bluuebunny/crossref_metadata_2025 huggingface dataset:
Granule Exocytosis Contributes to Priming and Activation of the Human Neutrophil Respiratory Burst
Authors: Uriarte Silvia M. , Rane Madhavi J. , Luerman Gregory C. , Barati Michelle T. , Ward Richard A. , Nauseef William M. , McLeish Kenneth R.
Published: June 2011

The role of exocytosis in the human neutrophil respiratory burst was determined using a fusion protein (TAT–SNAP-23) containing the HIV transactivator of transcription (TAT) cell-penetrating sequence and the N-terminal SNARE domain of synaptosome-associated protein-23 (SNAP-23). This agent inhibited stimulated exocytosis of secretory vesicles and gelatinase and specific granules but not azurophil granules. GST pulldown showed that TAT–SNAP-23 bound to the combination of vesicle-associated membrane protein-2 and syntaxin-4 but not to either individually. TAT–SNAP-23 reduced phagocytosis-stimulated hydrogen peroxide production by 60% without affecting phagocytosis or generation of HOCl within phagosomes. TAT–SNAP-23 had no effect on fMLF-stimulated superoxide release but significantly inhibited priming of this response by TNF-α and platelet-activating factor. Pretreatment with TAT–SNAP-23 inhibited the increase in plasma membrane expression of gp91phox in TNF-α–primed neutrophils, whereas TNF-α activation of ERK1/2 and p38 MAPK was not affected. The data demonstrate that neutrophil granule exocytosis contributes to phagocytosis-induced respiratory burst activity and plays a critical role in priming of the respiratory burst by increasing expression of membrane components of the NADPH oxidase.
Alternative Pathway Activation of Complement by Shiga Toxin Promotes Exuberant C3a Formation That Triggers Microvascular Thrombosis
Authors: Morigi Marina , Galbusera Miriam , Gastoldi Sara , Locatelli Monica , Buelli Simona , Pezzotta Anna , Pagani Chiara , Noris Marina , Gobbi Marco , Stravalaci Matteo , Rottoli Daniela , Tedesco Francesco , Remuzzi Giuseppe , Zoja Carlamaria
Published: June 2011

Shiga toxin (Stx)-producing E.coli O157:H7 has become a global threat to public health; it is a primary cause of diarrhea-associated hemolytic uremic syndrome (HUS), a disorder of thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure with thrombi occluding renal microcirculation. In this study, we explored whether Stx triggers complement-dependent microvascular thrombosis in in vitro and in vivo experimental settings of HUS. Stx induced on human microvascular endothelial cell surface the expression of P-selectin, which bound and activated C3 via the alternative pathway, leading to thrombus formation under flow. In the search for mechanisms linking complement activation and thrombosis, we found that exuberant complement activation in response to Stx generated an increased amount of C3a that caused further endothelial P-selectin expression, thrombomodulin (TM) loss, and thrombus formation. In a murine model of HUS obtained by coinjection of Stx2 and LPS and characterized by thrombocytopenia and renal dysfunction, upregulation of glomerular endothelial P-selectin was associated with C3 and fibrin(ogen) deposits, platelet clumps, and reduced TM expression. Treatment with anti–P-selectin Ab limited glomerular C3 accumulation. Factor B-deficient mice after Stx2/LPS exhibited less thrombocytopenia and were protected against glomerular abnormalities and renal function impairment, indicating the involvement of complement activation via the alternative pathway in the glomerular thrombotic process in HUS mice. The functional role of C3a was documented by data showing that glomerular fibrin(ogen), platelet clumps, and TM loss were markedly decreased in HUS mice receiving C3aR antagonist. These results identify Stx-induced complement activation, via P-selectin, as a key mechanism of C3a-dependent microvascular thrombosis in diarrhea-associated HUS.
Genetic Polymorphism of Cancer Susceptibility Genes and HPV Infection in Cervical Carcinogenesis
Authors: Nunobiki Osamu , Ueda Masatsugu , Toji Eisaku , Yamamoto Michiko , Akashi Kyoko , Sato Naomi , Izuma Shinji , Torii Kiyo , Tanaka Ichiro , Okamoto Yoshiaki , Noda Sadamu
Published: May 2011

It is widely accepted that specific human papillomavirus (HPV) types are the central etiologic agent of cervical carcinogenesis. However, a number of infected women do not develop invasive lesions, suggesting that other environmental and host factors may play decisive roles in the persistence of HPV infection and further malignant conversion of cervical epithelium. Although many previous reports have focused on HPV and environmental factors, the role of host susceptibility to cervical carcinogenesis is largely unknown. Here, we review the findings of genetic association studies in cervical carcinogenesis with special reference to polymorphisms of glutathione-S-transferase (GST) isoforms, p53 codon 72, murine double-minute 2 homolog (MDM2) gene promoter 309, and FAS gene promoter -670 together with HPV types including our recent research results.
Application of Asymetrical and Hoke Designs for Optimization of Laccase Production by the White-Rot Fungus Fomes fomentarius in Solid-State Fermentation
Authors: Neifar Mohamed , Kamoun Amel , Jaouani Atef , Ellouze-Ghorbel Raoudha , Ellouze-Chaabouni Semia
Published: May 2011

