bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in biometrics and moult of non‐breeding Red Knots Calidris canutus in southern Africa and Scotland reflect contrasting climatic conditions
Authors: SUMMERS RON W. , UNDERHILL LES G. , WALTNER MANFRED , SWANN ROBERT L.
Published: October 2009

We describe the migration, biometrics and moult of Red Knot Calidris canutus canutus in southern Africa and compare them with the biometrics and moult of Calidris canutus islandica in northern Europe to examine possible adaptations to different environments during the non‐breeding season. Northward and southward migration of C. c. canutus took place along the coast of Western Europe and there was one recovery in West Africa (Mauritania), suggesting a coastal migration round West Africa rather than migration across the Sahara, as recorded in other waders. Adult Knots in South Africa had no additional fattening in November–January (fat index of 7%), in contrast to C. c. islandica wintering in Britain. This is consistent with the theory that extra fat is required only where food shortages are likely. The bills of canutus were longer than those of islandica but their wings were shorter, confirming the sub‐specific assignments and origin of this population. The average duration of primary moult in South Africa was 95 days, shorter than that of other Arctic‐breeding waders that moult in South Africa, but longer than of islandica moulting in Scotland (77 days). Mean starting and completion dates were 20 July and 5 October for islandica and 25 October and 28 January for canutus. The timing and duration of primary moult for these two subspecies suggest that waders need to complete moult before the northern winter when food supplies are limited, whilst waders in benign climates face no such pressures. First‐year canutus either retained old primaries for much of their first year or had a partial moult of inner or other primaries. Adults departed on northward migration in mid‐April, having attained a mean departure mass of c. 190 g (maximum 232 g). The mean fat index at this time was 24% (maximum 29%) and the fat‐free flight muscle mass increased. The predicted flight range of 4000 km falls short of the distance to the first likely refuelling site in West Africa, suggesting that birds rely on assistance from favourable winds.
Haemodynamic effects of patent foramen ovale and atrial septal defect closure: a comparison during percutaneous shunt closure
Authors: Luermans Justin G. L .M. , Bos Willem J. W. , Post Martijn C. , Ten Berg Jurriën M. , Thijs Plokker H. W. , Suttorp Maarten J.
Published: October 2009

Objectives:  We investigated the haemodynamic effect of percutaneous closure of an intra‐atrial shunt, using non‐invasive finger pressure measurements.

Background:  Percutaneous closure of both patent foramen ovale (PFO) and atrial septal defect (ASD) is widely practised. Currently no data are available on short‐term haemodynamic changes induced by closure.

Methods:  Twenty‐five consecutive patients (mean age 49 ± 17 years, 10 men) who underwent a percutaneous closure of a PFO (n = 15) or ASD (n = 10) were included in this study. During the procedure blood pressure and heart rate (HR) were monitored continuously with a Finometer®. Changes in systolic, mean, and diastolic pressure, stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were computed from the pressure registrations using Modelflow® methodology.

Results:  Baseline characteristics were similar for the PFO and ASD patients. After PFO closure none of the haemodynamic parameters changed significantly. After ASD closure the systolic, mean, and diastolic pressures increased 7·1 ± 5·4 (P = 0·003), 3·8 ± 3·5 (P = 0·007) and 2·0 ± 3·0 mmHg (P = ns) respectively. HR decreased 5·1 ± 5·3 beats per minute (P = 0·01). SV, CO and TPR increased 8·5 ± 6·4 ml (13·5%; P = 0·002), 0·21 ± 0·45 l min−1 (5·6%; P = ns) and 0·02 ± 0·14 dynes (4·1%; P = ns) respectively. The changes in SV differ between the PFO and ASD patients (P = 0·009).

