bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for 30‐day readmission in general medical patients admitted from the emergency department: a single centre study
Authors: Shu C‐C. , Lin Y‐F. , Hsu N‐C. , Ko W‐J.
Published: July 2011

Background:  Overcrowding in emergency departments (ED) around the world is an increasingly serious problem with an adverse impact on both patient flow and patient outcomes. A significant contributing factor to ED overcrowding is possibly due to readmission. Risk factors for readmission in patients admitted from ED are rarely studied, particularly in Asian countries where the length of stay is reportedly longer.

Methods:  A retrospective study of patients admitted to general medical wards from the ED of a referral centre in northern Taiwan from November 2009 to April 2010 was conducted. The primary outcome was 30‐day hospital readmission and clinical characteristics were analysed for predictors of readmission.

Results:  Of the recruited 2698 patients, 451 (16.7%) were readmitted within 30 days after discharge. Age, gender, marital status and the activities of daily living (Barthel's score) were not associated with 30‐day readmission. Higher Charlson score ((score 2–4) hazard ratio (HR): 1.42, 95% confidence interval (CI): 1.07–1.89; (score >4) HR: 1.93, 95% CI: 1.37–2.73), longer hospital stay ((8–14 days) HR: 1.51, 95% CI: 1.17–1.95; (15–28 days) HR: 1.64, 95% CI: 1.22–2.19; (>28 days) HR: 1.97, 95% CI: 1.43–2.71), and presence of underlying active malignancy (HR: 1.66, 95% CI: 1.27–2.16) and anaemia (HR: 1.26, 95% CI: 1.02–1.55) were independently associated with readmission.

Conclusion:  Medical patients admitted from the ED of a referral centre have a 30‐day readmission rate of 16.7%. Post‐discharge care should focus on patients with higher Charlson score, longer hospitalisation, anaemia and underlying active malignancy, which are independent predictive factors for 30‐day readmission.
Prevalence of paraproteinaemia in older Australians
Authors: Suan D. , Hughan M. , Bates S. , Rochtchina E. , Empson M. , Mitchell P. , Fulcher D. A.
Published: July 2011

Background:  Estimates of the prevalence of paraproteinaemia vary, from 1% in persons aged over 25 years to 10% in those aged over 80 years, although there are limited data from well‐defined populations. We sought to determine the prevalence of paraproteinaemia in Australians aged 50 years and over, and to determine risks factors for its presence.

Methods:  We performed a population‐based, cross‐sectional study using data and serum collected in the Blue Mountains Eye Study. Serum samples from 2933 patients were analysed by capillary zone electrophoresis and, where indicated, immunosubtraction, which allowed for both quantitation and isotype detection.

Results:  A paraprotein was detected in 134 of the 2933 samples, giving an overall prevalence of 4.6% (95% confidence interval, 3.8–5.3%). The presence of a paraprotein was strongly age‐related (Ptrend= 0.001), with a prevalence of 2.8% in persons aged 50–59 years, rising steadily to 9.1% in those aged 80 years and over. The prevalence was significantly higher in men (5.9%) compared with women (4.0%) (P= 0.03).

Conclusion:  We conclude that approximately one in 20 Australians aged 50 years or over harbours a paraprotein, a prevalence that appears higher than from similar cohorts in other countries.
Voice hearing: A secondary analysis of talk by people who hear voices
Authors: Jones Malcolm , Coffey Michael
Published: July 2011

Unitary explanations of mental illness symptoms appear to be inadequate when faced with everyday experiences of living with these conditions. In particular, the experience of voice hearing is not sufficiently accounted for by biomedical explanations. This paper revisits data collected from a sample of people who hear voices to perform a secondary analysis with the aim of examining the explanatory devices deployed by individuals in their accounts of voice hearing. Secondary analysis is the use of existing data, collected for a previous study, in order to explore a research question distinct from the original inquiry. In this study, we subjected these data to a thematic analysis. People who hear voices make use of standard psychiatric explanations about the experience in their accounts. However, the accounts paint a more complex picture and show that people also impute personal meaning to the experience. This in turn implicates both personal and social identity; that is, how the person is known to themselves and to others. We suggest that this knowledge can inform a more thoughtful engagement with the experiences of voice hearing by mental health nurses.
Risk factors for fractured clavicle in the newborn
Authors: Lurie Samuel , Wand Suzanna , Golan Abraham , Sadan Oscar
Published: July 2011

Aim:  To disclose potential risk factors for sustaining a fractured clavicle in the newborn.

Method:  A retrospective case‐control analysis of women who gave birth to an infant with a fractured clavicle during a four‐year period (2003–2006) was performed. A control group of newborns who did not sustain a fractured clavicle was formed (2:1) matched for maternal age, parity and gestational age at delivery.

Results:  The rate of fractured clavicle was 0.35%. Heavier newborns' birth weight (3632.9 ± 376.1 g vs 3429.5 ± 513.0 g, P < 0.05) and the use of oxytocin (91.3% vs 69.5%, P < 0.05) were associated with the occurrence of fractured clavicle during birth. Fractured clavicle was not well correlated with maternal height, maternal pregestational body mass index, maternal body mass index at delivery, maternal weight gain during pregnancy, induction of labor, duration of the second stage of labor, instrumental delivery or newborn birth weight of more than 4000 g.