Statistical approaches were employed for the optimization of different cultural parameters for the production of laccase by the white rot fungus Fomes fomentarius MUCL 35117 in wheat bran-based solid medium. first, screening of production parameters was performed using an asymmetrical design 2533//16, and the variables with statistically significant effects on laccase production were identified. Second, inoculum size, CaCl2 concentration, CuSO4 concentration, and incubation time were selected for further optimization studies using a Hoke design. The application of the response surface methodology allows us to determine a set of optimal conditions (CaCl2, 5.5 mg/gs, CuSO4, 2.5 mg/gs, inoculum size, 3 fungal discs (6 mm Ø), and 13 days of static cultivation). Experiments carried out under these conditions led to a laccase production yield of 150 U/g dry substrate.
Voltammetric Detection of Dopamine in Presence of Ascorbic Acid and Uric Acid at Poly (Xylenol Orange) Film-Coated Graphite Pencil Electrode
Authors: Chandra Umesh , Kumara Swamy B. E. , Gilbert Ongera , Sherigara B. S.
Published: May 2011

Poly (xylenol orange) film-coated graphite pencil electrode was fabricated for the detection of dopamine in the presence of ascorbic acid and uric acid in phosphate buffer solution of pH 7. The redox peaks obtained at modified electrode shows a good enhancement. The scan rate effect was found to be a diffusion-controlled electrode process. The electrochemical oxidation of dopamine was depended on pH, and the limit of detection was found to be 9.1×10−8 M. The simultaneous study gave and excellent result with great potential difference between dopamine and other bioactive organic molecules by using both cyclic voltammetric and differential pulse voltammetric techniques. The present modified graphite electrode was applied to the detection of dopamine in the injection samples, and the recovery obtained was satisfactory.
Comparison of Measured Creatinine Clearance and Clearances Estimated by Cockcroft-Gault and MDRD Formulas in Patients with a Single Kidney
Authors: Ferreira-Filho Sebastião Rodrigues , Cardoso Camila Caetano , de Castro Luiz Augusto Vieira , Oliveira Ricardo Mendes , Sá Renata Rodrigues
Published: May 2011

There are doubts about whether the values obtained from the Cockroft-Gault (ClCG) and Modification of Diet in Renal Disease (GFRMDRD) formulas are comparable to the more traditional formula used to obtain the creatinine clearance from a 24-hour urine collection (ClCrm), particularly in patients with only one kidney. The present study aimed to compare these formulas in individuals with one remaining kidney after previous nephrectomy (Nx) and to verify which estimated formula correlates more closely with ClCrm. Thirty-six patients who had undergone Nx had their renal filtration analyzed with ClCG, GFRMDRDand by ClCrm. The average time after Nx was years, and the average age at the time of the study was years old (X ± SD). The results of three clearances were  mL·min·m2for ClCrm, mL·min·m2for ClCrCG, and mL·min·m2for GFRMDRD(with ClCrm> ClCrCGand GFRMDRD; ). No difference was found between the ClCrCGand GFRMDRDvalues (). The data demonstrated that both estimate formulas were strongly correlated with ClCrm, although ClCrCGwas more closely associated with ClCrmthan GFRMDRD(ClCrCGwith and GFRMDRDwith ; ). In conclusion, for people with only one kidney remaining after NX, our data showed that glomerular filtration rate estimation by ClCrCGis more related to the values obtained with the traditional clearance measurement based on a 24-hour urine collection test.
Effects of Concentration of Organically Modified Nanoclay on Properties of Sulfonated Poly(vinyl alcohol) Nanocomposite Membranes
Authors: Sanglimsuwan Apiradee , Seeponkai Narumon , Wootthikanokkhan Jatuphorn
Published: May 2011

Electrolyte nanocomposite membranes for proton exchange membrane fuel cells and direct methanol fuel cells were prepared by carrying out a sulfonation of poly(vinyl alcohol) with sulfosuccinic acid and adding a type of organically modified montmorillonite (layered silicate nanoclay) commercially known as Cloisite 93A. The effects of the different concentrations (0, 2, 4, 6, 8 wt. %) of the organoclay in the membranes on water uptake, ion exchange capacity (IEC), proton conductivity, and methanol permeability were measured, respectively, via gravimetry, titration, impedance analysis, and gas chromatography techniques. The IEC values remained constant for all concentrations. Water uptakes and proton conductivities of the nanocomposite membranes changed with the clay content in a nonlinear fashion. While all the nanocomposite membranes had lower methanol permeability than Nafion115, the 6% concentration of Cloisite 93A in sulfonated poly(vinyl alcohol) membrane displayed the greatest proton conductivity to methanol permeability ratio.
Diffuse Pulmonary Infiltrates in an Old Man with Chronic Lymphocytic Leukemia
Authors: Hosseinnezhad Alireza , Seguel Joseph M. , Villanueva Andrew G
Published: May 2011

An 82-year-old man known case of chronic lymphocytic leukemia (CLL) presented with fever and weakness. He had never received any treatment for his CLL in the past. On admission he was found to be in mild respiratory distress with bilateral crackles and had markedly elevated white blood count (WBC) (137 K/uL with 93% lymphocytes). His respiratory status deteriorated necessitating noninvasive ventilatory support. Chest computed tomography (CT) scan revealed bilateral diffuse ground glass opacities, so broad spectrum antibiotic therapy was initiated. Despite that, he remained febrile and cultures were all negative. Chest x-rays showed progressive worsening of diffuse alveolar opacities. Bronchoalveolar lavage (BAL) was negative for infectious etiologies, however flow cytometry of the fluid was consistent with CLL. Chemotherapy with chlorambucil was started. Although most of the pulmonary infiltrates in CLL patients are due to infectious causes, leukemic cells infiltration should be considered as well in CLL patients with respiratory symptoms who do not respond appropriately to standard antimicrobial regimen.
Die kerk en mense op straat in die informele behuisingsgebiede in Mangaung/Bloemfontein
Authors: Verster Pieter
Published: May 2011

