bluuebunny/crossref_metadata_2025 huggingface dataset:
Donor Leukocyte Transfusions for Treatment of Leukemic Relapse after Bone Marrow Transplantation
Authors: Kolb H‐J. ,   EBMT Immunology and Chronic Leukemia Working Parties
Published: August 2011

Allogeneic bone marrow transplantation is an effective treatment of leukemia. Intensive chemo‐ and radiotherapy used for conditioning and T‐cells of the graft contribute to the control of leukemia. Animal experiments indicate that transfusion of lymphocytes from the marrow donor convert into complete chimerism without producing graft‐versus‐host disease, if delayed for two months or more. Transfusion of donor leukocytes (DLT) after marrow transplantation has induced lasting remissions in the majority of patients with chronic myelogenous leukemia (CML) in hematological or cytogenetic relapse, some patients with acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), transformed phase CML and multiple myeloma (MMY). The mechanism of the graft‐versus‐leukemia reaction is discussed.
Suicide Gene Transduced T‐cells for the Regulation of the Graft‐versus‐Leukemia Effect
Authors: Bonini C. , Ciceri F. , Marktel S. , Bordignon C.
Published: August 2011

In allogeneic marrow transplantation (BMT), donor lymphocytes play a central therapeutic role in both graft‐versus‐leukemia and immune reconstitution. However, their use is limited by the risk of severe graft‐vs‐host disease (GvHD). Different strategies have been investigated to obtain all the benefits derived from donor lymphocytes while avoiding the risk of GvHD. In the first pilot study, infusions of donor lymphocytes transduced with the Herpes Simplex virus thymidine kinase (HSV‐tk) suicide resulted in anti‐tumor activity in 50% of patients. Acute GvHD could be effectively controlled by ganciclovir‐ induced elimination of the transduced cells. If these results will be confirmed in larger studies, genetic manipulation of donor lymphocytes will increase efficacy and safety of allogeneic marrow transplantation.
Antenatal Genotyping of the Blood Groups of the Fetus
Authors: Avent N.D.
Published: August 2011

Antenatal genotyping of the fetus is now in widespread use as an aid to the clinical management in cases where there is the potential of haemolytic disease of the newborn occurring. The rapid diagnosis of an antigen‐negative fetus will preclude the requirement for further, potentially risky invasive procedures being performed, whilst the determination of an antigen‐positive fetus allows the potential of intensifying obstetric care for this pregnancy. Molecular genotyping is a major clinical application which has led from the determination of the molecular bases of blood group antigens expressed, most of which have been defined at the level of the gene. All assays used are dependent on the Polymerase Chain Reaction amplification of fetal DNA derived from either amniotic fluid or chorionic villi. Recent work has explored the potential of utilising fetal cells found to be present in maternal peripheral blood as a source of nucleic acid for prenatal diagnosis. Using non‐invasive methods will preclude exposing mother and fetus to the potential hazards of invasive methods (amniocentesis, chorionic villus sampling and cordocentesis) which include miscarriage, fetal malformations and further maternal alloimmunisation.
Monitoring of Oxygen Delivery in Cardiac and Vascular Surgery
Authors: Spahn D.R.
Published: August 2011

Monitoring the adequacy of oxygen (02) delivery is of paramount significance in the perioperative period of surgical patients undergoing cardiac and major vascular surgery. These patients are at considerable risk for ischemic perioperative complications due to a high incidence of coronary artery disease. Monitoring the adequacy of global 02 delivery is based on observing stability of haemodynamics, absence of elevated lactate levels and preservation of 02 consumption. Monitoring the adequacy of regional 02 delivery focuses on the coronary, cerebral, splanchnic and renal circulation. Myocardial ischemia can be detected relatively easily by continuous ECG monitoring of leads II and V5 and in selected cases by transesophageal echocardiography. There are relatively few monitoring modalities clinically available at the present time to reliably assess adequacy of 02 delivery in the cerebral, splanchnic and renal circulation. Expecting relatively low intra‐ and postoperative haemoglobin levels per se does not necessarily mandate greatly exaggerated monitoring. However, continuous ECG monitoring of leads II and V5, invasive blood pressure measurement, determination of hourly urine production may be indicated in most patients. In high risk patients extended monitoring with a pulmonary artery catheter and transesophageal echocardiography may be indicated. Most important, however, is the clinical surveillance by an experienced physician integrating the information of all applied monitoring modalities who realises early alterations indicating (potentially) compromised 02 delivery.
EBV Specific CTL: A Model for Immune Therapy
Authors: Rooney C.M. , Heslop H.E. , Brenner M.K.
Published: August 2011

We have been generating Epstein‐Barr virus specific cytotoxic T cells for patients at high risk of developing EBV driven lymphoma. To discover the fate of the cells in vivo, we first marked them genetically, using a retroviral vector. Our results in 51 patients show that the approach is safe, that the CTL persist for several years and that they are able to mediate anti‐viral and anti‐tumor effects. We are now studying other virally‐linked malignancies to discover whether a similar approach will be of therapeutic value.
Interactions between Science, Government and Media on Selection and Testing of Donors
Authors: Sazama K.
Published: August 2011

The international media attention to “bad blood” has fueled governmental action in countries around the world. Donor selection criteria continue to expand, focusing most recently on the possibility of exclusion due to intranasal cocaine use and, in the US, due to incarceration for more than 72 hours. As newer methods of testing evolve, more deferrals will occur due to improved testing. An emerging area of concern is the non‐standardized notification of donors who are ineligible to donate and lack of a centralized listing of such deferred donors. Because of the consequences to recipients, improvements in both donor questioning and testing are necessary. Further studies are needed to understand and improve these processes.
Blood Collection and the Labile Blood Components: What should the Regulators ask for?
Authors: Maniatis A. , Adamides E.
Published: August 2011

Efforts to promote the quality and safety of blood collection are underway in most European Union (EU) member states but the level of quality management continues to differ significantly not only between countries but also among Blood Collection Establishments (BCE's) within a country.