Conclusion:  We could not identify significant risk factors that could be dealt with in order to avoid a fractured clavicle being sustained during birth. Most fractured clavicles occur in normal newborns following normal labor and delivery.
Clinical outcome of stage Ia1 squamous cell carcinoma of the uterine cervix and pathological findings of initial conization
Authors: Yoshinaga Mitsuhiro , Hamada Tomonori , Orita Yuji , Yoshitomi (Shintomo) Nao , Matsuo Takashi , Tsuji Takahiro , Tabata Kazuhiro , Douchi Tsutomu
Published: July 2011

Aim:  The present study investigated the clinical outcome of stage Ia1 squamous cell carcinoma (SCC) of the uterine cervix at a single institute.

Materials and Methods:  Subjects were 84 patients with cervical SCC, International Federation of Gynecology and Obstetrics stage Ia1 diagnosed according to conization findings between January 2000 and June 2009. Correlations between clinical outcome and pathological findings on initial conization were investigated.

Results:  Of 65 hysterectomy (without pelvic lymphadenectomy) patients, two (3.1%) showed metastasis to the vaginal wall, and two (3.1%) to the pelvic lymph nodes. Five patients (6.0%) showed lymphovascular invasion, and three (3.6%) showed confluent patterns of stromal invasion (confluent invasion) on initial conization findings. All of these five patients were included in the hysterectomy group. Of 19 patients with conization alone, two showed vaginal metastasis. Of four patients with vaginal metastasis, two showed lymphovascular invasion and one showed confluent invasion despite negative conization margin. In patients with nodal metastasis, stromal invasion of 3.0 mm and 2.8 mm, and horizontal spread of 6.8 mm and 6.9 mm were observed on conization, respectively. All patients are currently alive due to adequate therapy including chemo‐radiation for six patients with recurrent disease.

Conclusions:  In patients showing stromal invasion of nearly 3.0 mm and horizontal spread of nearly 7.0 mm in stage Ia1 cervical SCC, pelvic lymphadenectomy may be considered. Even for patients showing a negative conization margin, careful follow up is necessary, because vaginal metastasis sometimes occurs.
Three‐dimensional volume‐rendered imaging of normal and abnormal fetal fluid‐filled structures using inversion mode
Authors: Hata Toshiyuki , Mori Nobuhiro , Tenkumo Chiaki , Hanaoka Uiko , Kanenishi Kenji , Tanaka Hirokazu
Published: July 2011

A total of six normal and eight abnormal fetuses at 16–38 weeks of gestation were studied using transabdominal three‐dimensional sonography with an inversion mode. In normal fetuses, the stomach, gallbladder and bladder could be depicted. In particular, peristalsis of the stomach was noted. In the case of holoprosencephaly, fused hemispheres were evident. In the case of hydrocephalus, the enlargement of ventricular cavities was noted. In the case of bilateral pleural effusion, the spatial relationship and size of the effusions were depicted. In the case of meconium peritonitis, the spatial relationship between the dilated intestines and ascites was depicted. In two cases of hydronephrosis, the dilated renal pelvis and calyces were clearly shown. In the case of multicystic dysplastic kidney, the number and size of cysts were clearly identified. In the case of left ovarian cyst, the anatomical relationships among the ovarian cyst, kidney, stomach and bladder could be easily understood.
Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: A randomized study
Authors: Sesti Francesco , Ruggeri Velia , Pietropolli Adalgisa , Piancatelli Raffaella , Piccione Emilio
Published: July 2011

Aim:  To compare postoperative outcomes and effects on quality of life following thermal balloon ablation (TBA) or laparoscopic supracervical hysterectomy (LSH) in women with heavy menstrual bleeding (HMB).

Material and Methods:  Sixty‐eight women requiring surgical treatment for HMB were randomly allocated into two treatment arms: TBA (n = 34) and LSH (n = 34). The randomization procedure was based on a computer‐generated list. The primary outcome was a comparison of the effects on menstrual bleeding (Pictorial Blood Loss Assessment Chart [PBAC]) between the two procedures. The secondary outcome measures were quality of life, improvement of bleeding patterns, intensity of postoperative pain, and early postoperative complications. Continuous outcome variables were analyzed using Student's t‐test. Discrete variables were analyzed with the χ2 test or Fisher's exact test. P < 0.05 was considered statistically significant.

Results:  The PBAC score was significantly reduced in both treatment groups. After LSH all women had amenorrhea. After TBA there was a significant improvement of bleeding frequency and length. The postoperative pain intensity at 24 h was significantly minor in women treated with TBA rather than with LSH. The Medical Outcomes Survey Short Form 36 (SF‐36) score improved in both groups. However, LSH showed a negative impact on the emotional state. No intraoperative complications occurred, and no case was returned to the theatre in either group.