The challenges posed by informal settlements are enormous, also in the Bloemfontein/ Mangaung area. The question asked in this article was how the church can reach out to people on the streets and in the informal settlements. Research was conducted to establish the views of the church and the task it has from randomly approached people on the streets. The Bible speaks positively on the task of the people of Israel and the church to reach out to foreigners. The church in informal settlements should see the people on the streets as its responsibility. A very important aspect is to gain structures in the informal community for the churches to be present in a more concrete way. Although the church remains the people of God and is not limited to structures, the presence of structures can in many ways enhance the positive help and influence of the church in the community; even to the people on the streets.
Enforcing Quality Metrics over Equipment Utilization Rates as Means to Reduce Centers for Medicare and Medicaid Services Imaging Costs and Improve Quality of Care
Authors: Sura Amit , Ho Alexander
Published: May 2011

Radiology has been the focus of efforts to reduce inefficiencies while attempting to lower medical costs. The 2010 Medicare Physician Fee Schedule has reduced Centers for Medicare and Medicaid Services’ (CMS) reimbursements related to the technical component of imaging services. By increasing the utilization rate, the cost of equipment spreads over more studies, thus lowering the payments per procedure. Is it beneficial for CMS to focus on equipment utilization as a cost-cutting measure? Can greater financial and quality of care rewards be made by improving metrics like appropriateness criteria and pre-authorization?

On examining quality metrics, such as appropriateness criteria and pre-authorization, promising results have ensued. The development and enforcement of appropriateness criteria lowers overutilization of studies without requiring unattainable fixed rates. Pre-authorization educates ordering physicians as to when imaging is indicated.
The Fetal Magnetic Resonance Imaging Experience in a Large Community Medical Center
Authors: Ghobrial Peter M , Levy Rebecca A , O’Connor Stephen C
Published: May 2011

Fetal magnetic resonance imaging (MRI) continues to prove a useful problem solving tool for diagnostic and management decision making issues encountered in the antenatal period. In this paper, we attempt to review basic fetal MRI protocol considerations and demonstrate key imaging findings through multiple modalities, with pathologic correlation in several cases. A study of five fetal MRI cases, from our institution, were selected in order to highlight both the indications for, and benefits obtained from this advanced imaging technique. Fetal MRI proved useful in each case in better defining fetal anomalies, especially where ultrasound (due to drawbacks such as shadowing by pelvic bones) was unable to be completely diagnostic. The more in-depth study made possible by MRI also helped with formulation of disease prognosis and estimation of survival chances of the fetus. Further, MRI as a diagnostic and prognostic tool has become more ubiquitous across the medical community. This imparts tangible benefit to patients, who are now able to find this service within arm's reach. Whereas previously these patients were obligatorily referred up to 90 miles away from our centre for further medical work-up, now a large percentage can obtain their prenatal imaging and perinatal care locally. In addition, medical education benefits as new types of cases, those with pathology of the antenatal period, are retained for work-up and management in these large community settings. Cases from our institution exemplify these types of pathologies, from fetal chest masses to a syndromic presentation of bilateral renal agenesis.
Social Support and Hope among Egyptian Women with Breast Cancer after Mastectomy
Authors: Denewer Adel , Farouk Omar , Mostafa We'am , Elshamy Karima
Published: May 2011

Introduction

Breast cancer is the most common cancer among Egyptian women. We report the unique assessment of hope and social support outcomes of women with breast cancer after mastectomy in Egyptian community.

Patients and methods

Between July 2009 and June 2010, three hundred and one women with newly diagnosed breast cancer joined this study. Socio-demographic data including patient's age, level of education, occupation, social status, and residence were collected by means of structured interviews based on special questionnaires. These questionnaires were designed to measure hope and social support.

Results

Age ranged from 21 to 88 years (median = 45.8 years and SD ± 13.3). A low degree of hope was reported in 103 patients (34.2%), a moderate degree in 109 patients (36.2%), and a high degree in 89 patients (29.6%). A low degree of social support was reported in 119 patients (39.5%), a moderate degree in 101 patients (33.6%), and a high degree in 81 patients (26.9%).

Conclusions

Social support is related to many psychological factors, which can be quantitatively analyzed and it can predict hope. However, there were no significant differences between the socio-demographic variables (age, educational levels, residence and martial status) and social support, hope, and their sub-components among Egyptian women with breast cancer.
An Unusual Case of Hypercalcemia Associated with Graves’ Disease and Vitamin D Deficiency
Authors: Korytnaya Evgenia , Rao Nagashree Gundu , Mayrin Jane V.
Published: May 2011

Objective

To present a case of hypercalcemia associated with thyrotoxicosis in a patient with vitamin D deficiency and review biochemical changes during the course of treatment.

Methods

We report a case, describe the changes in serum calcium, phosphorus, parathyroid hormone in Graves’ disease and concomitant Vitamin D deficiency. We compare our findings to those reported in literature.

