bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics of intraductal papillary mucinous neoplasm manifesting as acute pancreatitis or acute recurrent pancreatitis
Authors: Jang Ji Woong , Kim Myung‐Hwan , Jeong Seung Uk , Kim Jeongseok , Park Do Hyun , Lee Sang Soo , Seo Dong‐Wan , Lee Sung‐Koo , Kim Jin Hee
Published: January 2013

Background and Aim

Comparatively little is known about acute pancreatitis or acute recurrent pancreatitis (AP/ARP) with intraductal papillary mucinous neoplasm of the pancreas (IPMN) as the causative lesion although there have been many reports about the malignant potential of IPMN as a premalignant lesion.

Methods

From 2000 to 2008, in a single tertiary referral center, out of 784 patients coded by the International Classification of Disease‐10 with IPMN, 489 patients fulfilled our diagnostic criteria of IPMN. After careful exclusion of all known causes of AP/ARP, 34 patients with IPMN as the cause of AP/ARP were enrolled.

Results

AP/ARP caused by IPMN occurred in 34 (7%) out of 488 patients with IPMN, and the prevalence rate of AP/ARP was higher in the main‐duct/combined type than in the branch‐duct type (14% [16/111] vs 5% [18/378], respectively, P = 0.002). The severity of pancreatitis was mild, based on the computed tomography severity index score (median 2, range 0–4). Histologic review of 24 patients with surgical resection revealed four adenomas (17%), 17 borderline malignancies (71%), two carcinomas in situ (8%), and one invasive carcinoma (4%). AP/ARP did not recur in any of the 24 surgically resected patients during the follow‐up period (median 52 months, range 38–115 months).

Conclusions

AP/ARP caused by IPMN was of infrequent occurrence. AP/ARP caused by IPMN occurred more frequently in the main‐duct/combined type than in the branch‐duct type. Most cases were mild in severity and benign in histopathology. AP/ARP can be an initial manifestation of IPMN, though uncommon, which leads to diagnosis.
Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy
Authors: Rochon Paula A. , Gruneir Andrea , Gill Sudeep S. , Wu Wei , Fischer Hadas D. , Bronskill Susan E. , Normand Sharon‐Lise T. , Austin Peter C. , Seitz Dallas P. , Bell Chaim M. , Fu Longdi , Lipscombe Lorraine , Anderson Geoffrey M. , Gurwitz Jerry H.
Published: January 2013

Objectives

To understand how drug therapy differently affects older women and men.

Design

Population‐based, retrospective cohort study.

Setting

Ontario, Canada.

Participants

Twenty‐one thousand five hundred twenty‐six older adults (13,760 women, 7,766 men) with dementia newly started on oral atypical antipsychotic therapy between April 1, 2007, and March 1, 2010.

Measurements

Numbers and rates of serious events. Serious events were defined as a hospital admission or death within 30 days of treatment initiation. Unadjusted and adjusted odds ratios of women and men were compared in the full cohort and in strata based on setting of care, age, Charlson Comorbidity Index (CCI), and antipsychotic dose.

Results

Of 21,526 older adults with a median age of 84, 1,889 (8.8%) had a serious event (1,044 women, 7.6%; 845 men, 10.9%). Of these, 363 women (2.6%) and 355 men (4.6%) died. Men were more likely than women to be hospitalized or die during the 30‐day follow‐up period (adjusted odds ratio = 1.47, 95% confidence interval = 1.33–1.62) and consistently more likely to experience a serious event in each stratum. A gradient of risk according to drug dose was found for the development of a serious event in women and men.

Conclusion

The risk of developing a serious event shortly after the initiation of antipsychotic therapy was high in women and men with dementia but was consistently higher in older men. This pattern remained the same in strata based on setting of care, age, CCI, and antipsychotic dose.
High Blood Pressure and Cognitive Decline in Mild Cognitive Impairment
Authors: Goldstein Felicia C. , Levey Allan I. , Steenland N. Kyle
Published: January 2013

Objectives

To determine whether high blood pressure (BP) levels are associated with faster decline in specific cognitive domains.

Design

Prospective longitudinal cohort.

Setting

Uniform Data Set of the National Institutes of Health, National Institute on Aging Alzheimer's Disease Centers.

Participants

One thousand three hundred eighty‐five participants with a diagnosis of mild cognitive impairment (MCI) and measured BP values at baseline and two annual follow‐up visits.

Measurements

Neuropsychological test scores and Clinical Dementia Rating Sum of Boxes (CDR Sum) score.

Results

Participants with MCI with two or three annual occasions of high BP values (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) had significantly faster decline on neuropsychological measures of visuomotor sequencing, set shifting, and naming than those who were normotensive on all three occasions. High systolic BP values were associated as well with faster decline on the CDR Sum score.

Conclusion

Hypertension is associated with faster cognitive decline in persons at risk for dementia.
Subunit‐dependent inhibition and potentiation of 5‐HT3 receptor by the anticancer drug, topotecan
Authors: Nakamura Yukiko , Ishida Yusuke , Yamada Takahiro , Kondo Makoto , Shimada Shoichi
Published: January 2013