Conclusion:  The effectiveness of TBA as a possible treatment of HMB is confirmed. However, LSH showed a definitive improvement of the symptoms, and a better life quality profile. Further controlled prospective studies are required for identifying the best surgical approach in women with HMB.
Massive postpartum hemorrhage after chemotherapy in a patient with acute promyelocytic leukemia
Authors: Aoki Aiko , Yoneda Noriko , Yoneda Satoshi , Miyazono Takayoshi , Sugiyama Toshiro , Saito Shigeru
Published: July 2011

A pregnant woman was diagnosed with acute promyelocytic leukemia at 38 weeks of gestation. Induction of labor was successful, and the patient delivered a healthy male baby. Soon after delivery, she was treated with chemotherapy using all‐trans‐retinoic acid (ATRA). The number of white blood cells was increased on the fifth postpartum day and retinoic acid syndrome (RAS) was considered a concern. On the sixth postpartum day, remission induction chemotherapy with idarubicin and cytosine arabinoside was started. On the seventh postpartum day, massive uterine bleeding of more than 1300 mL suddenly occurred. As administration of cytotoxic agents may induce disseminated intravascular coagulation, we should take care to avoid uterine bleeding after chemotherapy in acute promyelocytic leukemia cases treated soon after delivery.
“Every Iraqi's Nightmare”: Blogging Peace in Occupied Baghdad
Authors: Attewell Wesley
Published: July 2011

Abstract:  The importance of war blogs is increasingly acknowledged, but their political dimensions remain largely unexplored. This paper provides a series of critical readings of Riverbend's Baghdad Burning and addresses two main issues. First, there is a systematic tension between the ways in which Riverbend is “subalternized” (by her readers and herself) and her attempts to reclaim the ground upon which post‐invasion Iraq is represented. Second, the invasion has fundamentally reworked the ways in which the figure of the “Iraqi” is constructed. These epistemological and ontological processes are always complex and partial: they occur at a variety of geographical scales and they are mobilized by a diversity of actors, making it very difficult to pin them down in time and space. Nevertheless, they highlight the difficulties of reducing Riverbend's project of resistance to a simple act of speaking out: of telling the reader what life is “really like” in occupied Baghdad.
THEORY AND PRACTICE OF CLINICAL ETHICS SUPPORT SERVICES: NARRATIVE AND HERMENEUTICAL PERSPECTIVES
Authors: PORZ ROUVEN , LANDEWEER ELLEKE , WIDDERSHOVEN GUY
Published: July 2011

In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of ‘theory’ and show how it is interwoven with ‘practice’ as we go along. First, we look at theory in its foundational role: in our case ‘narrative ethics’ and ‘philosophical hermeneutics’ provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like ‘story’, ‘responsibility’, or ‘vulnerability’ to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice‐versa.
MONOLOGICAL VERSUS DIALOGICAL CONSCIOUSNESS – TWO EPISTEMOLOGICAL VIEWS ON THE USE OF THEORY IN CLINICAL ETHICAL PRACTICE
Authors: OHNSORGE KATHRIN , WIDDERSHOVEN GUY
Published: July 2011

In this article, we argue that a critical examination of epistemological and anthropological presuppositions might lead to a more fruitful use of theory in clinical‐ethical practice. We differentiate between two views of conceptualizing ethics, referring to Charles Taylors' two epistemological models: ‘monological’ versus ‘dialogical consciousness’. We show that the conception of ethics in the model of ‘dialogical consciousness’ is radically different from the classical understanding of ethics in the model of ‘monological consciousness’. To reach accountable moral judgments, ethics cannot be conceptualized as an individual enterprise, but has to be seen as a practical endeavor embedded in social interactions within which moral understandings are being negotiated. This view has specific implications for the nature and the role of ethical theory. Theory is not created in the individual mind of the ethicist; the use of theory is part of a joint learning process and embedded in a cultural context and social history. Theory is based upon practice, and serves practical purposes. Thus, clinical ethics support is both practical and theoretical.
THE ROLE OF EMOTIONS IN MORAL CASE DELIBERATION: THEORY, PRACTICE, AND METHODOLOGY
Authors: MOLEWIJK BERT , KLEINLUGTENBELT DICK , WIDDERSHOVEN GUY
Published: July 2011

In clinical moral decision making, emotions often play an important role. However, many clinical ethicists are ignorant, suspicious or even critical of the role of emotions in making moral decisions and in reflecting on them. This raises practical and theoretical questions about the understanding and use of emotions in clinical ethics support services. This paper presents an Aristotelian view on emotions and describes its application in the practice of moral case deliberation.

According to Aristotle, emotions are an original and integral part of (virtue) ethics. Emotions are an inherent part of our moral reasoning and being, and therefore they should be an inherent part of any moral deliberation. Based on Aristotle's view, we examine five specific aspects of emotions: the description of emotions, the attitude towards emotions, the thoughts present in emotions, the reliability of emotions, and the reasonable principle that guides an emotion. We then discuss three ways of dealing with emotions in the process of moral case deliberation. Finally, we present an Aristotelian conversation method, and present practical experiences using this method.
EVIDENCE – COMPETENCE – DISCOURSE: THE THEORETICAL FRAMEWORK OF THE MULTI‐CENTRE CLINICAL ETHICS SUPPORT PROJECT METAP
Authors: REITER‐THEIL STELLA , MERTZ MARCEL , SCHÜRMANN JAN , STINGELIN GILES NICOLA , MEYER‐ZEHNDER BARBARA
Published: July 2011

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.

A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist in North‐America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how‐to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end‐of‐life decisions (major ethical topics).

In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi‐centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.