Results

Our patient had hypercalcemia secondary to thyrotoxicosis alone, which was confirmed by low parathyroid hormone level and resolution of hypercalcemia with treatment of thyrotoxicosis. The case was complicated by a concomitant vitamin D deficiency. Serum calcium elevation in patients with thyrotoxicosis occurs secondary to hyperthyroidism alone or due to concurrent hyperparathyroidism. Hypercalcemia from thyrotoxicosis is usually asymptomatic and is related to bone resorption. Vitamin D deficiency can be seen in patients with thyrotoxicosis because of accelerated metabolism, poor intestinal absorption and increased demand during bone restoration phase. Coexistence of hypercalcemia and Vitamin D deficiency in patients with thyrotoxicosis is rare, but possible, and 25-hydroxyvitamin D levels should be checked. The definite treatment for hypercalcemia in thyrotoxicosis is correction of thyroid function.

Conclusion

Hypercalcemia in thyrotoxicosis should be distinguished from concomitant hyperparathyroidism and confirmed by resolution of hypercalcemia with control of thyrotoxicosis. Patients with hypercalcemia and thyrotoxicosis may also have vitamin D deficiency and 25-OH Vitamin D levels should be checked.
On the Existence of the Graded Exponent for Finite Dimensional ℤp-graded Algebras
Authors: Di Vincenzo Onofrio M. , Nardozza Vincenzo
Published: May 2011

Let F be an algebraically closed field of characteristic zero, and let A be an associative unitary F-algebra graded by a group of prime order. We prove that if A is finite dimensional then the graded exponent of A exists and is an integer.
Symptoms of Oral Submucosal Fibrosis: Our Experience with Intralesional Injection Treatment
Authors: Dhond PV , Yadav Rajesh , Mittal Mudit , Kant Shashi
Published: May 2011

Objective

This study evaluates the symptoms and effects of peroral intralesional injections in relieving the symptoms of oral submucosal fibrosis (OSMF) in our clinical settings.

Study design

Retrospective clinical review at a primary care hospital of 32 patients with extensive OSMF who underwent peroral intralesional injections of steroid, hyaluronidase, placentrex and lignocaine performed in office setting.

Results

The main symptoms were change in color of buccal mucosa, trismus, burning mouth, vesicles in oral cavity. All patients experienced considerable improvement in their symptoms over a duration of 2 to 6 weeks.

Conclusions

Though, a large number of Indian population is suffering and seeking treatment for OSMF, unfortunately not much has been done in this area. It is difficult to find studies on peroral intralesional injection technique. When there is lack of reliable evidence of oral submucosal fibrosis treatment, the old technique of peroral intralesion shots of steroid, hyaluronidase, placentrex in lignocaine is safe and effective in resolving the symptoms associated with OSMF. The therapy is very cost effective and also reduces the need of surgery.
Polymorphous Low-grade Adenocarcinoma of the Palate: Report of a Case and Review of Literature
Authors: Gupta Siddharth , Kumar C Anand , Raghav Namita
Published: May 2011

Polymorphous low-grade adenocarcinoma (PLGA) is a malignancy arising predominantly from minor salivary glands. PLGAs account for 10% of all tumors and 25% of all malignancies of the minor salivary glands. It has been frequently described as occurring in hard or soft palate minor salivary glands; some cases being described in the tongue and in major salivary glands. We report a case of PLGA of the palate extending into the maxillary sinus and nasal cavity diagnosed on the basis of histopathology and treated by subtotal maxillectomy. The review of literature concerning clinical, histological and immunohistochemical features, as well as the proper management concerning this tumor is included.
Primary Small Cell Carcinoma of Nasal Cavity Presenting as Unilateral Blindness
Authors: Chauhan Ashutosh , Chakarborty NC , Nath Pramod , Ganguly Manomoy
Published: May 2011

Primary sinonasal small cell carcinomas are extremely rare lesions. We present a case of 29-year-old male patient, who initially presented with recurrent right sided nasal obstruction and occasional epistaxis, but came to medical attention when he developed progressive deterioration of vision in ipsilateral eye. Radiological examination showed a tumor with epicenter in right nasal cavity with extensive local infiltration. The histopathology picture and immunohistochemistry profile of the tumor showed it to be a primary small cell neuroendocrine tumor. Extensive imaging studies revealed no other site of primary. He was treated with induction chemotherapy followed by concomitant chemoradiotherapy. Complete clinical response was seen and the patient has been disease free since last 20 months. The report discusses the diagnostic criteria which differentiates this extremely rare but aggressive tumor from a much more common and more indolent tumor, esthesioneuroblastoma.
Spontaneous Small Bowel Perforations in Patients Receiving Radiotherapy or Chemotherapy for Advanced Head and Neck Cancer
Authors: Sidramesh Muttagi , Chaturvedi Pankaj
Published: May 2011

Gastroduodenal perforations are known to occur due to various causes. However, such problems involving small bowel and manifesting spontaneously, especially in a head and neck cancer patient, undergoing chemoradiation has never been described in the literature. We report three cases of head and neck cancer that were undergoing treatment (one case curative and two cases palliative), during which small bowel perforation manifested requiring urgent surgical intervention. We seek to highlight this problem, so as to ascertain the possible mechanisms of its causation, identify a group of patients at risk, evolve possible preventive strategies and facilitate earlier diagnosis and treatment.
Pediatric Infraorbital Nerve Schwannoma: A Rare Clinical Entity
Authors: Raviraj GA , Rony Thomas , Dhanraj GA , Rao Vishal US
Published: May 2011