The European Commission has asked for blood safety and self‐sufficiency in the Community and has initiated action in this direction. What is sought is harmonization of practices in the transfusion chain but such cannot be accomplished solely through recommendations and directives given the sociocultural and economic differences among EU member states. Active support for the development of common standards and a common quality system as well as an inspection and accreditation system would certainly help. The goal of self‐sufficiency should certainly be emphasized but may be difficult to achieve, given the unpredictability of factors that may affect demand and supply. Through bipartisan initiatives however, between the USA and EU, consensus regarding the issue of blood safety, could be reached.
Organizational Changes in Estonia
Authors: Everaus H.
Published: August 2011

The situation of the blood transfusion service in Estonia is analyzed since 1991. Considerable changes towards the establishment of a cost‐effective on a cost‐ efficient system providing self‐sufficiency of good quality blood products in future have been made. National blood transfusion service based on voluntary nonremunerated donations is under development.
Retrospective review of ilioinguinal‐iliohypogastric nerve block with general anesthesia for herniotomy in ex‐premature neonates
Authors: Thong Sze Y. , Lim Suan L. , Ng Agnes Suah Bwee
Published: August 2011

Objectives and aims:  We examine the efficacy and complications of general anesthesia with ilioinguinal‐iliohypogastric nerve block performed on ex‐premature neonates undergoing inguinal herniotomy.

Background:  The ex‐premature neonate has many co‐morbidities and is at risk of postoperative apnea and bradycardia. Anesthesia techniques aimed to provide good surgical conditions include general anesthesia and central neuroaxial techniques. There are still significant complications after these techniques and none is superior.

Methods/Materials:  A retrospective search of our department’s computer database was conducted on ex‐premature neonates, post‐menstrual age of 48 weeks and under, who received general anesthesia and ilioinguinal‐iliohypogastric nerve block for bilateral inguinal herniotomy from 1997 to 2009.

Results:  Eighty‐two neonates were selected. All medical notes were traced and information including the demographics, co‐morbidities and perioperative data were obtained. The mean gestational age was 30.3 weeks (sd ± 3.2) and the mean post‐conception age was 40.0 weeks (sd ± 3.1). Mean birth weight was 1284 g (sd ± 518) and mean weight at the time of surgery was 2795 g (sd ± 958). Thirty‐two (39.0%) neonates had apnea of prematurity, which required caffeine treatment. Thirty‐five (42.7%) neonates required intubation for ventilatory support preoperatively. There was a good success rate of the ilioinguinal‐iliohypogastric nerve block in 73 (89.0%) patients. They were deemed successful clinically by the attending anesthesiologist. No perioperative rescue opioid was required. Four neonates had postoperative apnea requiring intervention.

Conclusion:  Ilioinguinal‐iliohypogastric nerve block has a success rate similar to other techniques and when combined with general anesthesia, provides a viable alternative technique of anesthesia in these high‐risk patients.
Manifestation of Long QT syndrome with normal QTc interval under anesthesia: a case report
Authors: Mandal Banashree , Kaur Gurpreet , Batra Yatindra K. , Mahajan Sachin
Published: August 2011

Patients with congenital Long QT are known to have normal QT interval in symptom‐free period and in the early years of life. Precipitating factors like surgical stress, interactions with anesthetic agents prolonging QT interval, and electrolyte imbalances can manifest with life threatening arrhythmias in congenital or acquired Long QT syndrome. We report a case of concealed LQTS manifesting under anesthesia and its subsequent perioperative course.
Comparing incident diabetes as defined by fasting plasma glucose or by HbA1c. The AusDiab, Inter99 and DESIR studies
Authors: Soulimane S. , Simon D. , Shaw J. E. , Zimmet P. Z. , Vol S. , Vistisen D. , Magliano D. J. , Borch‐Johnsen K. , Balkau B.
Published: August 2011

Diabet. Med. 28, 1311–1318 (2011)

Aim  We examined the ability of fasting plasma glucose and HbA1c to predict 5‐year incident diabetes for an Australian cohort and a Danish cohort and 6‐year incident diabetes for a French cohort, as defined by the corresponding criteria.

Methods  We studied 6025 men and women from AusDiab (Australian), 4703 from Inter99 (Danish) and 3784 from DESIR (French), not treated for diabetes and with fasting plasma glucose < 7.0 mmol/l and HbA1c < 48 mmol/mol (6.5%) at inclusion. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l and/or treatment for diabetes or as HbA1c ≥ 48 mmol/mol (6.5%) and/or treatment for diabetes.