We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES.
Preschoolers’ Use of Morphosyntactic Cues to Identify Generic Sentences: Indefinite Singular Noun Phrases, Tense, and Aspect
Authors: Cimpian Andrei , Meltzer Trent J. , Markman Ellen M.
Published: July 2011

Generic sentences (e.g., “Birds lay eggs”) convey generalizations about entire categories and may thus be an important source of knowledge for children. However, these sentences cannot be identified by a simple rule, requiring instead the integration of multiple cues. The present studies focused on 3‐ to 5‐year‐olds’ (N = 91) use of morphosyntactic cues—in particular, on whether children can (a) interpret indefinite singular noun phrases (e.g., “a strawberry”) as generic and (b) use a verb’s tense and aspect (e.g., “A bat sleeps/slept/is sleeping upside down”) to determine whether its subject noun phrase is generic. Children demonstrated sensitivity to both cues. Thus, solving the in‐principle problem of identifying generics may not be beyond the reach of young children’s comprehension skills.
Characterizing Children’s Expectations About Expertise and Incompetence: Halo or Pitchfork Effects?
Authors: Koenig Melissa A. , Jaswal Vikram K.
Published: July 2011

Do children expect an expert in one domain to also be an expert in an unrelated domain? In Study 1, 32 three‐ and four‐year‐olds learned that one informant was an expert about dogs relative to another informant. When presented with pictures of new dogs or of artifacts, children who could remember which informant was the dog expert preferred her over the novice as an informant about the names of dogs, but they had no preference when the informants presented artifact labels. In Study 2, 32 children learned that one informant was incompetent about dogs whereas another was neutral. In this case, children preferred the neutral speaker over the incompetent one about both dogs and artifacts. Taken together, these results suggest that for children, expertise is not subject to a “halo effect,” but incompetence may be subject to a “pitchfork effect.”
Effects of a Punitive Environment on Children's Executive Functioning: A Natural Experiment
Authors: Talwar Victoria , Carlson Stephanie M. , Lee Kang
Published: July 2011

Few studies have examined the influence of environmental factors on children's executive functioning (EF) performance. The present study examined the effects of a punitive vs. non‐punitive school environment on West African children's EF skills. Tasks included a ‘cool’ (relatively non‐affective) and ‘hot’ (relatively affective/motivational) version of three EF tasks: delay of gratification; gift delay; and dimensional change card sort. Children had more difficulties with the hot versions of the tasks than the cool versions, and older children outperformed younger children. After controlling for verbal ability (Peabody picture vocabulary test‐third edition), a consistent pattern of interaction between school and grade level emerged. Overall, kindergarten children in the punitive school performed no differently than their counterparts in the non‐punitive school. However, in grade 1, children in the punitive school performed significantly worse than their counterparts in the non‐punitive school. These results point to the need to consider interactions among discipline style, age, and internalization processes of self‐regulation to better understand environmental influences on EF development.
Social‐Cultural‐Historical Contradictions in an L2 Listening Lesson: A Joint Activity System Analysis
Authors: Cross Jeremy
Published: July 2011

Informed and inspired by neo‐Vygotskian theory, this article outlines a study exploiting a contemporary conceptualization of Wells's (2002) joint activity system model as an exploratory framework for examining and depicting the social‐cultural‐historical contradictions in second‐language (L2) learners’ joint activity. The participants were a pair of advanced‐level Japanese English‐as‐a‐foreign‐language learners, and their joint activity was the focus of analysis in a lesson they completed together, which was based on a pedagogical cycle aimed at developing their metacognition of L2 listening. To address the various dimensions depicted in the joint activity system model utilized, data from written journals, interviews, and dialogue were analyzed. The analysis explored the learners’ motives, history and beliefs, pair work, goals, and pattern of interaction in order to identify the social‐cultural‐historical contradictions shaping their development of metacognition of L2 listening. The joint activity system analysis illustrated that a number of social‐cultural‐historical contradictions were both driving and inhibiting learners’ metacognitive development.
A study on the prognostic value of clinical and surgical features of dermatofibrosarcoma protuberans in Korean patients
Authors: Kim M. , Huh C.H. , Cho K.H. , Cho S.
Published: July 2011

Background  Dermatofibrosarcoma protuberans (DFSP) is a rare spindle cell tumour with locally aggressive characteristics. Only few studies on the epidemiology of DFSP in Asians have been reported.

Objectives  The purpose of the study was to evaluate the epidemiological and clinical characteristics of DFSP in Korean patients and determine the prognostic factors that affect disease‐free survival.

Methods  We conducted a retrospective review of patients diagnosed with primary or recurrent DFSP between 2000 and 2009 at three Seoul National University Hospitals. Patient, tumour and treatment factors were analysed for local recurrence‐free survival.

Results  We analysed data for 65 patients, of whom 36 (55.4%) were female. The mean age at disease onset was 34.4 years with 50% aged between 20 and 40 years. Involved sites were most often on the trunk (66.1%). Among the 65 patients, 60 patients underwent wide excision; seven patients (10.8%) experienced local recurrence during 3.6 years of follow‐up. The recurrence‐free survival was significantly related to the microscopic resection margins (P = 0.005), clinical presentation (P = 0.002) and frequency of recurrence (P = 0.014) in the univariate analysis. There were three cases with metastasis, two of whom died because of progression of the disease despite continuous chemotherapy with imatinib mesylate.