This report elaborates a rare case of infraorbital nerve Schwannoma in an 8-year-old boy who presented with the recurrent progressively increasing swelling over the right cheek following initial treatment. The mass was excised surgically via a facial approach. Infraorbital nerve sheath tumors occurring in the pediatric age are rare and can be often mistaken for infectious causes in this age group. Surgery remains the mainstay of treatment in these tumors. Early diagnosis and prompt surgical treatment can serve to minimize the treatment related morbidity arising from multiple interventions while avoiding undue apprehension. Pediatric infraorbital schwannomas, although a rare entity, should be considered in the differential diagnosis of long standing pediatric facial swellings.
To Assess the Effectiveness of Self-Instructional Module on Knowledge regarding Effect of Massage Therapy in Reducing Labor Pain
Authors: Raddi Sudha A , Kaur Simer Preet
Published: June 2011

Objectives

To assess the knowledge of 3rd year GNM students regarding effect of massage therapy in reducing labor pain before and after the implementation of self-instructional module. To evaluate the effect of self-instructional module in enhancing the knowledge of 3rd year GNM students regarding the effect of massage therapy in reducing labor pain and to compare the knowledge of samples regarding the effect of massage therapy in reducing labor pain in relation to selected demographic variables (age at 12th std. education, medium of 12th std. education, percentage of 1st and 2nd year GNM exam, number of attempts, location of house and mother education).

Methods

The research approach for the study was that of an evaluative one with one group pre- and post-test design. The sample size considered for the study was 50 general nursing and midwifery students. The sampling technique used for the study was convenience sampling, which is a type of nonprobability sampling. The tool used for gathering relevant data was a structured questionnaire on knowledge of effect of massage therapy in reducing labor pain.

Results

Analysis of data was done on the basis of objectives and hypotheses. Data analysis of level of knowledge revealed that during pretest, no student had highly adequate knowledge of effect of massage therapy on labor pain, 9 (18%) had moderately adequate knowledge, while 41(82%) had inadequate knowledge. It was worth noting during post-test, where no student had inadequate knowledge and majority of 50 (100%) had highly adequate knowledge. While assessing the effectiveness of the structured instructional module on effect of massage therapy on labor pain, the pre-test and post-test data analysis by using Wilcoxon signed rank test revealed the mean post-test score (27.88 ± 1.27) was higher than the mean pre-test score (13.14 ± 2.93). Since the calculated z-value was 6.16 and p-value was 0.00, thus proving that p < 0.05 (data was analyzed using SPSS software).

Conclusions

Based on the analyses, the following inference was drawn. There was evident increase in the knowledge scores in all the areas included in the study after the administration of self-instructional module. Thus, it was inferred that the structured teaching program was effective and while the knowledge gain score is commendable, there is still room for improvement.
Pruritic Urticarial Papules and Plaques of Pregnancy Developing in a Gravida having Overt Diabetes with Hypothyroidism, Pre-eclampsia and Anemia
Authors: Munikrishna M , Shashidhar B
Published: June 2011

Specific dermatoses of pregnancy refer to a group of skin diseases that are encountered predominantly during or immediately following pregnancy. This is a case report of pruritic urticarial papules and plaques of pregnancy developing in a 29-year-old lady primigravida lady is associated with overt diabetes with hypothyroidism, pre-eclampsia and anemia. The diagnosis of PUPPP is a clinical one, as the histopathology is often nonspecific and the direct immunofluorescence is negative. She responded to treatment with antipruritic topical medication, topical steroid and oral antihistamine. Prompt and effective management is very important in decreasing maternal and fetal mortality and morbidity when we come across a pregnant mother with multiple problems.
Successful Outcome following Antepartum Amnioinfusion in Pregnancy Complicated with Severe Oligohydramnios with APLA Syndrome
Authors: Kumar Sunesh , Karmakar Debjyoti , Singla Shilpa , Singh Neeta , Roy Kallol K
Published: June 2011

Objective

This case was reported to highlight an alternative form of management for patients, including amnioinfusion as one of the tools in an uncommon setting.

Methods

Transabdominal amnioinfusion was done in the patient at 24 weeks for severe oligohydramnios without PPROM. At 26 weeks she was found to be APLAS. Patient was also started on enoxaparin and low dose aspirin.

Results

Pregnancy continued till 36 weeks with delivery of healthy fetus.

Conclusion

Our excellent outcome for the patient having marked oligohydramnios with amnioinfusion along with LMWH clearly underlines the place for such procedures in selected cases.
Ethics in Obstetric Ultrasound: The Past 25 Years in Perspective
Authors: McCullough Laurence B , Chervenak Frank A
Published: May 2011

Ethics is an essential component of obstetric ultrasound, an area in which the authors have collaborated for the past 25 years. The authors describe their collaboration. They then present one of the core ethical concepts of obstetric ultrasound: The ethical concept of the fetus as a patient. Next, they present one of the clearest clinical applications of ethics to obstetric ultrasound: Autonomy-enhancing strategies. The authors hope that these two paradigms will convince the reader that ethics is an essential dimension of obstetric ultrasound and stimulate further interest.
Fetal Brain Function: Lessons Learned and Future Challenges of 4D Sonography
Authors: Kadic Aida Salihagic , Predojevic Maja
Published: May 2011

Maturation of the central nervous system (CNS) is reflected in fetal behavior. Modern technology, such as four-dimensional (4D) sonography improved assessment of fetal behavior in all three trimesters of pregnancy. After summing our own experiences and experiences of the leading authors in the field of fetal and neonatal neurology, new prenatal screening test for assessment of fetal behavior has been suggested. Test was named Kurjak antenatal neurodevelopmental test (KANET). Up to now results of KANET are encouraging and they have been published in several prominent journals. Nevertheless, potential of KANET in the assessment of integrity of the fetal central nervous system needs to be confirmed by studies that are in progress in several world university centers.
Analysis of Quality of Nuchal Translucency Measurements
Authors: Echevarria Mónica , Comas Carmen , Serra Bernat , Rodríguez Ignacio , Sabrià Joan
Published: May 2011

Objective

Quantitative analysis of the quality of nuchal translucency (NT) measurements.