Conclusions:  Using non‐invasive finger pressure measurements, we found that SV, mean and systolic blood pressure increased immediately after percutaneous closure of an ASD in adults, whereas the percutaneous PFO closure had no effect on haemodynamic characteristics.
EVIDENCE FOR THE USE OF EGYPTIAN BLUE IN AN 11TH CENTURY MURAL ALTARPIECE BY SEM–EDS, FTIR AND SR XRD (CHURCH OF SANT PERE, TERRASSA, SPAIN)
Authors: LLUVERAS A. , TORRENTS A. , GIRÁLDEZ P. , VENDRELL‐SAZ M.
Published: October 2009

The present study shows the analysis performed on pigment samples taken from Sant Pere (Terrassa, Catalonia, Spain), a remarkable church built in the Romanesque style. On the basis of the results obtained from the analysis, an interesting discussion arises after finding evidence of Egyptian blue in one of the samples, a discovery that was not expected due to the time period of the samples. The pigments were identified by the combined use of FTIR and SEM with an EDS facility. For the blue pigment, since the EDS and FTIR analyses suggested the possible presence of cuprorivaite, micro‐XRD experiments using synchrotron radiation were run.
ACCOUNTING FOR SRI LANKA'S EXPENDITURE INEQUALITY 1980–2002: REGRESSION‐BASED DECOMPOSITION APPROACHES
Authors: Gunatilaka Ramani , Chotikapanich Duangkamon
Published: October 2009

Sri Lanka liberalized its economy in 1977, paving the way for more rapid economic growth and higher rates of job creation. But tensions over distributional issues still plague the body politic. This paper investigates the evolution of Sri Lanka's expenditure distribution in the period 1980–2002 and uses three decomposition methodologies—the Fields, the Shapley value decomposition, and Yun's unified method—to determine underlying causes. The study finds that while average adjusted expenditure rose across strata, the rich experienced more rapid expenditure growth leading to greater inequality. Inequality change was driven by differential access to infrastructure, education, and occupation status. Demographic factors, including ethnicity, and spatial factors contributed very little. The study recommends policies that ensure more equitable access to income earning assets such as education and infrastructure services, and that contain the rise in inequality along sectoral, regional, and ethnic fault lines.
THE ESTIMATION OF PENSIONER EQUIVALENCE SCALES USING SUBJECTIVE DATA
Authors: Stewart Mark B.
Published: October 2009

This paper uses panel data on pensioners' subjective evaluations of their financial positions to construct equivalence scales for pensioners. A pensioner couple is estimated to require an income 44 percent higher than a comparable single pensioner to reach the same standard of living. This is significantly less than the equivalence scale value implied by the ratio of state pension rates, the McClements equivalence scale value, and the scale value derived from Engel curve estimation for food expenditure using the same data source. The estimated equivalence scale value is robust to variations in the definition of the pensioner sample, the measurement of income, and the econometric model used.
Infant Skin Microstructure Assessed In Vivo Differs from Adult Skin in Organization and at the Cellular Level
Authors: Stamatas Georgios N. , Nikolovski Janeta , Luedtke Michael A. , Kollias Nikiforos , Wiegand Benjamin C.
Published: October 2009

Abstract:  Functional differences between infant and adult skin may be attributed to putative differences in skin microstructure. The purpose of this study was to examine infant skin microstructure in vivo and to compare it with that of adult skin. The lower thigh area of 20 healthy mothers (ages 25–43) and their biological children (ages 3–24 months) was examined using in vivo noninvasive methods including fluorescence spectroscopy, video microscopy, and confocal laser scanning microscopy. Stratum corneum and supra‐papillary epidermal thickness as well as cell size in the granular layer were assessed from the confocal images. Adhesive tapes were used to remove corneocytes from the outer‐most layer of stratum corneum and their size was computed using image analysis. Surface features showed differences in glyph density and surface area. Infant stratum corneum was found to be 30% and infant epidermis 20% thinner than in adults. Infant corneocytes were found to be 20% and granular cells 10% smaller than adult corneocytes indicating a more rapid cell turnover in infants. This observation was confirmed by fluorescence spectroscopy. Dermal papillae density and size distribution also differed. Surprisingly, a distinct direct structural relationship between the stratum corneum morphology and the dermal papillae was observed exclusively in infant skin. A change in reflected signal intensity at ∼100 μm indicating the transition between papillary and reticular dermis was evident only in adult skin. We demonstrate in vivo qualitative and quantitative differences in morphology between infant and adult skin. These differences in skin microstructure may help explain some of the reported functional differences.
Steroid‐induced Periorificial Dermatitis in Children—Clinical Features and Response to Azelaic Acid
Authors: Jansen Thomas , Melnik Bodo C. , Schadendorf Dirk
Published: October 2009