Conclusions  We report the epidemiologic and clinical characteristics of DFSP in Korea. Patients with recurrent disease at presentation and frequent recurrence have a high risk of recurrence and metastasis, and therefore close observation is needed in these patients.
Preserving genetic diversity in threatened species reintroductions: how many individuals should be released?
Authors: Tracy L. N. , Wallis G. P. , Efford M. G. , Jamieson I. G.
Published: July 2011

Reintroduction guidelines recommend that ‘adequate’ numbers of individuals be released to minimize loss of genetic diversity, but these numbers are rarely quantified. We present a framework for assessing the number of individuals required for an island reintroduction that takes account of allele loss both during the founding event and in the following establishment phase with a low population size. This is the first attempt to model release numbers for reintroductions in order to preserve alleles with a specified initial frequency, while taking post‐release mortality rates, population growth rates and site carrying capacity into account. Probability of allele retention was sensitive to both release number and post‐release demography. The rate of allele loss was strongly influenced by both environmental stochasticity and delayed population growth but was little affected by increasing the annual turnover rate of the breeding population. We illustrate the model's application using parameter estimates from a threatened New Zealand passerine, the mohua Mohoua ochrocephala, for which reintroduction is a common management tool. Our modelling indicates that when population growth is moderate (λ=1.3), c. 60 individuals would need to be released to achieve at least 95% certainty that alleles at an initial frequency of 0.05 would be retained after 20 years (five overlapping generations), which is double the number typically released in translocations of mohua and other threatened forest passerines in New Zealand.
Propofol post‐conditioning induced long‐term neuroprotection and reduced internalization of AMPAR GluR2 subunit in a rat model of focal cerebral ischemia/reperfusion
Authors: Wang Haiyun , Luo Mengqiang , Li Cui , Wang Guolin
Published: July 2011

J. Neurochem. (2011) 119, 210–219.

We previously reported that propofol (20 mg/kg/h) post‐conditioning provided acute (up to 24 h) neuroprotection in rats with transient middle cerebral artery occlusion. In this study, we extend these data by examining long‐term protection and exploring underlying mechanisms involving AMPA receptor GluR2 subunit internalization. Rats were treated with propofol 20 mg/kg/h after 60 min of occlusion (beginning of reperfusion for 4 h). Propofol post‐conditioning reduced infarct volume and improved spatial memory deficiencies (up to 28 days) induced by ischemia/reperfusion injury. Additionally, Propofol post‐conditioning promoted neurogenesis in the dentate gyrus of hippocampus, as measured by bromodeoxyuridine and neuron‐specific nuclear protein immunofluorescence‐double staining at day 28 after reperfusion. Finally, propofol post‐conditioning increased the surface expression of AMPA receptor GluR2 subunit, thus inhibited the internalization of this part until 28 days after stroke. In conclusion, our data suggest that propofol post‐conditioning provides long‐term protection against focal cerebral ischemia/reperfusion injury in rats. Furthermore, we found that the inhibition of AMPA receptor GluR2 subunit internalization may contributed to this long‐term neuroprotection.
Imaging – the interface with pharmacology: looking to the future
Authors: Lawrence Andrew J. , Heinz Andreas
Published: July 2011

Basic research is constantly adopting novel, innovative and powerful approaches to enable a deeper interrogation of the specific subject matter. A clear example of this strategy is the development of multiple imaging modalities, both in vitro and in vivo based, that have revolutionized medical research, drug discovery, diagnosis and clinical monitoring. In this themed section of the British Journal of Pharmacology, we highlight a number of imaging platforms which are discussed in relation to their applicability for pharmacological experiments, including longitudinal studies. As such, the authors endeavour to describe the technology, its limitations and how these approaches can complement pharmacological research. In addition, there is discussion of the role of pharmacological imaging from a clinical perspective.
Azelnidipine is a calcium blocker that attenuates liver fibrosis and may increase antioxidant defence
Authors: Ohyama T , Sato K , Kishimoto K , Yamazaki Y , Horiguchi N , Ichikawa T , Kakizaki S , Takagi H , Izumi T , Mori M
Published: July 2011

BACKGROUND AND PURPOSE

Oxidative stress plays a critical role in liver fibrogenesis. Reactive oxygen species (ROS) stimulate hepatic stellate cells (HSCs), and ROS‐mediated increases in calcium influx further increase ROS production. Azelnidipine is a calcium blocker that has been shown to have antioxidant effects in endothelial cells and cardiomyocytes. Therefore, we evaluated the anti‐fibrotic and antioxidative effects of azelnidipine on liver fibrosis.

EXPERIMENTAL APPROACH

We used TGF‐β1‐activated LX‐2 cells (a human HSC line) and mouse models of fibrosis induced by treatment with either carbon tetrachloride (CCl4) or thioacetamide (TAA).

KEY RESULTS

Azelnidipine inhibited TGF‐β1 and angiotensin II (Ang II)‐activated α1(I) collagen mRNA expression in HSCs. Furthermore, TGF‐β1‐ and Ang II‐induced oxidative stress and TGF‐β1‐induced p38 and JNK phosphorylation were reduced in HSCs treated with azelnidipine. Azelnidipine significantly decreased inflammatory cell infiltration, pro‐fibrotic gene expressions, HSC activation, lipid peroxidation, oxidative DNA damage and fibrosis in the livers of CCl4‐ or TAA‐treated mice. Finally, azelnidipine prevented a decrease in the expression of some antioxidant enzymes and accelerated regression of liver fibrosis in CCl4‐treated mice.