The 5‐hydroxytryptamine (serotonin, 5‐HT) type 3 (5‐HT3) receptor belongs to the superfamily of Cys‐loop ligand‐gated ion channels, and can be either homopentameric (5‐HT3A) or heteropentameric (5‐HT3AB) receptor. Several modulators are known, which either inhibit or potentiate this channel, but few have any appreciable selectivity between the two subtypes or can modulate one receptor differently to the other. In this study, we show that the anticancer drug, topotecan, bidirectionally modulates the 5‐HT3 receptor using a two‐electrode voltage clamp technique. Topotecan inhibited 5‐HT‐gated current through homomeric 5‐HT3A receptors. Interestingly, however, additional expression of the 5‐HT3B subunit changed the response to topotecan dramatically from an inhibitory to a potentiatory one. This effect was dependent on the level of 5‐HT3B subunit expression. Moreover, the effect was reduced in the receptors containing the 5‐HT3B(Y129S) polymorphic variant. These finding could explain individual differences in the sensitivity to topotecan‐induced nausea and vomiting.
Convincing Yourself to Care About Others: An Intervention for Enhancing Benevolence Values
Authors: Arieli Sharon , Grant Adam M. , Sagiv Lilach
Published: January 2013

To study value change, this research presents an intervention with multiple exercises designed to instigate change through both effortful and automatic routes. Aiming to increase the importance attributed to benevolence values, which reflect the motivation to help and care for others, the intervention combines three mechanisms for value change (self‐persuasion, consistency‐maintenance, and priming). In three experiments, 142 undergraduates (67% male, ages 19–26) participated in an intervention emphasizing the importance of either helping others (benevolence condition) or recognizing flexibility in personality (control condition). We measured the importance of benevolence values before and after the task. In Experiment 1, the intervention increased U.S. participants' benevolence values. In Experiment 2, we replicated these effects in a different culture (Israel) and also showed that by enhancing benevolence values, the intervention increased participants' willingness to volunteer to help others. Experiment 3 showed that the increases in the importance of benevolence values lasted at least 4 weeks. Our results provide evidence that value change does not require fictitious feedback or information about social norms, but can occur through a 30‐min intervention that evokes both effortful and automatic processes.
Comparative pharmacokinetics of a tumour-targeting therapy candidate rh-IFNα2a–NGR with rh-IFNα2a administered intravenously in mice and rats
Authors: Wang Xue-Xi , Lu Li , Song Chun-Li , Qian Wei-Na , Zhang Sheng-Yan , Zhang Ying-Qi , Wu Yong-Jie
Published: January 2013

Objectives

rh-IFNα2a-NGR is a promising anti-tumor candidate. The aim of present study was to compare pharmacokinetics of rh-IFNα2a-NGR with rh-IFNα2a.

Methods

Pharmacokinetics and elimination were investigated after intravenous administration to mice and rats. Compared tumor and tissue distribution profiles between rh-IFNα2a-NGR and rh-IFNα2a were illustrated in the tumor transplanted mice of SP2/0 myeloma. Double antibody sandwich ELISA method was used to assess the level of both rh-IFNα2a-NGR and rh-IFNα2a in serum, tissue, bile and urine.

Key findings

After a single intravenous administration, the pharmacokinetic characters of rh-IFNα2a-NGR and rh-IFNα2a were described using a two-compartment model. No significant differences were observed between the two drugs in pharmacokinetic and elimination data. However, the concentration of rh-IFNα2a-NGR in tumor was 5.34 times and 1.52 times as high as that of rh-IFNα2a at 0.5 h (P < 0.01) and 1 h. In addition, immunohistochemical stain displayed rh-IFNα2a-NGR was predominantly located in tumor vascular tissues.

Conclusions

rh-IFNα2a-NGR could be an agent for tumor vascular-targeting therapy and these findings provided references for further clinical study.
Reproductive response of fat‐tailed Barbarine ewes subjected to short‐term nutritional treatments including spineless cactus (Opuntia ficus‐indica f. inermis) cladodes
Authors: Sakly C. , Rekik M. , Ben Salem I. , Lassoued N. , Gonzalez‐Bulnes A. , Ben Salem H.
Published: January 2013

Reproductive outputs in fat‐tailed Barbarine sheep in central Tunisia are often low because of feed shortage and the low nutritive value of diets. Supplementation with conventional concentrates is economically unsuitable in central Tunisia, so more cost‐effective and sustainable alternative feeding strategies need to be developed. We tested effects of short‐term nutritional treatments including cactus cladodes during the induction of ‘male effect’ on fertility and prolificacy parameters (follicular growth, ovulatory response and early embryo losses). One hundred and twenty ewes were distributed in 4 equal groups balanced for live weight grazed natural pastures and were supplemented for 21 days, starting day 10 after introduction of rams, with cactus cladodes (CA), cactus cladodes and soybean meal (CAS), concentrate (CC) or only soybean meal (S). Nutritional treatment did not affect live weight in this experiment. Ewes receiving cactus had higher number of large pre‐ovulatory follicles (≥6 mm; 1.08 ± 0.05), between days 14 and 19 after introduction of rams, than females in the CC and S ewes (0.64 ± 0.06; p < 0.05). However, there were no differences in the onset of oestrous behaviour in response to ‘male effect’ or in the number of corpora lutea. Average ovulation rates were 1.42 ± 0.16 for CC, 1.47 ± 0.13 for CAS, 1.31 ± 0.15 for CA and 1.31 ± 0.13 for S groups respectively. Finally, reproductive wastages at day 35 after mating were not different between groups being 0.33 ± 0.19 for CC, 0.60 ± 0.17 for CAS, 0.43 ± 0.16 for CA and 0.31 ± 0.15 for S groups respectively. It is concluded that Barbarine ewes fed nutritional treatments including cactus performed similarly to those receiving diets including conventional concentrate feeds.
Pharmacokinetics of ganciclovir and valganciclovir in the adult horse
Authors: Carmichael R. J. , Whitfield C. , Maxwell L. K.
Published: January 2013