Abstract:  Periorificial dermatitis, a common skin disease in young women, has been occasionally reported in children. This study elaborates the clinical features of periorificial dermatitis in children as well as possible pathogenetic factors and the response to 20% azelaic acid cream. A total of 10 children aged 3 to 12 (mean 7.7) years suffering from nongranulomatous periorificial dermatitis for 3 to 7 (mean 4.9) months were evaluated, and dermatologic examination was carried out. Pretreatment was documented. Skin prick tests with a panel of six common inhalative allergens and patch tests with the European Standard Series were performed. An association between atopy and periorificial dermatitis was evaluated, and patients were screened for skin colonization by fungi, bacteria, and Demodex mites. They were treated with 20% azelaic acid cream, which was topically applied twice daily on all affected areas, until complete resolution was achieved. Treatment period was followed by an individual observation period. Periorificial dermatitis had developed in typical distribution and morphology. In all patients, low‐ to high‐potency topical corticosteroids had been used on the face prior to manifestation. Atopy was found in half of the patients. Allergological, bacteriological, and mycological examinations did not reveal pathologic results. Demodex mites could not be demonstrated by skin surface biopsy. Treatment with 20% azelaic acid cream led to complete resolution of skin lesions after 4 to 8 (mean 5.4) weeks in all patients. Transient exacerbation of skin condition with a peak between the 2nd and 6th day of treatment could be observed in three patients. Side effects of 20% azelaic acid cream were registered in six patients and were predominantly present in the first 2 weeks of treatment. Side effects were minimal and became rarer with ongoing treatment. No recurrences were seen within a follow‐up period of 2 to 8 (mean 4.4) months. Treatment with 20% azelaic acid cream could provide an effective and safe alternative therapeutic option in children with nongranulomatous periorificial dermatitis.
Endonasal Endoscopic Management of Contact Point Headache and Diagnostic Criteria
Authors: Mohebbi Alireza , Memari Framarz , Mohebbi Saleh
Published: October 2009

(Headache 2010;50:242‐248)

Background.— Some types of headaches with sinonasal origin may be present in the absence of inflammation and infection. The contact points between the lateral nasal wall and the septum could be the cause of triggering and sustained pain via trigeminovascular system.

Objective.— The aim of this study was to evaluate the feasibility and effectiveness of endoscopic surgery in the sinonasal region for treatment of headache with special attention paid to specific diagnostic methods and patient selection.

Methods.— This was a prospective, non‐randomized and semi‐quasi experimental research study. Thirty‐six patients with chronic headaches who had not previously responded to conventional treatments were evaluated by rhinoscopy and/or endoscopy, local anesthetic tests and computed tomography scans as diagnostic criteria. These patients were divided into 4 groups based on the diagnostic methods utilized. The intensity of headaches pre‐ and post‐operatively were recorded by utilizing the visual analog scale scale and performing analysis with analysis of variance test comparison and Statistical Package for Social Sciences. Average follow‐up was 30 months.

Results.— Our overall success rate approximated 83% while the complete cure rate was 11%. Patients in group 4 achieved the best results. In this group all diagnostic criteria were positive. In addition, patient responses were statistically significant in groups with more than one positive criteria compared with group 1 who only had positive examination. The positive response of 14 migrainous patients diagnosed with migraine prior to treatment was 64%.