CONCLUSIONS AND IMPLICATIONS

Azelnidipine inhibited TGF‐β1‐ and Ang II‐induced HSC activationin vitroand attenuated CCl4‐ and TAA‐induced liver fibrosis, and it accelerated regression of CCl4‐induced liver fibrosis in mice. The anti‐fibrotic mechanism of azelnidipine against CCl4‐induced liver fibrosis in mice may have been due an increased level of antioxidant defence. As azelnidipine is widely used in clinical practice without serious adverse effects, it may provide an effective new strategy for anti‐fibrotic therapy.
Angiofibroma of the nasal cavity in 13 dogs
Authors: Burgess K. E. , Green E. M. , Wood R. D. , Dubielzig R. R.
Published: July 2011

This case series describes a rare entity, nasal angiofibroma, in 13 dogs that were presented to the University of Wisconsin, School of Veterinary Medicine from 1988 to 2000. All dogs in this case series presented with clinical signs and radiographic changes that were strongly suggestive of a locally invasive neoplasm. However, histopathology completed on transnostral core biopsy samples revealed benign appearing vascular proliferation with secondary lymphosuppurative inflammation was established despite cytologic criteria of malignancy present in five dogs. On the basis of the outcomes in this case series, nasal angiofibroma should be considered a differential for dogs presenting with clinical signs consistent with a malignant nasal tumour.
Successful Treatment with Topical N‐Acetylcysteine in Urea in Five Children with Congenital Lamellar Ichthyosis
Authors: Bassotti Adriana , Moreno Silvia , Criado Elena
Published: July 2011

Abstract:  We reported the efficacy of topical cutaneous N‐acetylcysteine in children with type I lamellar ichthyosis. The drug was applied on predetermined body surface areas two times a day for 6 weeks, followed by a daily maintenance application. During the first 2 weeks of treatment, a significant improvement occurred. After 4 months of maintenance application, a marked overall improvement occurred in all the treated areas. Only two patients showed mild adverse effects such as light burning, pruritus, and irritation. Even though a larger group of patients should be necessary to confirm the data, topical 10% N‐acetylcysteine emulsion prepared in urea 5% seems to be a valuable and safe therapeutic option for lamellar ichthyosis in children, with benefit not only for skin lesions but also for ectropion avoiding a surgical procedure.
Physiological Skin Manifestations in Twins: Association with Maternal and Neonatal Factors
Authors: Gupta Priyanka , Faridi Mohammad Moonis Akbar , Batra Mayanka
Published: July 2011

Abstract:  There is paucity of literature on the incidence and clinical associations of transient benign dermatological conditions in twin neonates. This prospective study evaluated 253 live‐born twin babies (≥23 wks) at a tertiary care hospital in Delhi, India. All study subjects were observed for the first 7 days of life, and regular dermatological examination was performed. The primary focus was on palatine Epstein pearls (PEP), milia, erythema toxicum neonatorum (ETN), and physiological skin desquamation (PDS). Zygosity was determined with the help of sex combination of the pairs, chorionicity of the placentae, and seven blood group phenotypes. Chi‐square test, Cohen’s kappa test, and logistic regression analysis were done. PEP, milia, ETN, and PDS were seen in 88.1%, 83.4%, 2.4%, and 4.3% twin babies, respectively. Preputial Epstein pearls were not seen. Birth order, maternal anemia, route of delivery, meconium staining of amniotic fluid, gestational maturity, birth weight, and presence of intrauterine growth restriction were found to be associated with one or more of the studied skin conditions (p < 0.05), but maternal age, pregnancy‐induced hypertension, and sex of the baby did not affect incidence of any (p > 0.05). The intrapair concordance was highly significant (p < 0.001) in mono‐ and dizygotic twins. PEP and milia were equally common in the evaluated twins as compared to reports in singletons, while ETN and PDS were less common in this twin cohort. Environmental and genetic factors may regulate physiological skin manifestations in newborns.
A Comparative Trial Comparing the Efficacy of Tacrolimus 0.1% Ointment with Aquaphor Ointment for the Treatment of Keratosis Pilaris
Authors: BREITHAUPT ANDREW D. , ALIO ALESSANDRA , FRIEDLANDER SHEILA F.
Published: July 2011

Abstract:  Keratosis pilaris is common, but little information exists regarding effective therapy for this sometimes clinically and often cosmetically troublesome disorder. This small pilot study compared the efficacy of Aquaphor ointment with tacrolimus ointment 0.1% and found that both were effective and well tolerated by patients.
Myocardial Contractility and Relaxation After Deep Hypothermic Circulatory Arrest in a Neonatal Piglet Model
Authors: Tirilomis Theodor , Popov Aron‐Frederik , Liakopoulos Oliver J. , Schmitto Jan D. , Bensch Marc , Steinke Katja , Coskun K. Oguz , Schoendube Friedrich A.
Published: July 2011