Equine herpes myeloencephalopathy, resulting from equine herpes virus type 1 (EHV‐1) infection, is associated with substantial morbidity and mortality in the horse. As compared to other antiviral drugs, such as acyclovir, ganciclovir has enhanced potency againstEHV‐1. This study investigated the pharmacokinetics of ganciclovir and its oral prodrug, valganciclovir, in six adult horses in a randomized cross‐over design. Ganciclovir sodium was administered intravenously as a slow bolus at a dose of 2.5 mg/kg, and valganciclovir was administered orally at a dose of 1800 mg per horse. Intravenously administered ganciclovir disposition was best described by a three‐compartment model with a prolonged terminal half‐life of 72 ± 9 h. Following the oral administration of valganciclovir, the mean observed maximum serum ganciclovir concentration was 0.58 ± 0.37 μg/mL, and bioavailability of ganciclovir from oral valganciclovir was 41 ± 20%. Superposition predicted that oral dosing of 1800‐mg valganciclovir two times daily would fail to produce and maintain effective plasma concentrations of ganciclovir. However, superposition suggested that i.v. administration of ganciclovir at 2.5 mg/kg every 8 h for 24 h followed by maintenance dosing of 2.5 mg/kg every 12 h would maintain effective ganciclovir serum concentrations in most horses throughout the dosing interval.
Deformation and melting of steel projectiles in hypervelocity cratering experiments
Authors: KENKMANN T. , TRULLENQUE G. , DEUTSCH A. , HECHT L. , EBERT M. , SALGE T. , SCHÄFER F. , THOMA K.
Published: January 2013

Abstract– We carried out hypervelocity cratering experiments with steel projectiles and sandstone targets to investigate the structural and mineralogical changes that occur upon impact in the projectile and target. The masses of coherent projectile relics that were recovered in different experiments ranged between 58% and 92% of their initial projectile masses. A significant trend between impact energy, the presence of water in the target, and the mass of projectile relics could not be found. However, projectile fragmentation seems to be enhanced if the target contains substantial amounts of water. Two experiments that were performed with 1 cm sized steel projectiles impacting at 3400 and 5300 m s−1 vertically onto dry Seeberger sandstone were investigated in detail. The recovered projectiles are intensely plastically deformed. Deformation mechanisms include dislocation glide and dislocation creep. The latter led to the formation of subgrains and micrometer‐sized dynamically recrystallized grains. In case of the 5300 m s−1 impact experiment, this deformation is followed by grain annealing. In addition, brittle fracturing and friction‐controlled melting at the surface along with melting and boiling of iron and silica were observed in both experiments. We estimated that heating and melting of the projectile impacting at 5300 m s−1 consumed 4.4% of the total impact energy and was converted into thermal energy and heat of fusion. Beside the formation of centimeter‐sized projectile relics, projectile matter is distributed in the ejecta as spherules, unmelted fragments, and intermingled iron‐silica aggregates.
Examining the Role of Mitochondria in Ca2+ Signaling in Native Vascular Smooth Muscle
Authors: McCarron John G. , Olson Marnie L. , Wilson Calum , Sandison Mairi E. , Chalmers Susan
Published: January 2013

Mitochondrial Ca2+ uptake contributes important feedback controls to limit the time course of Ca2+signals. Mitochondria regulate cytosolic [Ca2+] over an exceptional breath of concentrations (~200 nM to >10 μM) to provide a wide dynamic range in the control of Ca2+ signals. Ca2+ uptake is achieved by passing the ion down the electrochemical gradient, across the inner mitochondria membrane, which itself arises from the export of protons. The proton export process is efficient and on average there are less than three protons free within the mitochondrial matrix. To study mitochondrial function, the most common approaches are to alter the proton gradient and to measure the electrochemical gradient. However, drugs which alter the mitochondrial proton gradient may have substantial off target effects that necessitate careful consideration when interpreting their effect on Ca2+ signals. Measurement of the mitochondrial electrochemical gradient is most often performed using membrane potential sensitive fluorophores. However, the signals arising from these fluorophores have a complex relationship with the electrochemical gradient and are altered by changes in plasma membrane potential. Care is again needed in interpreting results. This review provides a brief description of some of the methods commonly used to alter and measure mitochondrial contribution to Ca2+ signaling in native smooth muscle.
Qualitative Iranian study of parents' roles in adolescent girls' physical activity habit development
Authors: Hosseini Seyyed Vahide , Anoosheh Monireh , Abbaszadeh Abbas , Ehsani Mohammad
Published: January 2013

Parents are likely to be key influences on children's physical activity behaviors, although it is not clear how. This study was designed to explore parents' roles in Iranian adolescent girls' physical activity habit development. A qualitative study was conducted by means of semistructured one‐to‐one interviews with 25 participants, including 16 adolescent girls (10–19 years of age), seven mothers, and two fathers. Content analysis was applied. Two main themes emerged as parental role in adolescent girls' physical activity behavior: developing interest in physical activity (making children familiar with physical activity, discovering talents, and role modeling) and providing support to adolescents for physical activity (material and immaterial). This study provided a better understanding of how Iranian parents influence their children's physical activity behavior. This will enable nurses to design more effective family‐based interventions.
Self‐efficacy, self‐care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: A cross‐sectional survey
Authors: Wu Shu‐Fang Vivienne , Huang Yi‐Ching , Lee Mei‐Chen , Wang Tsae‐Jyy , Tung Heng‐Hsin , Wu Meng‐Ping
Published: January 2013