Methods

This is a retrospective single-center study. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians (October 2003-November 2009). The performance of NT measurements was analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown-rump length (CRL) values and FMF certification was statistically tested.

Results

A total of 14,978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0.98. (2) Mean percentage of cases >95th and <5th percentiles were 5.0 and 4.2% respectively. (3) Logarithmic mean and SD of the NT-MoM values were 0.00 and 0.13 respectively. (4) The DR for trisomy 21 at screening time was 90.7% for a FPR of 6.7% for standard screening strategy. (5) According to cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. Operator experience, exclusive dedication to FM, FMF certification and a range of CRL values > 60 mm had a statistical impact improving these standards.

Conclusion

Overall quality standards show optimal NT measurements in our unit. Experience a dedicated profile to fetal medicine ultrasound, CRL over 60 mm and FMF certification has a significant positive impact on the quality standards.
Integrated Screening for Chromosomal Anomalies: Strategies in Developing Countries
Authors: Rao Jai Prakash
Published: May 2011

Ultrasound screening has advantages over maternal serum screening. These include confirmation of embryo viability, accurate assessment of gestational age, early diagnosis of multiple pregnancies and identification of chorionicity, the detection of major structural abnormalities, major defects of the heart and great arteries, skeletal dysplasias and genetic syndrome and measurement of NT thickness in assessing the risk for Down's syndrome. Nuchal translucency (NT) has emerged as the most sensitive ultrasound marker for detection of chromosomal anomalies in the first trimester. However, the use of ultrasound in routine screening still faces problems with reliability and quality control. Combination of maternal age, NT and first and biochemical second-trimester markers is known as the integrated test. A major goal of screening tests is to achieve high detection rate and low false-positive rate at a low cost. The integrated test best meets these criteria. It could achieve a detection rate of 85% for a false-positive rate of 1.2%. It has a much better positive predictive value and, therefore, fewer amniocentesis and fewer losses of normal fetuses. Only screen-positive cases could be taken for invasive testing.
Ductus Venosus: A Love Story of 14 Years
Authors: Montenegro Nuno , Matias Alexandra
Published: May 2011

Ductus venosus is a tiny vessel with a central role in fetal circulation. Combining B-mode with color and pulsed Doppler is feasible to identify this vessel and evaluate the blood flow waveform at 11 to 13 weeks. The higher prevalence of abnormal A-wave in fetuses with abnormal karyotype and/or cardiac defects turned DV evaluation into a useful marker for chromosomal abnormalities and cardiopathies. Even when combined with nuchal translucency (NT) or biochemical markers, DV blood flow evaluation contributes to an increase in sensitivity and reduces false-positive rate. Abnormal ductal flow is also related to a worse fetal and perinatal outcome. In monochorionic twin pregnancies, in addition to NT measurement at 11 to 14 weeks, the Doppler assessment of DV blood flow increases relevantly the performance of screening for those at higher risk of developing twin-to-twin transfusion syndrome. This story of 14 years surely contributed to change the way first trimester screening is being implemented.
Skeletal Dysplasia
Authors: Antsaklis Aris , Anastasakis Eleftherios
Published: May 2011

The word dysplasia originates from the ancient Greek words dys (anomalous) and plasia (formation). Skeletal dysplasia (SD) is a heterogeneous group of congenital anomalies characterized by abnormalities in the development of bone and cartilage tissues. These diseases may present either in the form of isolated findings or a phenotypic manifestation of a chromosomal aberration or a genetic disorder. Prenatal diagnosis is mainly on the ultrasonographic appearance, which is usually achieved during the second trimester of pregnancy. Two-dimensional ultrasonography may detect the majority of SD, however, difficulties in the diagnosis as well as the differential diagnosis are frequently arising. In such cases, further evaluation is needed by the use of additional imaging modalities or by invasive procedures, in order to detect an underlying chromosomal abnormality or a single gene disorder. Accurate diagnosis is crucial in order to establish successful genetic counseling as well as appropriate case management. This approach includes the use of three-dimensional ultrasonography and three-dimensional computed tomography; whereas fetal magnetic resonance imaging is less important. These new imaging modalities have an important role in the prenatal multidisciplinary approach of the diagnosis of SD. Despite the indisputable progress that has been achieved during the last few years, in some cases, the antenatal detection of SD delays and is feasible only at the late second or even third trimester. Thus, important ethical and medical issues arise in the antenatal management and counseling of these pregnancies, particularly in the case of lethal SD.
From Fetal Imaging to Pediatric Gynecology Imaging in a 22-Year Span
Authors: Almirante Corazon Yabes
Published: May 2011

A review of the ultrasound experiences of the author since 1989 up to the present. Ultrasound pictures taken for fetal and pediatric gynecology imaging are presented. The impact of ultrasound examination is the improvement of perinatal outcome and diagnosis and management of gynecological problems of children, thus preserving their future fertility.
Hypotensive Anesthesia with Propofol Infusion Pump: A Boon for Endoscopic Sinus and Nasal Polyps Surgery
Authors: Naik Sudhir M , Naik Sarika S
Published: June 2011

Background

Successful outcome of endoscopic sinus surgery depends on complete visualization of the operative field and intraoperative control of bleeding. Major disadvantage of general anesthesia is the increased bleeding encountered, which can interfere with optimum visualization of the intranasal anatomy unless hypotensive methods are used.