Results  For AusDiab, incident fasting plasma glucose‐defined diabetes was more frequent than HbA1c‐defined diabetes (PMcNemar < 0.0001), the reverse applied to Inter99 (PMcNemar < 0.007) and for DESIR there was no difference (PMcNema = 0.17). Less than one third of the incident cases were detected by both criteria. Logistic regression models showed that baseline fasting plasma glucose and baseline HbA1c predicted incident diabetes defined by the corresponding criteria. The standardized odds ratios (95% confidence interval) for HbA1c were a little higher than for fasting plasma glucose, but not significantly so. They were respectively, 5.0 (4.1–6.1) and 4.1 (3.5–4.9) for AusDiab, 5.0 (3.6–6.8) and 4.8 (3.6–6.3) for Inter99, 4.8 (3.6–6.5) and 4.6 (3.6–5.9) for DESIR.

Conclusions  Fasting plasma glucose and HbA1c are good predictors of incident diabetes defined by the corresponding criteria. Despite Diabetes Control and Complications Trial‐alignment of the three HbA1c assays, there was a large difference in the HbA1c distributions between these studies, conducted some 10 years ago. Thus, it is difficult to compare absolute values of diabetes prevalence and incidence based on HbA1c measurements from that time.
Alien and native plant life‐forms respond differently to human and climate pressures
Authors: Marini Lorenzo , Battisti Andrea , Bona Enzo , Federici Germano , Martini Fabrizio , Pautasso Marco , Hulme Philip E.
Published: August 2011

Aim  To investigate whether differences in the elevational trend in native and alien species richness were dependent on climate or human pressures. Specifically we tested whether life‐form and/or alien/native status modifies the response of plant species richness to human population and temperature along: (1) a complete elevational gradient, and (2) within separate elevational bands that, by keeping temperature within a narrow range, elucidate the effects of human pressures more clearly.

Location  Two provinces (c. 7507 km2) on the southern border of the European Alps (Italy), subdivided into 240 contiguous sampling cells (c. 35.7 km2).

Methods  We used an extensive dataset on alien and native species richness across an elevation gradient (20–2900 m a.s.l.). Richness of natives and naturalized aliens were separately related to temperature, human population and Raunkiaer life‐form using general linear mixed models. Life‐form describes different plant strategies for survival during seasons with adverse cold/arid conditions.

Results  The relationship between species richness and temperature for natives was strongly dependent on life‐form, while aliens showed a consistent positive trend. Similar trends across alien and native life‐forms were found for the relationship between species richness and human population along the whole gradient and within separate elevational bands.

Main conclusions  The absence of life‐form‐dependent responses amongst aliens supports the hypothesis that the distribution of alien plant species richness was more related to propagule pressure and availability of novel niches created by human activities than to climatic filtering. While climate change will potentially contribute to relaxing species thermal constraints, the response of alien species to future warming will also be contingent on changes in anthropogenic pressures.
Native and naturalized range size in Pinus: relative importance of biogeography, introduction effort and species traits
Authors: Procheş Şerban , Wilson John R. U. , Richardson David M. , Rejmánek Marcel
Published: August 2011

Aim  Pine trees (genus Pinus) represent an ancient lineage, naturally occurring almost exclusively in the Northern Hemisphere, but introduced and widely naturalized in both hemispheres. As large trees of interest to forestry, they attract much attention and their distribution is well documented in both indigenous and naturalized ranges. This creates an opportunity to analyse the relationship between indigenous and naturalized range sizes in the context of different levels of human usage, biological traits and the characteristics of the environments of origin.

Location  Global.

Methods  We combined and expanded pre‐existing data sets for pine species distributions and pine species traits, and used a variety of regression techniques (including generalized additive models and zero‐inflated Poisson models) to assess which variables explained naturalized and indigenous range sizes.

Results  Indigenous and naturalized range sizes are positively correlated but there are many notable exceptions. Some species have large indigenous ranges but small or no naturalized ranges, whereas others have small indigenous ranges, but have naturalized in many regions. Indigenous range is correlated to factors such as seed size (−), age at first reproduction (−), and latitude (+, supporting Rapoport's rule), but also to the extent of coverage of species in the forestry literature (+). Naturalized range size is strongly influenced by the extent of coverage of species in the forestry literature (+), a proxy for propagule pressure. Naturalization was also influenced by average elevation in the indigenous range (−) and age at first reproduction (−).

Main conclusions  The macroecological and evolutionary pressures facing plant groups are not directly transferable between indigenous and naturalized ranges. In particular, there are strong biases in species naturalization and expansion in invasive ranges that are unrelated to factors determining indigenous range size. At least for Pinus, a new set of macroecological patterns are emerging which are profoundly influenced by humans.
Banded Regularization of Autocovariance Matrices in Application to Parameter Estimation and Forecasting of Time Series
Authors: Bickel Peter J. , Gel Yulia R.
Published: August 2011

The paper addresses a ‘large p–small n’ problem in a time series framework and considers properties of banded regularization of an empirical autocovariance matrix of a time series process. Utilizing the banded autocovariance matrix enables us to fit a much longer auto-regressive AR(p) model to the observed data than typically suggested by the Akaike information criterion, while controlling how many parameters are to be estimated precisely and the level of accuracy. We present results on asymptotic consistency of banded autocovariance matrices under the Frobenius norm and provide a theoretical justification on optimal band selection by using cross-validation. Remarkably, the cross-validation loss function for banded prediction is related to the conditional mean-square prediction error and, thus, may be viewed as an alternative model selection criterion. The procedure proposed is illustrated by simulations and application to predicting the sea surface temperature index in the Niño 3.4 region.
Estimation of Direct Effects for Survival Data by using the Aalen Additive Hazards Model
Authors: Martinussen Torben , Vansteelandt Stijn , Gerster Mette , Hjelmborg Jacob von Bornemann
Published: August 2011