The relationships between self‐efficacy, self‐care behavior, anxiety, and depression for Taiwanese individuals with type 2 diabetes were determined in this study. Depression and anxiety are common symptoms that can contribute toward adverse medical outcomes. A descriptive, cross‐sectional, correlational design was used. The sample comprised 201 patients with type 2 diabetes from diabetes outpatient clinics at three teaching hospitals in Taiwan. The results of this study revealed that people with diabetes who had received diabetes health education, regularly made clinical visits, underwent treatment, and did not smoke demonstrated a high self‐efficacy score (P < 0.05). Self‐efficacy among people with diabetes positively correlated with illness duration (P < 0.05), treatment (P < 0.01), and self‐care behavior (P < 0.01). Self‐efficacy among people with diabetes negatively correlated with anxiety and depression (P < 0.01). Self‐efficacy can be a predictor of anxiety and depression (P < 0.01). This study revealed that enhancing self‐efficacy levels might reduce anxiety and depression. Self‐efficacy‐enhancing programs should be held regularly in clinical practices. Conducting psychological research on diabetes drives policy and healthcare system change.
Gene‐for‐gene relationship in the host–pathogen system Malus × robusta 5–Erwinia amylovora
Authors: Vogt Isabelle , Wöhner Thomas , Richter Klaus , Flachowsky Henryk , Sundin George W. , Wensing Annette , Savory Elizabeth A. , Geider Klaus , Day Brad , Hanke Magda‐Viola , Peil Andreas
Published: January 2013

Fire blight is a destructive bacterial disease caused by Erwinia amylovora affecting plants in the family Rosaceae, including apple. Host resistance to fire blight is present mainly in accessions of Malus spp. and is thought to be quantitative in this pathosystem.

In this study we analyzed the importance of the E. amylovora effector avrRpt2EA, a homolog of Pseudomonas syringae avrRpt2, for resistance of Malus × robusta 5 (Mr5).

The deletion mutant E. amylovora Ea1189ΔavrRpt2EA was able to overcome the fire blight resistance of Mr5. One single nucleotide polymorphism (SNP), resulting in an exchange of cysteine to serine in the encoded protein, was detected in avrRpt2EA of several Erwinia strains differing in virulence to Mr5. E. amylovora strains encoding serine (S‐allele) were able to overcome resistance of Mr5, whereas strains encoding cysteine (C‐allele) were not. Allele specificity was also observed in a coexpression assay with Arabidopsis thaliana RIN4 in Nicotiana benthamiana. A homolog of RIN4 has been detected and isolated in Mr5.

These results suggest a system similar to the interaction of RPS2 from A. thaliana and AvrRpt2 from P. syringae with RIN4 as guard. Our data are suggestive of a gene‐for‐gene relationship for the host–pathogen system Mr5 and E. amylovora.
The Impact of Hemodialysis on the Dispersion of Ventricular Repolarization
Authors: KALANTZI KALLIRROI , GOUVA CHARA , LETSAS KONSTANTINOS P. , VLACHOPANOU APHRODITE , FOULIDIS VALERIOS , BECHLIOULIS ARIS , KATOPODIS KONSTANTINOS P. , GOUDEVENOS JOHN A. , KORANTZOPOULOS PANAGIOTIS
Published: January 2013

Background

Sudden cardiac death is prevalent in chronic hemodialysis (HD) patients while the dialysis process may have arrhythmogenic potential. We sought to examine the effect of HD on conventional electrocardiographic parameters as well as on novel indexes of repolarization, given that increased spatial dispersion of repolarization is related to ventricular arrhythmias.

Methods

We recorded clinical, echocardiographic, and laboratory parameters as well as electrocardiographic indexes before and after a single HD session. Specifically, we calculated the QTc interval, the QRS duration, the T peak‐to‐end (Tpe) interval, and the Tpe/QT ratio.

Results

The study population consisted of 66 chronic HD patients (mean age: 68.9 ± 11.8 years, 40 males). Heart rate, blood pressure, QRS duration, QTc interval, and QT dispersion did not change significantly after the HD session. However, the Tpe interval and the Tpe/QT ratio increased significantly (80 [65–90] ms vs 85 [77.5–100] ms; P = 0.04, and 0.21 [0.18–0.24] vs 0.25 [0.21–0.28]; P = 0.05, respectively). Correlation analysis and multiple regression analysis failed to show significant associations between the baseline parameters and the baseline values of Tpe and Tpe/QT or between the change of the laboratory parameters during HD and the corresponding change of the Tpe and the Tpe/QT values. No significant arrhythmias were observed during the HD sessions.

Conclusions

HD induces an increase in novel markers of spatial dispersion of ventricular repolarization. Whether the assessment of these indexes of heterogeneity of repolarization at baseline or their change during HD has a prognostic value with regard to future untoward events, remains to be elucidated.
Efficacy of Lower Limb Compression in the Management of Vasovagal Syncope—Randomized, Crossover Study
Authors: SANTOS RAFAEL QUEIROZ DOS , SMIDT LUIS , SUZIGAN BRUNA HELENA , DE SOUZA LUCAS VIEIRA , BARBISAN JUAREZ NEUHAUS
Published: January 2013

Introduction

Vasovagal syncope (VS) is the most prevalent cause of transient loss of consciousness. The treatment consists of lifestyle modifications and pacemaker in some patients. The purpose of this study is to evaluate the effect of measures to compress the lower limbs in patients with recurrent episodes of VS submitted to the tilt‐test (TT).