Objectives

To study the different anesthetic techniques in relation to their impact on blood loss and duration of surgery. The role of propofol was also evaluated.

Design

Department of Anesthesia and ENT, Head and Neck Surgery, KVG Medical College and Hospital, Sullia, Karnataka, India.

Materials and methods

213 cases of endoscopic sinus surgeries done for nasal polyposis, sinusitis, dacryocystitis and septorhinoplasties under local and general anesthesia were evaluated between June 2009 and August 2010.

Result

A good operative field was seen with propofol anesthesia compared to halothane anesthesia. The problems of fogging and frequent suctioning were lesser with propofol hypotensive anesthesia.

Conclusion

Hypotensive anesthesia using propofol infusion is the anesthesia of choice for extensive nasal polyposis. Propofol when used both for induction as well as maintenance of general anesthesia in endoscopic sinus surgeries significantly reduces the blood loss, thereby improving the visibility of the endonasal structures and minimizes the chance of complications related to endoscopic sinus surgery.
A Study of External Nasal Splints used in Nasal Bone Fractures and Rhinoplasties
Authors: Naik Sudhir , Naik Sudhir M
Published: June 2011

Background/Objectives

Plaster of Paris (POP), thermoplastic splints and self-adhesive padded aluminium splints are the most common splinting methods used after reduction of fractured nasal bones and rhinoplasty. All these methods have their proponents but may have one or more disadvantages in the way of being cumbersome, time-consuming, bulky, conspicuous and expensive.

Design

A retrospective study at KVG Medical College and Hospital, department of ENT and head and neck surgery.

Intervention

94 cases of splinting done for nasal bone fractures and rhinoplasties were included in our study. POP and adhesive aluminium splints were used to stabilize the nasal framework.

Results

Eleven cases of nondislocated nasal fractures and 10 cases of internal augmentation rhinoplasties were stabilized by aluminium nasal splints. 69 cases of displaced nasal fractures and 4 cases of external rhinoplasties were stabilized by POP splints.

Conclusions

POP splints give the best stabilization for nasal bone fractures as well as for rhinoplasties but are bulky and conspicuous. Aluminium nasal splints are not bulky and conspicuous but cannot be used for fractures with lacerations and external rhinoplasties.
On the behaviour of the tropopause folding events over the Tibetan Plateau
Authors: Chen X. L. , Ma Y. M. , Kelder H. , Su Z. , Yang K.
Published: May 2011

Abstract. Due to its harsh natural conditions, there had not been any intensive radiosonde observations over the Tibetan Plateau (TP) before the year 2008, when a regional radiosonde observation network was implemented through a Sino-Japan joint cooperation project. This paper reports, on the basis of these observations, on an analysis of the structure of upper troposphere and lower stratosphere (UTLS) and provides observations of stratosphere and troposphere exchange (STE) over the TP. Due to sparseness of high resolution radiosonde data, many previous studies assumed that there was only one thermal tropopause over the TP. Actually, the radiosonde temperature profiles in winter time over the TP often exhibit a multiple tropopause (MT). The MT occurs in winter with a high frequency over the Plateau. MT events during this time are associated with tropopause folds near the subtropical westerly jet. The MT consistently varied with the movement of the jet. The MT becomes a single tropopause with the development of the monsoon. The detailed analyses of MT characteristics are reported in this paper. Earlier analyses of global MT events (with data based on GPS radio occultation, ERA-40 data and Integrated Global Radiosonde Archive database) resulted in a climatic frequency of MT occurrences in the winter season over the Plateau is not more than 40 %. Based on high resolution data of intensive radiosonde observations, our estimations of MT occurrence over the Plateau can be as high as 80 % during certain winters. This reminds us to pay more attention to the MT events above the Plateau. The influence of the coarse vertical resolution and other effects on the estimation of MT occurrence frequency are also discussed. The stratospheric intruding episodes are generally associated with the presence of subtropical jet stream over the Plateau. The complex structure of dynamic tropopause folding over the Plateau have been reflected by the thermal MT events observed by radiosondes. The intrusion of air masses from the stratosphere may contribute to a higher upper tropospheric ozone concentration in winter than in summer above the plateau.
Impact of deep convection on the tropical tropopause layer composition in Equatorial Brazil
Authors: Marécal V. , Krysztofiak G. , Mébarki Y. , Catoire V. , Lott F. , Attié J.-L. , Arteta J. , Deeter M. N. , Freitas S. R. , Longo K. M. , Renard J.-B. , Robert C.
Published: May 2011