We extend the definition of the controlled direct effect of a point exposure on a survival outcome, other than through some given, time-fixed intermediate variable, to the additive hazard scale. We propose two-stage estimators for this effect when the exposure is dichotomous and randomly assigned and when the association between the intermediate variable and the survival outcome is confounded only by measured factors, which may themselves be affected by the exposure. The first stage of the estimation procedure involves assessing the effect of the intermediate variable on the survival outcome via Aalen’s additive regression for the event time, given exposure, intermediate variable and confounders. The second stage involves applying Aalen’s additive model, given the exposure alone, to a modified stochastic process (i.e. a modification of the observed counting process based on the first-stage estimates). We give the large sample properties of the estimator proposed and investigate its small sample properties by Monte Carlo simulation. A real data example is provided for illustration.
Penalized Classification using Fisher’s Linear Discriminant
Authors: Witten Daniela M. , Tibshirani Robert
Published: August 2011

We consider the supervised classification setting, in which the data consist of p features measured on n observations, each of which belongs to one of K classes. Linear discriminant analysis (LDA) is a classical method for this problem. However, in the high dimensional setting where p≫n, LDA is not appropriate for two reasons. First, the standard estimate for the within-class covariance matrix is singular, and so the usual discriminant rule cannot be applied. Second, when p is large, it is difficult to interpret the classification rule that is obtained from LDA, since it involves all p features. We propose penalized LDA, which is a general approach for penalizing the discriminant vectors in Fisher’s discriminant problem in a way that leads to greater interpretability. The discriminant problem is not convex, so we use a minorization–maximization approach to optimize it efficiently when convex penalties are applied to the discriminant vectors. In particular, we consider the use of L1 and fused lasso penalties. Our proposal is equivalent to recasting Fisher’s discriminant problem as a biconvex problem. We evaluate the performances of the resulting methods on a simulation study, and on three gene expression data sets. We also survey past methods for extending LDA to the high dimensional setting and explore their relationships with our proposal.
Corticosteroid‐induced gene expression in allergen‐challenged asthmatic subjects taking inhaled budesonide
Authors: Kelly MM , King EM , Rider CF , Gwozd C , Holden NS , Eddleston J , Zuraw B , Leigh R , O'Byrne PM , Newton R
Published: August 2011

BACKGROUND AND PURPOSE Inhaled corticosteroids (ICS) are the cornerstone of asthma pharmacotherapy and, acting via the glucocorticoid receptor (GR), reduce inflammatory gene expression. While this is often attributed to a direct inhibitory effect of the GR on inflammatory gene transcription, corticosteroids also induce the expression of anti‐inflammatory genes in vitro. As there are no data to support this effect in asthmatic subjects taking ICS, we have assessed whether ICS induce anti‐inflammatory gene expression in subjects with atopic asthma.

EXPERIMENTAL APPROACH Bronchial biopsies from allergen‐challenged atopic asthmatic subjects taking inhaled budesonide or placebo were subjected to gene expression analysis using real‐time reverse transcriptase‐PCR for the corticosteroid‐inducible genes (official gene symbols with aliases in parentheses): TSC22D3 [glucocorticoid‐induced leucine zipper (GILZ)], dual‐specificity phosphatase‐1 (MAPK phosphatase‐1), both anti‐inflammatory effectors, and FKBP5 [FK506‐binding protein 51 (FKBP51)], a regulator of GR function. Cultured pulmonary epithelial and smooth muscle cells were also treated with corticosteroids before gene expression analysis.

KEY RESULTS Compared with placebo, GILZ and FKBP51 mRNA expression was significantly elevated in budesonide‐treated subjects. Budesonide also increased GILZ expression in human epithelial and smooth muscle cells in culture. Immunostaining of bronchial biopsies revealed GILZ expression in the airways epithelium and smooth muscle of asthmatic subjects.

CONCLUSIONS AND IMPLICATIONS Expression of the corticosteroid‐induced genes, GILZ and FKBP51, is up‐regulated in the airways of allergen‐challenged asthmatic subjects taking inhaled budesonide. Consequently, the biological effects of corticosteroid‐induced genes should be considered when assessing the actions of ICS. Treatment modalities that increase or decrease GR‐dependent transcription may correspondingly affect corticosteroid efficacy.
ENVIRONMENTAL CONTROL OF STALK LENGTH IN THE BLOOM‐FORMING, FRESHWATER BENTHIC DIATOM DIDYMOSPHENIA GEMINATA (BACILLARIOPHYCEAE)1
Authors: Kilroy Cathy , Bothwell Max
Published: August 2011