Methods and Results

Twenty patients, average age 30.5 years (15–75), 13 (65%) female, with a clinical diagnosis of VS and previous TT with a positive result and who had at least one episode of syncope during the last year, were included in this placebo‐controlled randomized crossover study. The patients underwent two consecutive TT, at a 1‐hour interval, with and without compression by pneumatic compression boots with 40 mmHg at the heels and 30 mmHg for the legs. The blood pressure (BP) and heart rate (HR) of these patients were monitored continuously. The outcome assessors were blinded. The results of the TT were positive in 13 (65%) of the patients in the control groups and in two (10%) of the patients with compression (P < 0.0001). Throughout the test, the systolic BP was not different among the groups. On the other hand, the HR measures showed a difference only in the tilted position at 2 minutes, of 73 ± 16 beats per minute (bpm) in the control group and of 69 ± 16 bpm (P = 0.047) in the compression group.

Conclusion

Compression of the lower limbs is very effective to render the TT negative in patients with a diagnosis of VS.
QRS Duration Changes in Patients with Hypoplastic Left Heart Syndrome Undergoing Hybrid Palliation: Prehybrid to Post‐Fontan
Authors: TSAI SHANE , HUSAIN NAZIA , FISCHER ABIGAIL , RO PAMELA S. , CHEATHAM JOHN P. , GALANTOWICZ MARK , CUA CLIFFORD L.
Published: January 2013

Background

QRS prolongation has been shown to be a predictor of mortality in patients with certain forms of congenital heart disease. QRS changes have not been well described in patients with single ventricle physiology, particularly in those undergoing the hybrid procedure.

Objective

To describe QRS changes in a cohort of patients with hypoplastic left heart syndrome (HLHS) who underwent hybrid palliation and to evaluate if QRS duration is associated with mortality.

Methods

Chart review of 54 patients with HLHS who underwent hybrid procedure between 2002 and 2009 was performed. Patients awaiting surgical palliation were excluded. Patients who survived Fontan completion (HLHS‐S, n = 30) were compared to non‐survivor (HLHS‐NS, n = 24). Electrocardiograms were reviewed for maximal QRS duration (ms) at three pre‐ and postsurgical stages: (1) hybrid procedure, (2) comprehensive stage 2 procedure, and (3) Fontan procedure.

Results

In HLHS‐S, there was a significant increase in QRS from birth to Fontan completion (15.6 ± 9.3 ms). QRS duration increased 8.5 ± 8.9 ms between posthybrid to precomprehensive stage 2, and 5.4 ± 9.7 ms between postcomprehensive stage 2 to Fontan. Following Fontan procedure, mean QRS decreased 4.3 ± 8.5 ms. There was no significant mean difference in QRS change between HLHS‐S and HLHS‐NS following hybrid procedure. Pre‐ and posthybrid and pre‐ and postcomprehensive stage 2 QRS durations were not different between HLHS‐S and HLHS‐NS who underwent a comprehensive stage 2 procedure. There was a significant difference in QRS difference following comprehensive stage 2 in HLHS‐S (0.9 ± 7.1 ms) compared to HLHS‐NS (−7.1 ± 10.0 ms).

Conclusions

QRS duration significantly increased from hybrid to Fontan completion in HLHS‐S. There was a significant decrease in QRS duration in patients who died following comprehensive stage 2 procedure. Larger studies are needed to assess the significance of these QRS changes.
Percutaneous Radiofrequency Ablation of the Splanchnic Nerves in Patients with Chronic Pancreatitis: Results of Single and Repeated Procedures in 11 Patients
Authors: Verhaegh Bas P.M. , van Kleef Maarten , Geurts José W. , Puylaert Martine , van Zundert Jan , Kessels Alphons G.H. , Masclee Ad A.M. , Keulemans Yolande C.A.
Published: January 2013

Background

Pain is a major problem for chronic pancreatitis (CP) patients. Unfortunately, medical therapy often fails. Endoscopic and surgical treatments are invasive, and results vary. Percutaneous radiofrequency ablation of the splanchnic nerves (RFSN) is a relatively new and minimally invasive procedure for treatment of intractable pain in CP patients.

Materials and Methods

We retrospectively evaluated 18 RFSN procedures in 11 CP patients, all refractory to analgesics. Five patients underwent a second procedure; two patients underwent a third procedure. NRS pain scores were assessed. Complications, analgesics usage, and length of the pain‐free period were recorded.

Results

Radiofrequency ablation of the splanchnic nerves was effective in 15/18 interventions. The mean NRS pain score decreased from 7.7 ± 1.0 to 2.8 ± 2.7 (P ≤ 0.001). The pain‐free period lasted for a median period of 45 weeks. The effect of repeated interventions was comparable to the initial procedure. One transient side effect was reported. Four patients reported significantly reduced analgesic usage; 4 patients completely stopped their pain medication.

Conclusion

Radiofrequency ablation of the splanchnic nerves is a minimally invasive, effective procedure for pain relief. After the effect has subsided, RFSN can be successfully repeated. RFSN might become an alternative treatment in a selected group of CP patients. A larger, randomized trial is justified to substantiate these findings.
Control limits for accumulation of plant metabolites: brute force is no substitute for understanding
Authors: Morandini Piero
Published: January 2013