Abstract. This paper documents measurements of carbon monoxide (CO), ozone (O3) and temperature in the tropical tropopause layer over Equatorial Brazil for the first time. These measurements were sampled by the balloon-borne instrument SPIRALE (Spectroscopie Infa-Rouge par Absorption de Lasers Embarqués) in June 2005 and in June 2008, both at the transition period from wet to dry season. The height of the Tropical Tropopause Layer (TTL) top and bottom determined from the chemical species profiles are similar for the two flights. Nevertheless the measured profiles of ozone and CO are different in their volume mixing ratio and shape. The larger CO values measured in the TTL in 2005 can be linked to a more intense biomass burning activity in 2005 than in 2008. We also show that both measured profiles are influenced by convection but in different ways leading to different shapes. The CO profile in 2005 is characterised by a generally smooth decrease in the TTL from tropospheric to stratospheric conditions, except for two layers of enhanced CO around 14.2 (>100 parts per billion by volume = ppbv) and 16.3 km altitude (>85 ppbv). Backward trajectories indicate that these layers come from the vertical transport by remote deep convection occurring 2 and 3 days prior to the flight, respectively. This shows that the transition period from wet to dry season is favourable for the transport of significant amounts of CO in the TTL, sometimes above the level of zero radiative heating, because of increasing biomass burning together with decaying but still important convective activity. In 2008 we focus our analysis on a 1 km deep layer, between 17 and 18 km, where both the temperature and the ozone profiles are uniform in the vertical, corresponding to a layer of well-mixed air. We show that this unusual behaviour is indirectly related to the interaction between convection and the Quasi-Biennial Oscillation (QBO), through vertically propagating gravity waves. Quasi-stationary gravity waves are likely to be produced by convective systems and certainly break in the intense wind shear that imposes the QBO at these altitudes. This conclusion is supported by the fact that the 16–18 km layer is devoid of ice particles (hence the mixing is not convective) and from backward trajectories that point towards a convective region as the origin of the air masses in this layer.
Observation of a mesospheric front in a dual duct over King George Island, Antarctica
Authors: Bageston J. V. , Wrasse C. M. , Batista P. P. , Hibbins R. E. , Fritts D. C. , Gobbi D. , Andrioli V. F.
Published: May 2011

Abstract. A mesospheric bore was observed with an all-sky airglow imager on the night of 9–10 July 2007 at Ferraz Station (62° S, 58° W), located on King George island on the Antarctic Peninsula. The observed bore propagated from southwest to northeast with a well defined wave front and a series of crests behind the main front. There was no evidence of dissipation during its propagation within the field of view. The wave parameters were obtained via a 2-D Fourier transform of the imager data providing a horizontal wavelength of 33 km, an observed period of 6 min, and a horizontal phase speed of 92 m s−1. Simultaneous mesospheric winds were measured with a medium frequency (MF) radar at Rothera Station (68° S, 68° W) and temperature profiles were obtained from the SABER instrument on the TIMED satellite. These wind and temperature profiles were used to estimate the propagation environment of the bore. A wavelet technique was applied to the wind in the plane of bore propagation at the OH emission height spanning three days centered on the bore event to define the dominant periodicities. Results revealed a dominance of near-inertial periods, and semi-diurnal and terdiurnal tides suggesting that the ducting structure enabling bore propagation occurred on large spatial scales. The observed tidal motions were used to reconstruct the winds employing a least-squares method, which were then compared to the observed ducting environment. Results suggest an important contribution of large-scale winds to the ducting structure, but with buoyancy frequency variations in the vertical also expected to be important. These results allow us to conclude that the bore was supported by a duct including contributions from both winds and temperature (or stability). A co-located airglow temperature imager operated simultaneously with the all-sky imager confirmed that the bore event was the dominant small-scale wave event during the analysis interval.
Tropospheric and total ozone columns over Paris (France) measured using medium-resolution ground-based solar-absorption Fourier-transform infrared spectroscopy
Authors: Viatte C. , Gaubert B. , Eremenko M. , Hase F. , Schneider M. , Blumenstock T. , Ray M. , Chelin P. , Flaud J.-M. , Orphal J.
Published: May 2011

Abstract. Ground-based Fourier-transform infrared (FTIR) solar absorption spectroscopy is a powerful remote sensing technique providing information on the vertical distribution of various atmospheric constituents. This work presents the first evaluation of a mid-resolution ground-based FTIR to measure tropospheric ozone, independently of stratospheric ozone. This is demonstrated using a new atmospheric observatory (named OASIS for "Observations of the Atmosphere by Solar absorption Infrared Spectroscopy"), installed in Créteil (France). Indeed, the information content of OASIS ozone retrievals is clearly sufficient to monitor separately tropospheric (from the surface up to 8 km) and stratospheric ozone. Daily mean tropospheric ozone columns derived from the Infrared Atmospheric Sounding Interferometer (IASI) and from OASIS measurements have been compared for summer 2009 and a good agreement of −5.6 (±16.1) % is observed. Also, a qualitative comparison between in-situ surface ozone measurements and OASIS data clearly shows OASIS's capacity to monitor seasonal tropospheric ozone variations, as well as ozone pollution episodes in summer 2009 around Paris. Two extreme pollution events were identified (on the 1 July and 6 August 2009) for which ozone partial columns from OASIS and predictions from a regional air-quality model (CHIMERE) were compared by respecting temporal and spatial coincidence criteria. Quantitatively, an average bias of 0.2 %, a mean square error deviation of 7.6 %, and a correlation coefficient of 0.91 was found between CHIMERE and OASIS. This demonstrates that a mid-resolution FTIR instrument in ground-based solar absorption geometry is a promising technique for monitoring tropospheric ozone.