Blooms of the freshwater stalked diatom Didymosphenia geminata (Lyngb.) M. Schmidt in A. Schmidt typically occur in oligotrophic, unshaded streams and rivers. Observations that proliferations comprise primarily stalk material composed of extracellular polymeric substances (EPS) led us to ask whether or not the production of excessive EPS is favored under nutrient‐limited, high‐light conditions. We conducted experiments in outdoor flumes colonized by D. geminata using water from the oligotrophic, D. geminata–affected Waitaki River, South Island, New Zealand, to determine the relationship between D. geminata stalk length, cell division rates, and light intensity under ambient and nutrient‐enriched conditions. Stalk lengths were measured in situ, and cell division rates were estimated as the frequency of dividing cells (FDC). FDC responded positively to increasing light intensity and to nutrient additions (N+P and P). Under ambient conditions, stalk length increased as light level increased except at low ambient light levels and temperature. Nutrient enrichment resulted in decreased stalk length and negative correlations with FDC, with this effect most evident under high light. Our results are consistent with the hypothesis that extensive stalk production in D. geminata occurs when cell division rates are nutrient limited and light levels are high. Thus, photosynthetically driven EPS production in the form of stalks, under nutrient‐limited conditions, may explain the development of very high biomass in this species in oligotrophic rivers. The responses of FDC and stalk length under nutrient‐replete conditions are also consistent with occurrences of D. geminata as a nondominant component of mixed periphyton communities in high‐nutrient streams.
Hematopoietic stem cells from poor and good mobilizers are qualitatively equivalent
Authors: Jiang Liuyan , Malik Sunny , Litzow Mark , Gastineau Dennis , Micallef Ivana , Roy Vivek , Solberg Lawrence , Zubair Abba C.
Published: August 2011

BACKGROUND: Marrow damage from chemo‐ and radiation therapies has been suggested to affect quality and quantity of hematopoietic stem cell (HSC) products. We tested the hypothesis that CD34+ cells (HSCs) from low mobilizers are qualitatively inferior to HSCs from high mobilizers.

STUDY DESIGN AND METHODS: HSC quality was defined by proportion of primitive HSC subsets (CD34+CD38−, CD34+HLA‐DR−, and CD34+ in G0 stage of cell cycle), the proportion of HSCs that express CXCR4 and CD26 homing proteins, and days to neutrophil and platelet (PLT) engraftments after transplant. HSC content and CD34 subsets analyses were performed using flow cytometry following the ISHAGE protocol. We evaluated the HSC quantity and quality of 139 autologous filgrastim‐mobilized HSC products. Patients were categorized into low, moderate, and high mobilizers if their total HSC collection was less than 3 × 106, 3 × 106 or more and less than 5 × 106, and 5 × 106/kg or more, respectively.

RESULTS: The median number of primitive CD34 subsets increases with increasing HSC numbers and this association was significant (p = 0.001). However, when the ratios of the primitive CD34 subsets to total HSC counts were compared among the mobilization groups, the ratios were not significantly different. Coexpression of neither CD26 nor CXCR4 with CD34 antigen correlated with HSC mobilization. Evaluation of days to neutrophil engraftment among the mobilization groups did not show a significant difference (p = 0.1). However, days to PLT engraftment among the mobilization groups was significantly different (p = 0.05).

CONCLUSION: The quality of HSCs from low mobilizers was comparable to HSCs from high mobilizers.
Acute exacerbation of subclinical pulmonary fibrosis after red blood cell transfusion: a case report
Authors: Woodske Matthew , Donahoe Michael P. , Yazer Mark , Lee Janet S.
Published: August 2011

BACKGROUND: Red blood cell (RBC) transfusion is associated with lung injury in susceptible hosts, although many cases do not meet criteria for transfusion‐related acute lung injury. Patients with underlying pulmonary fibrosis can exhibit precipitous deteriorations in respiratory status of unknown etiology defined as acute exacerbations due to superimposed lung injury syndrome. It is unclear whether RBC transfusion is associated with acute exacerbation of underlying pulmonary fibrosis.

CASE REPORT: We describe a patient who underwent an uneventful elective left total hip replacement but developed anemia postoperatively. Twenty‐four hours after transfusion of her fifth nonleukoreduced AS‐5 RBC unit, she developed new bilateral airspace infiltrates associated with progressive hypoxemia. These RBC units were 35 to 38 days old. Despite supportive care and diuresis, the patient remained profoundly hypoxemic with infiltrates that progressed to fibrosis.

RESULTS: The patient had mild subclinical lower‐lobe predominant interstitial pulmonary fibrosis but developed diffuse bilateral ground glass opacities with areas of consolidation 24 hours after receiving her last RBC unit. Transbronchial biopsy of the right lower lobe showed active organizing pneumonia and underlying interstitial fibrosis, supporting the clinical diagnosis of acute exacerbation of pulmonary fibrosis. The bronchoalveolar lavage showed progressive bloody effluent, consistent with diffuse alveolar hemorrhage, a marker of lung injury. There was no evidence of viral inclusions, fungal elements, pneumocystis, or bacterial organisms.

CONCLUSION: Transfusion of multiple units of aged RBCs was temporally associated with an acute exacerbation and rapid progression of underlying subclinical pulmonary fibrosis.
Hemolysis of red blood cells during processing and storage
Authors: Gkoumassi Effimia , Dijkstra‐Tiekstra Margriet J. , Hoentjen Dinie , de Wildt‐Eggen Janny
Published: August 2011

BACKGROUND: During processing and storage, red blood cells (RBCs) undergo changes and cell injury resulting in hemolysis. Mostly, the separation of whole blood in top‐and‐bottom quadruple bag systems with break openings takes less than 4 minutes. However, longer separation times are not uncommon. The aims were to investigate whether hemolysis is increased in RBCs with longer separation time (RBCs>6 min) compared to regular RBCs (RBCsreg), to measure hemolysis increase during storage and to study whether frequency of hemolytic donations is donor dependent.