Which factors limit metabolite accumulation in plant cells? Are theories on flux control effective at explaining the results? Many biotechnologists cling to the idea that every pathway has a rate limiting enzyme and target such enzymes first in order to modulate fluxes. This often translates into large effects on metabolite concentration, but disappointing small increases in flux. Rate limiting enzymes do exist, but are rare and quite opposite to what predicted by biochemistry. In many cases however, flux control is shared among many enzymes. Flux control and concentration control can (and must) be distinguished and quantified for effective manipulation. Flux control for several ‘building blocks’ of metabolism is placed on the demand side, and therefore increasing demand can be very successful. Tampering with supply, particularly desensitizing supply enzymes, is usually not very effective, if not dangerous, because supply regulatory mechanisms function to control metabolite homeostasis. Some important, but usually unnoticed, metabolic constraints shape the responses of metabolic systems to manipulation: mass conservation, cellular resource allocation and, most prominently, energy supply, particularly in heterotrophic tissues. The theoretical basis for this view shall be explored with recent examples gathered from the manipulation of several metabolites (vitamins, carotenoids, amino acids, sugars, fatty acids, polyhydroxyalkanoates, fructans and sugar alcohols). Some guiding principles are suggested for an even more successful engineering of plant metabolism.
Development and validation of the K‐VSCOR for scoring Koebner's phenomenon in vitiligo/non‐segmental vitiligo
Authors: Diallo Abou , Boniface Katia , Jouary Thomas , Seneschal Julien , Morice‐Picard Fanny , Prey Sorilla , Cario‐André Muriel , Mazereeuw‐Hautier Juliette , Taieb Alain , Ezzedine Khaled
Published: January 2013

The relation of vitiligo/non‐segmental vitiligo (NSV) to Koebner's phenomenon is variably appreciated. Our objective was to develop and validate a simple clinical score for Koebner's phenomenon (KP) in patients with vitiligo/NSV. The study population was composed of 351 individuals in the development sample and 285 patients in the validation sample. Seven variables were independently associated with the presence of KP: disease duration of more than 3 yr, forehead + scalp areas, eyelids, wrists, genital + belt areas, knees and tibial crests. The score computed by the weighted sum of the rounded coefficients of these seven variables ranged from 0 to 56 (mean 38.39 ± 22.93). The probability of having KP was computed as follows: exp (−2.37 + 0.1*score)/exp [1 + (−2.37 + 0.1*score)]. When applying the score to each patient in the validation and the development sample, the score maintained adequate discrimination and calibration (AUC‐ROC = 0.78), arguing that KP can be adequately predicted using our score. Further studies should evaluate KP assessed by the K‐VSCOR in clinical practice with the aim to determine its association with clinical profile, course and treatment response of vitiligo.
Foot posture is associated with morphometry of the peroneus longus muscle, tibialis anterior tendon, and Achilles tendon
Authors: Murley G. S. , Tan J. M. , Edwards R. M. , De Luca J. , Munteanu S. E. , Cook J. L.
Published: January 2013

The aim of this study was to investigate the association between foot type and the morphometry of selected muscles and tendons of the lower limb. Sixty‐one healthy participants (31 male, 30 female; aged 27.1 ± 8.8 years) underwent gray‐scale musculoskeletal ultrasound examination to determine the anterior‐posterior (AP) thickness of tibialis anterior, tibialis posterior, and peroneus longus muscles and tendons as well as the Achilles tendon. Foot type was classified based on arch height and footprint measurements. Potentially confounding variables (height, weight, hip and waist circumference, rearfoot and ankle joint range of motion, and levels of physical activity) were also measured. Multiple linear regression models were used to determine the association between foot type with muscle and tendon morphometry accounting for potentially confounding variables. Foot type was significantly and independently associated with AP thickness of the tibialis anterior tendon, peroneus longus muscle, and Achilles tendon, accounting for approximately 7% to 16% of the variation. Flat‐arched feet were associated with a thicker tibialis anterior tendon, a thicker peroneus longus muscle, and a thinner Achilles tendon. Foot type is associated with morphometry of tendons that control sagittal plane motion of the rearfoot; and the peroneus longus muscle that controls frontal plane motion of the rearfoot. These findings may be related to differences in tendon loading during gait.
Effect of arm swing on effective energy during vertical jumping: Experimental and simulation study
Authors: Blache Y. , Monteil K.
Published: January 2013

Arm swing helps to increase vertical jump height (VJH), in part by a greater hip joint muscle work. The force–velocity relationship has been put forward to explain the increase in hip joint work. Nevertheless, the efficacy ratio, muscle shortening length, and active state might be parameters that affect the effective energy and then VJH. The purpose of this study was to evaluate the influence of arm swing on effective energy in vertical jumping. Eight subjects performed maximal squat jumps with (SJarm) and without arm swing (SJ). A simulation model of the musculo‐skeletal system was applied. For subjects and simulation, VJH was about 20% higher during SJarm. In subjects, this was explained by the shoulder joint work (34%) and an increase of L5‐S1 joint work (66%). In simulated jump, effective energy increase during SJarm (+80.74 J) was related to an improvement of the total muscle work and not to the efficacy ratio. The increase in total muscle work was due to anterior deltoid work and to greater erector spinae, biceps femoris, and gluteus work. The greater muscle works were explained by a slower shortening velocity for all the muscles and by a greater shortening length and active state for the biceps femoris.
Practical translation of hemorrhage control techniques to the civilian trauma scene
Authors: Lockey David J. , Weaver Anne E. , Davies Gareth E.
Published: January 2013

This article examines how established and innovative techniques in hemorrhage control can be practically applied in a civilian physician‐based prehospital trauma service. A “care bundle” of measures to control hemorrhage on scene are described. Interventions discussed include the implementation of a system to achieve simple endpoints such as shorter scene times, appropriate triage, careful patient handling, use of effective splints and measures to control external hemorrhage. More complex interventions include prehospital activation of massive hemorrhage protocols and administration of on‐scene tranexamic acid, prothrombin complex concentrate, and red blood cells. Radical resuscitation interventions, such as prehospital thoracotomy for cardiac tamponade, and the potential future role of other interventions are also considered.
The use of lyophilized plasma in a severe multi‐injury pig model
Authors: Lee Tim H. , Van Philbert Y. , Spoerke Nicholas J. , Hamilton Gregory J. , Cho S. David , Watson Kate , Differding Jerome , Schreiber Martin A.
Published: January 2013

Background

Shock and severe tissue injury lead to an endogenous coagulopathy mediated by activation of Protein C and hyperfibrinolysis known as acute traumatic coagulopathy. Together, hemodilution, acidosis, inflammation, and hypothermia result in a global trauma‐induced coagulopathy. Coagulopathy in trauma is associated with mortality. Early and effective hemostatic resuscitation is critical in restoring perfusion, correcting coagulopathy, and saving lives in exsanguinating trauma. Lyophilized plasma (LP) provides a logistically superior alternative to fresh frozen plasma (FFP).