Cooling before circulatory arrest or ischemic arrest has been reported to influence myocardial performance in isolated neonatal hearts. The aim of the present study was to analyze indices of myocardial contractility and relaxation in an in vivo neonatal model after deep hypothermic circulatory arrest (DHCA). DHCA (18°C; DHCA group; n = 8) or mild hypothermic cardiopulmonary bypass ([MH‐CPB] 32°C; MH‐CPB group; n = 10) was applied in newborn piglets. After reperfusion (60 and 120 min), left ventricular dP/dtmax increased in DHCA and MH‐CPB, while −dP/dtmax decreased slightly in DHCA and increased in MH‐CPB. Nevertheless, the differences between the two groups did not reach statistical significance. In conclusion, left ventricular contractility remained stable after reperfusion following DHCA, to some degree at the expense of the diastolic function.
Experience of Sternal Secondary Closure by Means of a Titanium Fixation System After Transverse Thoracosternotomy
Authors: Motomura Tadashi , Bruckner Brian , La Francesca Saverio , Mittelhaus Sebastian , Chike‐Obi Chuma , Leon‐Becerril Joel , Ngo Uy , Loebe Matthias
Published: July 2011

Sternal dehiscence is a common complication after transverse thoracosternotomy in patients undergoing bilateral sequential lung transplantation (BSLT). These patients can be treated with conservative therapy, but severe dehiscence requires surgical reapproximation and secondary closure of the sternum. Seventy‐one cases of patients who underwent BSLT between January 2007 and May 2009 were reviewed retrospectively. Out of 71 patients, the sternum was intact in two cases due to the use of bilateral anterolateral thoracotomy, and a clamshell incision had been utilized in 69 patients. Four patients (6.8%) presented with persistent chest pain with severe sternal dehiscence diagnosed by chest X‐ray and/or chest computed tomography, and underwent sternal reapproximation using the Synthes Titanium Sternal Fixation System for longitudinal sternal plating. All four patients had successful sternal realignment and resolution of their preoperative clinical symptoms. No perioperative or postoperative complications were observed. The Synthes Titanium Sternal Fixation System is an appropriate and effective method for internal fixation of the sternum when used for symptomatic severe sternal dehiscence after sequential BSLT via transverse thoracosternotomy.
African American adult apheresis donors respond to granulocyte–colony‐stimulating factor with neutrophil and progenitor cell yields comparable to those of Caucasian and Hispanic donors
Authors: Carilli Allison R. , Sugrue Michele W. , Rosenau Emma H. , Chang Myron , Fisk Diann , Medei‐Hill Michelle , Williams Katherine , Wiggins Laura , Wingard John R.
Published: July 2011

BACKGROUND: Granulocyte–colony‐stimulating factor (G‐CSF)‐mobilized peripheral blood progenitor cells (PBPCs) are the most common source of cells used for hematopoietic transplantation. Benign ethnic neutropenia has been found in persons of African descent, affecting circulating white blood cells (WBCs), but not WBC production within marrow. Persons of African descent have reduced neutrophil mobilization after steroid administration, and newborns have fewer nucleated and progenitor cells in their cord blood.

STUDY DESIGN AND METHODS: Twenty‐two African American (AA) and 12 Hispanic PBPC donors were age, sex, and weight matched with 34 Caucasian donors. Groups were compared based on WBC and neutrophil counts after mobilization and numbers of CD34+ cells collected on Day 5 of G‐CSF mobilization.

RESULTS: AA donors had significantly lower baseline WBC (6.1 ± 1.1 vs. 7.1 ± 1.7, p = 0.04) and neutrophil (3.4 ± 1.1 vs. 4.5 ± 1.3, p = 0.01) counts compared to matched Caucasian donors. G‐CSF–stimulated AAs had a significantly greater increase in WBC and neutrophil counts compared to matched Caucasians (889 ± 293% vs. 665 ± 230% neutrophils, p = 0.02). There was no significant difference in product cell counts when comparing total nucleated, CD3+, CD34+, and mononuclear cells or colony‐forming units (CFUs) between Caucasians and Hispanics or AAs and trends to greater numbers of neutrophils in products from AA donors.

CONCLUSION: When stimulated by G‐CSF, AAs are able to increase WBC and neutrophil counts to a higher degree than Caucasians, achieving similar numbers of neutrophil and progenitor cells in apheresis products despite starting from lower baseline blood counts.
Autoimmune hemolytic anemia in pediatric liver or combined liver and small bowel transplant patients: a case series and review of the literature
Authors: Li Marissa , Goldfinger Dennis , Yuan Shan
Published: July 2011

BACKGROUND: Autoimmune hemolytic anemia (AIHA) occurring after solid organ transplantation is an infrequently reported entity. We describe in this report six cases of AIHA in pediatric liver or combined liver and small bowel transplant patients.

STUDY DESIGN AND METHODS: We retrospectively identified and reviewed the records of pediatric liver or combined liver and small bowel transplant patients with both serologic and clinical evidence of AIHA. We also performed an English language literature review for prior publications of AIHA occurring after solid organ transplantation.

RESULTS: We identified six patients presenting with severe hemolysis 9 months to 14 years after transplantation. All six developed warm AIHA, and two had concomitant cold agglutinins. All except one patient received various therapeutic combinations including steroids, intravenous immune globulin, rituximab, plasmapheresis, splenectomy, and vincristine. Five patients achieved remission 2 weeks to 3 months after presentation. Although tacrolimus has been speculated to play a causative role in the development of AIHA after organ transplantation, our case series demonstrated slightly better outcomes despite continuing tacrolimus compared to published cases where most patients either received significantly reduced doses of tacrolimus or were switched to a different immunosuppressant (83% vs. 76% cumulative literature remission rate).