STUDY DESIGN AND METHODS: RBCs>6 min (n = 172) and 172 matched controls were tested for hemolysis on Days 1 and 21 RBC units from each group were stored at 4 ± 2°C and tested again after 5 weeks. Donor dependency was retrospectively investigated for 100 hemolytic RBC units.

RESULTS: RBCs>6 min exhibited a higher mean hemolysis rate than RBCsreg (0.058% vs. 0.033%). Four RBC units were hemolytic (>0.8%), all RBCs>6 min (2.36%). During storage, hemolysis in both groups increased with 0.24%. Hemolysis frequency did not seem to be donor dependent.

CONCLUSIONS: Increased separation time is a useful screening tool for potentially increased hemolysis rate in RBCs. Hemolysis rate increased during storage equally in both groups. Hemolysis frequency appears donor independent.
How Many Mechanisms Are Needed to Analyze Speech? A Connectionist Simulation of Structural Rule Learning in Artificial Language Acquisition
Authors: Laakso Aarre , Calvo Paco
Published: August 2011

Some empirical evidence in the artificial language acquisition literature has been taken to suggest that statistical learning mechanisms are insufficient for extracting structural information from an artificial language. According to the more than one mechanism (MOM) hypothesis, at least two mechanisms are required in order to acquire language from speech: (a) a statistical mechanism for speech segmentation; and (b) an additional rule‐following mechanism in order to induce grammatical regularities. In this article, we present a set of neural network studies demonstrating that a single statistical mechanism can mimic theapparentdiscovery of structural regularities, beyond the segmentation of speech. We argue that our results undermine one argument for the MOM hypothesis.
Availability of Target Odor Compounds from Seized Ecstasy Tablets for Canine Detection*,†
Authors: Macias Michael S. , Furton Kenneth G.
Published: August 2011

Abstract:  The aim of this study was to compare seized samples of 3,4‐methylenedioxy‐N‐methylamphetamine (MDMA) pills, used to train law enforcement detection canine teams, to determine what differences exist in the chemical makeup and headspace odor and their effect on detectability. MDMA solutions were analyzed by liquid chromatography–mass spectrometry. Analysis of these samples showed a wide variance of MDMA (8–25%). Headspace SPME‐GC/MS analysis showed that several compounds such as 3,4‐methylenedioxyphenylacetone and 1‐(3,4‐methylenedioxyphenyl)‐2‐propanol are common among these MDMA samples regardless of starting compound and synthesis procedure. However, differences, such as the level of the various methylenedioxy starting compounds, were shown to affect the overall outcome of canine detection, indicating the need for more than one MDMA training aid. Combinations of compounds such as the primary odor piperonal in conjunction with a secondary compound such as MDP‐2‐OH or isosafrole are recommended to maximize detection of different illicit MDMA samples.
Suicide Behind Bars: Trends, Inconsistencies, and Practical Implications
Authors: Felthous Alan R.
Published: August 2011

Abstract: The results of two comprehensive approaches are compared: the nationwide surveys of suicides in U.S. jails by Hayes and the international meta‐analyses of suicides in jails and prisons by Fazel et al. Factors are classified as demographic, situational, clinical, and methodical. More than 50% of U.S. jail suicide victims were men, white, unmarried, under 28 years of age, charged with minor or drug‐related offenses, and intoxicated with drugs or alcohol. Suicides significantly occurred in isolation. Suicide victims in the international study were significantly (p < 0.001) men, white, married, pretrial, and charged with or convicted of violent offenses. Psychiatric diagnosis, alcohol abuse, taking psychotropic medication, and suicidal ideation were also positively correlated in the international study, but suicide victims were distributed more evenly over age‐groups. Results of other studies illustrate the near universality of some findings. Three theories of suicide are briefly discussed.
How Useful is Basal Renal Tubular Epithelial Cell Vacuolization as a Marker for Significant Hyperglycemia at Autopsy?
Authors: Zhou Chong , Gilbert John D. , Byard Roger W.
Published: August 2011

Abstract:  Basal vacuolization of renal tubular epithelial cells (so‐called Armanni–Ebstein phenomenon) has been attributed to hyperglycemia causing accumulation of cytoplasmic glycogen. Review of 34 autopsy cases with significant hyperglycemia (vitreous glucose ≥15 mmol/L/270 mg/dL) was undertaken to determine whether there was any significant association between the degree of hyperglycemia and the severity of this morphological change (graded as 0, 1+, 2+, and 3+). No association was demonstrated. Review of the subgroup of 14 cases with terminal hyperglycemia without ketoacidosis was then undertaken to assess the effect of hyperglycemia in isolation on renal tubular epithelial cells. Vitreous glucose levels in these 14 cases ranged from 17 to 49.7 mmol/L (306–894.6 mg/dL) with a mean of 26.25 mmol/L (472.5 mg/dL) and β‐hydroxybutyrate levels ranged from 0.02 to 2.55 mmol/L (0.36–45.9 mg/dL) with a mean 0.79 mmol/L (14.22 mg/dL). Not one of the latter cases displayed basal vacuolization. No relationship between basal vacuolization of renal tubular epithelial cells at autopsy and terminal hyperglycemia could, therefore, be demonstrated.
Advantage of Affinity Histochemistry Combined with Histology to Investigate Death Causes: Indications from Sample Cases*
Authors: Bacci Stefano , DeFraia Beatrice , Romagnoli Paolo , Bonelli Aurelio
Published: August 2011