Conclusion.— Surgery in specific cases of headaches with more positive evidence of contact point could be successful, particularly if medical therapy has failed.
Topiramate for Migraine Prevention in a Naturalistic Setting: Results From an Open Label, Flexible Dose Study
Authors: Nelles Gereon , Delbrück Anette , Schulze Lutz , Kademann Barbara , Bornhoevd Karin , Schäfer Susanne , Schäuble Barbara
Published: October 2009

Background.— Headaches are one of the most common neurological symptoms and migraines are the most common primary headache disorder. The global prevalence of migraines is around 10% and the condition is associated with a high burden of disease. Despite an abundance of good quality evidence, only 1 in 5 of patients who fulfill the criteria for preventive migraine therapy are appropriately treated. Data on patient outcomes with preventive medication derive mostly from specialized academic centers, which contrasts with normal clinical practice where the majority of patients are treated outside tertiary care centers.

Objective.— To explore tolerability, safety and efficacy outcomes of patients receiving topiramate for migraine prevention in a naturalistic setting.

Methods.— After a 4‐week prospective baseline, patients with a diagnosis of migraine according to International Headache Society criteria and eligible for migraine prevention were treated with flexible dosing of topiramate for 24 weeks (core phase), and optionally for a total of 48 weeks. The primary safety analysis included adverse events (AEs) during the core phase. For the main efficacy measures, the absolute changes from baseline to end of core phase as well as last follow‐up visit were calculated for migraine days per 4 weeks, migraine attacks per 4 weeks, mean maximum visual analogue scale of migraine headache per 4 weeks and mean maximum pain intensity of migraine headache (4‐point scale) per 4 weeks. In addition, changes in individual quality of life aspects were captured.

Results.— The intention‐to‐treat population (ITT) consisted of 161 patients (90.7% female, mean age 45.7 ± 11.1 years). Topiramate median dose was 45.7 mg/day at endpoint. Some 74.1% of patients reported treatment emergent AEs, most frequently paresthesias (18.4%) and nausea (12.4%). Some 20.0% of patients withdrew from the study due to AEs. The mean number of migraine days per 4 week decreased from 6.2 ± 3.9 days at baseline to 3.9 ± 3.5 days at last core visit (P < .001). Mean maximum pain intensity per 4 week changed from 7.0 ± 2.3 at baseline to 4.7 ± 3.2 at last visit core phase (P < .001). Consumption of triptans and analgesics reduced during the course of the core phase (P < .005). Fifty‐one percent of all patients experienced at least a 50% reduction in migraine days during the core phase.

Conclusion.— Topiramate used for migraine prevention in non‐academic institutions is generally safe, well tolerated and results in good control of migraine headaches and improvement in several aspects of quality of life.
Prevalence and Incidence of Headache in Adolescent Finnish Twins
Authors: Virtanen Ruut , Aromaa Minna , Koskenvuo Markku , Sillanpää Matti , Rose Richard J. , Metsähonkala Liisa , Helenius Hans , Anttila Pirjo , Kaprio Jaakko
Published: October 2009

Objectives.— The study aim was to determinate changes in prevalence and incidence rates of headache among adolescent Finnish twins.

Methods.— Questionnaire data were collected during 1994‐1998 from a nationwide sample of Finnish families of 11‐year‐old twins who were born between 1983 and 1987 (n = 6262) and again at ages of 14 and 17.

Results.— During follow‐up, the prevalence of regular headache (ie, at least once a month = RHA) increased from 59% at age 11 to 65% at age 14 and decreased to 63% at age 17. Among boys the prevalence of RHA increased significantly from 59% at age 11 to 62% at age 14 decreasing to 52% at age 17. Among girls the prevalence rates increased significantly between ages of 11 and 14 from 60% to 68% up to 74% at age 17. The prevalence of weekly headache increased in girls between ages of 11 and 14 from 16% to 25%. Incidence of RHA (at least once a month) decreased from 47% at age 14 to 44% at age 17 in girls and from 44% at age 14 to 30% at age 17 in boys.