Study Design and Methods

Plasma was lyophilized following whole blood collection from anesthetized swine. A series of studies were performed using anesthetized swine subjected to a validated model of polytrauma and hemorrhagic shock including a Grade V liver injury. Animals were randomized to resuscitation using reconstituted LP fluids. Physiologic data and blood loss were measured. Coagulation status and inflammatory mediators were evaluated.

Results

Full volume reconstituted LP (100%LP) retains on average 86% coagulation factor activity compared to fresh plasma and when used in 1:1 ratios with red blood cells demonstrated superior hemostatic efficacy compared to FFP. Hypertonic LP reconstituted using 50% of the original plasma volume (50%LP) had higher coagulation factor concentrations, was well tolerated in swine, and equally effective compared to 100%LP with respect to physiologic and hemostatic properties. Buffering with ascorbic acid resulted in significant reductions in serum levels of tumor necrosis factor alpha and interleukin‐6.

Conclusion

By minimizing the volume of reconstituted LP and optimizing its anti‐inflammatory properties, an LP resuscitation fluid may be created to provide effective hemostatic resuscitation with superior logistical properties.
Spray‐dried plasma and fresh frozen plasma modulate permeability and inflammation in vitro in vascular endothelial cells
Authors: Wataha K. , Menge T. , Deng X. , Shah A. , Bode A. , Holcomb J.B. , Potter D. , Kozar R. , Spinella P.C. , Pati S.
Published: January 2013

Background

After major traumatic injury, patients often require multiple transfusions of fresh frozen plasma (FFP) to correct coagulopathy and to reduce bleeding. A spray‐dried plasma (SDP) product has several logistical benefits over FFP use in trauma patients with coagulopathy. These benefits include ease of transport, stability at room temperature, and rapid reconstitution for infusion. Our past work suggests that FFP promotes endothelial stability by inhibiting endothelial permeability.

Study Design and Methods

The main goal of this project is to determine if solvent‐detergent‐treated SDP is equivalent to FFP in inhibiting vascular endothelial cell (EC) permeability and inflammation in vitro. Furthermore, this study aimed to determine if solvent‐detergent treatment and spray drying of plasma alters the protective effects of FFP on EC function. The five groups tested in our studies are the following: 1) fresh frozen‐thawed plasma (FFP); 2) solvent‐detergent‐treated FFP; 3) solvent‐detergent‐treated SDP; 4) lactated Ringer's solution; and 5) Hextend.

Results

This study demonstrates that in vitro SDP and FFP equivalently inhibit vascular EC permeability, EC adherens junction breakdown, and endothelial white blood cell binding, an effect that is independent of changes in Vascular Cell Adhesion Molecule 1, Intracellular Adhesion Molecule 1, or E‐selectin expression on ECs. Solvent‐detergent treatment of FFP does not alter the protective effects of FFP on endothelial cell function in vitro.

Conclusion

These data suggest the equivalence of FFP and SDP on modulation of endothelial function and inflammation in vitro.
Primary hemostatic capacity of whole blood: a comprehensive analysis of pathogen reduction and refrigeration effects over time
Authors: Pidcoke Heather F. , McFaul Steve J. , Ramasubramanian Anand K. , Parida Bijaya K. , Mora Alex G. , Fedyk Chriselda G. , Valdez‐Delgado Krystal K. , Montgomery Robbie K. , Reddoch Kristin M. , Rodriguez Armando C. , Aden James K. , Jones John A. , Bryant Ron S. , Scherer Michael R. , Reddy Heather L. , Goodrich Raymond P. , Cap Andrew P.
Published: January 2013

Background

Whole blood (WB) has been used in combat since World War I as it is readily available and replaces every element of shed blood. Component therapy has become standard; however, recent military successes with WB resuscitation have revived the debate regarding wider WB use. Characterization of optimal WB storage is needed. We hypothesized that refrigeration preserves WB function and that a pathogen reduction technology (PRT) based on riboflavin and ultraviolet light has no deleterious effect over 21 days of storage.

Study Design and Methods

WB units were stored for 21 days either at 4°C or 22°C. Half of each temperature group underwent PRT, yielding four final treatment groups (n = 8 each): CON 4 (WB at 4°C); CON 22 (WB at 22°C); PRT 4 (PRT WB at 4°C); and PRT 22 (PRT WB at 22°C). Testing was at baseline, Days 1‐7, 10, 14, and 21. Assays included coagulation factors; platelet activation, aggregation, and adhesion; and thromboelastography (TEG).