Abstract:  Mast cell histochemistry has been proposed in addition to classic histological methods to estimate the course of traumatic events before and after death. We have addressed the utility of this approach on nine victims of different types of trauma. Sections of wounded skin were stained with hematoxylin and eosin and with fluorescent avidin to tag mast cells. Mast cell numbers were evaluated by both direct and digitalized counts. Intact skin was used as control. The results on mast cells implemented the findings upon hematoxylin and eosin stain and helped to put the wounds and death in chronological sequence. Digitalized morphometry allowed to reduce intra‐ and inter‐observer variation. We conclude that combined histological and histochemical analyses can be of practical use in forensic pathology, that a preliminary setting of the reference values is needed for each laboratory, and that image analysis can be of help for the quantification of the results.
Remote Spectroscopic Identification of Bloodstains*
Authors: Bremmer Rolf H. , Edelman Gerda , Vegter Tessa Dijn , Bijvoets Ted , Aalders Maurice C.G.
Published: August 2011

Abstract:  Blood detection and identification at crime scenes are crucial for harvesting forensic evidence. Unfortunately, most tests for the identification of blood are destructive and time consuming. We present a fast and nondestructive identification test for blood, using noncontact reflectance spectroscopy. We fitted reflectance spectra of 40 bloodstains and 35 nonbloodstains deposited on white cotton with spectroscopic features of the main compounds of blood. Each bloodstain was measured 30 times to account for aging effects. The outcome of the blood measurements was compared with the reflectance of blood‐mimicking stains and various body fluids. We found that discrimination between blood and nonblood deposited on white cotton is possible with a specificity of 100% and a sensitivity of 98%. In conclusion, a goodness of fit between the sample’s reflectance and the blood component fit may allow identification of blood at crime scenes by remote spectroscopy.
Investigation into the Merits of Infrared Imaging in the Investigation of Tattoos Postmortem
Authors: Starkie Alexandra , Birch Wendy , Ferllini Roxana , Thompson Tim J.U.
Published: August 2011

Abstract:  Infrared imaging has a history of use in the forensic examination of artwork and documents and is investigated here for its wider use in the detection of tattoos on the human body postmortem. Infrared photographic and reflectographic techniques were tested on 18 living individuals, displaying a total of 30 tattoos. It was observed that neither age, sex, age of the tattoo, nor, most significantly, skin color affected the ability to image the tattoos using infrared imaging techniques. Second, a piglet carcass was tattooed and the impact of the decomposition process on the visibility of the tattoos assessed. Changes were recorded for 17 days and decomposition included partial mummification and skin discoloration. Crucially, the discoloration was recorded as greatly affecting the image quality using conventional photography, but was insignificant to the infrared recording of these tattoos. It was concluded that infrared reflectography was beneficial in the investigation into tattoos postmortem.
Rapid Presumptive “Fingerprinting” of Body Fluids and Materials by ATR FT‐IR Spectroscopy*,†
Authors: Elkins Kelly M.
Published: August 2011

Abstract: Human body fluids and materials were evaluated using attenuated total reflectance Fourier transform infrared spectroscopy. Purified proteins, cosmetics, and foodstuffs were also assayed with the method. The results of this study show that the sampled fluids and materials vary in the fingerprint region and locations of the amide I peaks because of the secondary structure of the composite proteins although the C=O stretch is always present. The distinct 1016 cm−1peak serves as a signature for semen. The lipid‐containing materials (e.g., fingerprints, earwax, tears, and skin) can also be easily separated from the aqueous materials because of the strong CH3asymmetric stretch of the former. Blood–saliva and blood–urine mixtures were also successfully differentiated using combinations of peaks. Crime scene investigators employing rapid, portable, or handheld infrared spectroscopic instruments may be able to reduce their need for invasive, destructive, and consumptive presumptive test reagents in evaluating trace evidence.
Death Certification of “Suicide by Cop”
Authors: Neitzel Amber R. , Gill James R.
Published: August 2011

Abstract:  Death certification of “suicide by cop” is controversial among some medical examiners and coroners. We present five such deaths that were certified as suicides and discuss the medico‐legal issues involved with these certifications. To certify such a death as a suicide, certain criteria should be met. Suicide by cop is a circumstance that involves competing intentional acts that may result in dichotomous determinations of the manner of death. Despite the absence of direct self‐infliction, there is overwhelming evidence that these five individuals intended to end their own lives. Their use of an unusual method to accomplish this goal may inappropriately result in a reflexive certification of homicide. All of the decedents possessed weapons or a facsimile of a weapon. We present five instances of suicide by cop and contend that these types of deaths are best certified as suicides.
Fatal Acute Intracranial Injury, Subdural Hematoma, and Retinal Hemorrhages Caused by Stairway Fall*
Authors: Lantz Patrick E. , Couture Daniel E.
Published: August 2011