CONCLUSION: AIHA may occur in solid organ transplant patients at a much higher frequency than previously believed. Hemolysis is often severe and resistant to steroid treatment alone. Thus early diagnosis and institution of aggressive multimodality treatment, including the use of rituximab, may be needed to achieve remission.
Red blood cell preservation by droplet freezing with polyvinylpyrrolidone or sucrose‐dextrose and by bulk freezing with glycerol
Authors: Schmid Pirmin , Huvard Michael J. , Lee‐Stroka A. Hallie , Lee Jae Y. , Byrne Karen M. , Flegel Willy A.
Published: July 2011

BACKGROUND: Red blood cell (RBC) preservation is essential to transfusion medicine. Many blood group reference laboratories need a method to preserve rare blood samples for serologic testing at a later date. This study offers a comparison of three common cryoprotective agents and protocols used today: bulk preservation with glycerol and droplet freezing with sucrose‐dextrose (S+D) or polyvinylpyrrolidone (PVP).

STUDY DESIGN AND METHODS: Human blood from 14 volunteers was collected and frozen at set intervals over 2 weeks with PVP, S+D, or glycerol. The frozen RBCs were later thawed and the percentage of surviving RBCs was determined. Detailed protocols and an instructional video are supplied.

RESULTS: Over a 2‐week period, RBCs preserved with glycerol and thawed with a widely used protocol showed a recovery of 41 ± 16% (mean ± standard deviation) while those thawed with a modified glycerol protocol showed a recovery of 76 ± 8%. RBCs preserved by droplet freezing with S+D showed a recovery of 56 ± 11% while those preserved by droplet freezing with PVP showed a recovery of 85 ± 6%. Recovery values were similar with ethylenediaminetetraacetic acid or heparin anticoagulants, differing freezing rates, and varying droplet volumes.

CONCLUSION: Droplet freezing with PVP offered the greatest recovery. While bulk freezing with glycerol can also be effective, droplet freezing may be a more convenient method overall. It requires less effort to thaw, needs much less storage room, and allows blood group laboratories to be frugal with thawing rare samples.
Flow cytometric analyses of CD34+ cells with inclusion of internal positive controls
Authors: Gutensohn Kai , Jessen Maria , Ketels Andrea , Gramatzki Martin , Humpe Andreas
Published: July 2011

BACKGROUND: Flow cytometric measurement of CD34+ events is used to ensure the quality of human progenitor cell grafts. This study was conducted to evaluate whether the spiking of routine samples from peripheral blood and apheresis products with CD34+ positive controls is feasible.

STUDY DESIGN AND METHODS: A total of 42 samples from 32 patients and one healthy donor were stained in duplicate for CD34+ cells. Before flow cytometric analysis, one tube was spiked with stabilized CD34+ cells at a defined concentration.

RESULTS: Median numbers of viable CD34+ cells/µL did not differ between unspiked and spiked tubes (median 37, range 0‐714; and median 34, range 0‐719, respectively). The 95% confidence interval (CI) of the mean showed a broad overlap between these samples (41.9‐119.1 and 41.4‐119.3, respectively). In addition, the 95% CI of the mean for CD45+ cells/µL overlapped broadly and median numbers did not differ. Median viability of all CD45+ cells was significantly lower in the spiked tubes (96.75, range 64‐98.8 vs. 99.25, range 97.5‐99.8) with no overlap of the 95% CI of the mean viability.

CONCLUSION: The results of this study show that spiking of routine samples with internal positive controls does not affect CD34+ cell analyses, but does support the reliability of important clinical data. The inclusion of positive controls is expedient for laboratories that perform analyses with low CD34+ numbers and laboratories that use different flow cytometric analyzers and may also become a requirement to meet statutory regulations.
Partial D phenotypes and genotypes in the Chinese population
Authors: Ye Luyi , Wang Pan , Gao Huanhuan , Zhang Jiamin , Wang Chen , Li Qin , Han Shasha , Guo Zhonghui , Yang Ying , Zhu Ziyan
Published: July 2011

BACKGROUND: The D variant phenotypes are often categorized into weak D types and partial D types. Although the molecular basis underlying the partial D phenotype has been investigated in several races, data from Chinese populations are rare.

STUDY DESIGN AND METHODS: We collected partial D samples from 1,274,540 blood donors, as well as from sporadic patients in the Chinese population, over a 4‐year period. Samples with partial D phenotype were determined by commercial monoclonal anti‐D panels and molecular methods. Blood samples with discrepant results of serologic and molecular methods were further investigated by polymerase chain reaction (PCR) with sequence‐specific primers and nucleotide sequencing of RHD exons. The detection of antibodies was performed.

RESULTS: A total of 44 samples with partial D phenotypes were confirmed. Molecular typing revealed five different known aberrant alleles as well as four new RHD alleles. As described previously, DVI represented the most frequent partial D type in China with a total of 36 samples. However, discrepant results were observed in four DVI samples with serotyping and genotyping (i.e., DVI category identified by D‐screen test and grossly intact RHD gene identified by multiplex PCR). We also found four novel alleles, termed DFR‐4, DCS‐3, DCC, and DLX.

CONCLUSION: To date, this study presents the most comprehensive report on partial D in China. The distribution of partial D types in China was found to be complicated and polymorphic, whereas RhD genotyping of DVI‐variant samples might give inaccurate results due to a relatively high incidence of RHD(1227G>A) in the Chinese population.