Results

Prothrombin time (PT) and partial thromboplastin time increased over time; refrigeration attenuated the effects on PT (p ≤ 0.009). Aggregation decreased over time (p ≤ 0.001); losses were attenuated by refrigeration (p ≤ 0.001). Refrigeration preserved TEG parameters (p ≤ 0.001) and PRT 4 samples remained within normal limits throughout the study. Refrigeration in combination with PRT inhibited fibrinolysis (p ≤ 0.001) and microparticle formation (p ≤ 0.031). Cold storage increased shear‐induced platelet aggregation and ristocetin‐induced platelet agglutination (p ≥ 0.032), as well as GPIb‐expressing platelets (p ≤ 0.009).

Conclusion

The in vitro hemostatic function of WB is largely unaffected by PRT treatment and better preserved by cold storage over 21 days. Refrigerated PRT WB may be suitable for trauma resuscitation. Clinical studies are warranted.
The challenges of measuring bleeding outcomes in clinical trials of platelet transfusions
Authors: Estcourt Lise J. , Heddle Nancy , Kaufman Richard , McCullough Jeffrey , Murphy Michael F. , Slichter Sherrill , Wood Erica M. , Stanworth Simon J. ,   Biomedical Excellence for Safer Transfusion (BEST) Collaborative
Published: January 2013

Background

Many platelet (PLT) transfusion trials now use bleeding as a primary outcome; however, previous studies have shown a wide variation in the amount (5%‐70%) and type of bleeding documented. Differences in the way bleeding has been identified, recorded, and graded may account for some of this variability. This study's aim was to compare trials' method to document and grade bleeding.

Study Design and Methods

Data were collected via three methods: a review of study publications, study case report forms, and a questionnaire sent to the authors. Authors of randomized controlled trials of PLT transfusion that used bleeding as an outcome measure were identified from the searches reported by two recent systematic reviews. Twenty‐four authors were contacted, and 13 agreed to participate. Data submitted were reviewed and summarized.

Results

More recent studies with trained bleeding assessors, detailed documentation, and expanded grading systems have reported higher overall levels of bleeding. The World Health Organization grading system was widely used to grade bleeding, but there was no consistency in the bleeding grade definitions. For example, bleeding classified as Grade 2 in some studies (spreading petechiae) was classified as Grade 1 in other studies.

Conclusions

This study has highlighted differences in the method of recording and grading bleeding, which may account for some of the variation in reported bleeding rates. To ensure that differences between studies can be attributed to trial interventions or types of participant included, this study group is developing consensus bleeding definitions, a standardized approach to record and grade bleeding, and guidance notes to educate and train bleeding assessors.
Direct Costs of Bovine Spongiform Encephalopathy Control Measures in Germany
Authors: Probst C. , Gethmann J. M. , Heuser R. , Niemann H. , Conraths F. J.
Published: January 2013

On 26 November 2000, the first autochthonous case of bovine spongiform encephalopathy (BSE) was detected in Germany. Since then, a total of 413 BSE cases have been confirmed, resulting in the culling and destruction of 17 313 heads of cattle. In view of the possible risks for human and animal health, Germany has adopted EU regulations along with some additional requirements concerning active surveillance and response measures after detecting a BSE‐positive animal. In this study, we used a stochastic model to estimate the costs incurred by the ensuing legislative amendments responding to BSE between November 2000 and December 2010. The total costs were estimated to range between 1847 and 2094 million Euros. They peaked in 2001 (about 394 million Euros) and declined since. About 54% of the costs (approximately 1000 million Euros) were incurred by the extension of the feed ban for animal protein to all farmed livestock. Active surveillance accounted for 21% (405 million Euros), the incineration of animal protein for 13% (249 million Euros) and the removal of specified risk material for 11% (225 million Euros). Only 1% of the costs was related to response measures after detecting a BSE‐positive animal, including indemnity payments for culled cattle and confiscated carcasses at the slaughterhouse.
Large Eddy Simulations of Hydrogen Oxidation at Ultra-Wet Conditions in a Model Gas Turbine Combustor Applying Detailed Chemistry
Authors: Krüger Oliver , Terhaar Steffen , Paschereit Christian Oliver , Duwig Christophe
Published: January 2013

Humidified gas turbines (HGT) offer the attractive possibility of increasing plant efficiency without the cost of an additional steam turbine as is the case for a combined gas-steam cycle. In addition to efficiency gains, adding steam into the combustion process reduces NOx emissions. It increases the specific heat capacity (hence, lowering possible temperature peaks) and reduces the oxygen concentration. Despite the thermophysical effects, steam alters the kinetics and, thus, reduces NOx formation significantly. In addition, it allows operation using a variety of fuels, including hydrogen and hydrogen-rich fuels. Therefore, ultra-wet gas turbine operation is an attractive solution for industrial applications. The major modification compared to current gas turbines lies in the design of the combustion chamber, which should accommodate a large amount of steam without losing in stability. In the current study, the premixed combustion of pure hydrogen diluted with different steam levels is investigated. The effect of steam on the combustion process is addressed using detailed chemistry. In order to identify an adequate oxidation mechanism, several candidates are identified and compared. The respective performances are assessed based on laminar premixed flame calculations under dry and wet conditions, for which experimentally determined flame speeds are available. Further insight is gained by observing the effect of steam on the flame structure, in particular HO2 and OH* profiles. Moreover, the mechanism is used for the simulation of a turbulent flame in a generic swirl burner fed with hydrogen and humidified air. Large eddy simulations (LES) are employed. It is shown that by adding steam, the heat release peak spreads. At high steam content, the flame front is thicker and the flame extends further downstream. The dynamics of the oxidation layer under dry and wet conditions is captured; thus, an accurate prediction of the velocity field, flame shape, and position is achieved. The latter is compared with experimental data (PIV and OH* chemiluminescence). The reacting simulations were conducted under atmospheric conditions. The steam-air ratio was varied from 0% to 50%.