Abstract:  We describe an infant with an acute subdural hematoma, a fatal head injury, and severe hemorrhagic retinopathy caused by a stairway fall. His cerebral and ocular findings are considered diagnostic of abusive head trauma by many authors. Our literature search of serious injuries or fatalities from stairway or low‐height falls involving young children yielded 19 articles of primary data. These articles are discrepant, making the classification of a young child’s death following a reported short fall problematic. This case report contradicts the prevalent belief of many physicians dealing with suspected child abuse that low‐height falls by young children are without exception benign occurrences and cannot cause fatal intracranial injuries and severe retinal hemorrhages. The irreparable harm to a caregiver facing an erroneous allegation of child abuse requires physicians to thoroughly investigate and correctly classify pediatric accidental head injuries.
Littre Hernia—A Rare Cause of Unexpected Death in the Elderly
Authors: Tse Rexson , Byard Roger W.
Published: August 2011

Abstract:  A rare case of sudden and unexpected death is reported in an 87‐year‐old woman who was found dead at her home. At autopsy, the most striking finding was of a right‐sided direct inguinal hernia containing a 20 mm infarcted Meckel diverticulum, with proximal small intestinal obstruction. Significant stenosing atherosclerosis was present in all three major epicardial coronary arteries, but with no histological evidence of acute or chronic ischemic myocardial damage. Death was attributed to small intestinal obstruction due to direct inguinal herniation (and infarction) of a Meckel diverticulum (a Littre hernia), complicating ischemic heart disease. Although Littre hernias are not a reported cause of sudden death in the elderly, congenital gastrointestinal anomalies may rarely play a significant role in terminal episodes well beyond childhood years. The autopsy assessment of sudden death at any age involves detailed examination of the entire length of the intestinal tract.
Evaluation of peri‐implant bone resorption around Straumann Bone Level© implants placed in areas reconstructed with autogenous vertical onlay bone grafts
Authors: Chiapasco Matteo , Casentini Paolo , Zaniboni Marco , Corsi Elena
Published: August 2011

Aim of the study

To evaluate the survival and success rate of Straumann Bone Level implants placed in vertically atrophied edentulous jaws previously reconstructed with autogenous onlay bone grafts taken from the calvarium or the mandibular ramus.

Materials and methods

From 2007 to 2009, 18 patients presenting with vertical deficits of the edentulous ridges were treated with autogenous cortical bone grafts harvested from the mandibular ramus or the calvarium. Four to seven months afterward, 60 Straumann Bone Level implants were placed in the reconstructed areas. After a further waiting period of 2–3 months, patients were rehabilitated with implant‐supported fixed prostheses. Follow‐up ranged from 12 to 36 months (mean: 19 months) after the start of prosthetic loading. Graft resorption before implant placement, as well as survival and success rates of implants, were recorded.

Results

The mean bone resorption prior to implant placement was 0.18 mm for calvarial grafts and 0.42 mm for ramus grafts. Survival rate was 100% either for implants placed in calvarial grafts or implants placed in ramus grafts, while success rate was 90.3% for implants placed in calvarial grafts, and 93.1% for implants placed in ramus grafts.

Conclusion

Results from this study seem to demonstrate that implants with a platform‐switching design may predictably integrate in edentulous areas reconstructed with autogenous bone grafts, with survival rates consistent with those reported in recent literature reviews on the same topic, and also with implants placed in native bone. Conversely, this study was not able to demonstrate that implants with platform‐switching design may reduce bone resorption around implants placed in reconstructed areas.
Analysis of the influence of residual alveolar bone height on sinus augmentation outcomes
Authors: Avila‐Ortiz Gustavo , Neiva Rodrigo , Galindo‐Moreno Pablo , Rudek Ivan , Benavides Erika , Wang Hom‐Lay
Published: August 2011

Introduction

Maxillary sinus augmentation is a predictable implant site development technique for posterior atrophic maxillary ridges. However, graft consolidation requires adequate angiogenesis and migration of osteogenic cells from native bone. Therefore, the amount of residual bone height (RBH) may play a role in the rate of graft maturation. The purpose of this study was to analyze the influence of RBH in the histomorphometric outcomes of maxillary sinus augmentation procedures.

Material and methods

Patients in need of sinus augmentation were recruited for the study. Customized radiographic guides were fabricated and a cone‐beam computerized tomography scan was obtained at baseline. Two examiners measured RBH on the scans at the locations marked by the radiographic guide. Sinus grafting was performed by a lateral window approach using a particulated mineralized allograft. Patients were followed up for 6 months. At the time of implant placement, bone core biopsies were harvested using the radiographic guide, which was converted into a surgical guide. Samples were histomorphometrically analyzed. Proportion of vital bone (%VB), remaining allograft particles (%RA), and non‐mineralized tissue (%NMT) were quantified. Categorical analysis of correlation of RBH (<4 or ≥4 mm) with%VB and%RA was performed using a statistical model.

Results

Twenty‐one patients underwent sinus augmentation for a total of 21 sinuses. One patient developed an infection after grafting and was excluded. Histomorphometric analysis revealed that mean%VB was 20.47 ± 18.25, mean %RA was 29.04 ± 24.94, and average %NMT was 50.47 ± 12.76. No significant correlation between RBH and %VB (r = 0.016; P = 0.951), and RBH and % (r = 0.009; P = 0.971) was found. Similarly, categorical analysis of correlation showed no statistical significance.

Conclusion

These findings suggest that the remaining alveolar bone height does not appear to influence the maturation and consolidation of an allograft in the maxillary sinus.