warnakulasuriya S. Public awareness of oral cancer, of oral potentially malignant disorders and of their risk factors in some rural populations in Sri Lanka. Community Dent Oral Epidemiol 2010; 38: 540–548. © 2010 John Wiley & Sons A/S

Abstract – Objective:  The aim of this study was to investigate the level of public awareness of oral cancer, of oral potentially malignant disorders (OPMD) and of risk factors for developing these diseases in a province of Sri Lanka, a country with one of the highest incidences of these diseases in the world.

Methods:  A cross‐sectional community‐based survey was carried out in Sabaragamuwa province by interviewing 1029 subjects above 30 years of age, over a 1‐year period from November 2006.

Results:  The level of public awareness of oral cancer was 84%, but only 23% for OPMD. Awareness was especially poor in low socioeconomic groups. The majority of subjects were not aware of the symptoms of oral cancer and of OPMD. Thirty‐two percent were unaware that chewing betel quid was a risk factor for these diseases, as were 65% for tobacco smoking and 81% for heavy consumption of alcohol. Overall, 76% were not aware of any of the dangers inherent in the frequent use of areca nut. The majority of smokers, betel quid chewers and alcohol consumers were not aware that their lifestyles were placing their long‐term health at serious risk.

Conclusions:  Knowledge of oral cancer, OPMD and their associated risk factors was poor among this population, indicating an urgent need to implement public health education and promotion strategies.
Parameters associated with active caries lesions assessed by two different visual scoring systems on occlusal surfaces of primary molars – a multilevel approach
Authors: Braga Mariana M. , Martignon Stefania , Ekstrand Kim R. , Ricketts David N.J. , Imparato José Carlos P. , Mendes Fausto M.
Published: August 2010

Braga MM, Martignon S, Ekstrand KR, Ricketts DNJ, Imparato JCP, Mendes FM. Parameters associated with active caries lesions assessed by two different visual scoring systems on occlusal surfaces of primary molars – a multilevel approach. Community Dent Oral Epidemiol 2010; 38: 549–558. © 2010 John Wiley & Sons A/S

Abstract – Objective:  The aim of this in vivo study was to evaluate the association between several parameters related to children and to their teeth, and the presence of active carious lesions assessed by two different visual indices on occlusal surfaces of primary molars.

Methods:  Occlusal surfaces of 757 primary molars in 139 children (3–12 years old) were classified as sound, or having inactive or active carious lesions using the Nyvad criteria (NY) and the International Caries Detection and Assessment System (ICDAS‐II) and a supplemental lesion activity assessment system (ICDAS‐LAA). Several parameters related to the tooth and to the child were recorded. Associations between these parameters and the presence of active carious lesions on occlusal surfaces were evaluated using logistic multilevel analysis.

Results:  Second primary molar teeth and children with high caries experience were more frequently with active occlusal carious lesions compared to sound and inactive occlusal carious lesions classified by both visual scoring systems. Teeth with a mature dental plaque on the occlusal surface and younger children had more active caries than inactive occlusal carious lesions (excluding sound teeth in the analysis). A previous visit to a dentist was related to a lower frequency of active occlusal carious lesions classified by NY only, and upper primary molars presented with higher numbers of active occlusal carious lesions classified by ICDAS‐LAA.

Conclusions:  Presence of mature dental plaque and tooth type are tooth‐related variables associated with active carious lesions on occlusal surfaces of primary teeth, as well as anterior caries experience and age are variables related to the child.