Conclusions.— RHA is more common in girls than boys during puberty, while the incidence of RHA declined especially in boys during same age period.
Headache Disability Among Adolescents: A Student Population‐Based Study
Authors: Fuh Jong‐Ling , Wang Shuu‐Jiun , Lu Shiang‐Ru , Liao Yi‐Chu , Chen Shih‐Pin , Yang Chin‐Yi
Published: October 2009

(Headache 2010;50:210‐218)

Objective.— To examine the extent and to identify the relevant predictors of headache disabilities in adolescents.

Background.— Headaches are common in adolescents but their impact and related factors have not been extensively studied in adolescent communities.

Method.— We recruited and surveyed 3963 students aged 13‐15 from 3 middle schools using self‐administered questionnaires. The questionnaires were used to make 3 assessments: (1) headaches were diagnosed using a validated headache questionnaire; (2) headache disabilities were valuated using the 6‐question Pediatric Migraine Disability Assessment; (3) depression was measured using the Adolescent Depression Inventory.

Results.— The student response rate was 93%. In total, 484 students (12.2%) had migraines with or without auras, 444 (11.2%) had probable migraines, and 1092 (27.6%) had tension‐type headaches. The students with migraine had the highest Pediatric Migraine Disability Assessment scores (10.7 ± 20.0); whereas, the students with tension‐type headaches had the lowest scores (2.0 ± 4.4). Logistic regression analyses indicated that there were a number of independent predictors for moderate to severe headache‐related disability (Pediatric Migraine Disability Assessment score ≥31), including a migraine or probable migraine diagnosis, a higher depression score, severe headache intensity, and frequent headaches.

Conclusions.— The Pediatric Migraine Disability Assessment provides a simple tool to measure the impact of headaches in adolescents. Adolescents with migraine headaches suffered the greatest level of disability. Higher depression scores were associated with more severe headache‐related disabilities in adolescents, independent of headache frequency and severity.
Cluster Headache As the Result of Secondhand Cigarette Smoke Exposure During Childhood
Authors: Rozen Todd D.
Published: October 2009

(Headache 2010;50:130‐132)

Unique to cluster headache (CH) compared with all other primary headache conditions is its association with a personal history of cigarette smoking. Studies have indicated that greater than 80% of CH patients have a prolonged history of tobacco usage prior to CH onset. How tobacco exposure can lead to CH has not yet been elucidated. As secondhand smoke exposure during childhood has been linked to multiple medical illnesses could CH also be the result of childhood exposure to tobacco smoke? The United States Cluster Headache survey is the largest survey ever done of CH sufferers living in the United States. The survey addressed various clinical, epidemiologic, and economic issues related to CH. Several survey questions dealt with the issue of personal and parental smoking history. Results from the survey suggest that CH can result from secondhand cigarette smoke exposure during childhood as greater than 60% of non‐smoking CH patients had parents who smoked. Strengthening the probable association between secondhand smoke exposure and the development of CH is the fact that double the number of survey responders developed CH at or before 20 years of age if during their childhood they lived with a parent who smoked cigarettes.
Intraoperatively salvaged red blood cells contain nearly no functionally active platelets, but exhibit formation of microparticles: results of a pilot study in orthopedic patients
Authors: Oswald Elgar , Streif Werner , Hermann Martin , Hengster Paul , Mittermayr Markus , Innerhofer Petra
Published: October 2009

BACKGROUND: Previous data show improved clot formation after retransfusion of salvaged red blood cells (RBCs). This study was conducted to explore whether such RBCs contain clinically relevant numbers of active residual platelets (PLTs) or exhibit formation of microparticles (MPs).

STUDY DESIGN AND METHODS: Thirteen patients undergoing major orthopedic surgery were included in the study, and arterial blood samples from patients and samples from the retransfusion bag were analyzed with various PLT function tests and flow cytometry.

RESULTS: With commercial blood cell counters, the numbers of PLTs in the RBC unit were reduced to approximately 25% compared to patients' blood. In contrast, results from flow cytometry showed an 11‐ to 945‐fold reduction in median counts referring to total PLTs and free PLTs. Interestingly, smaller quantities of PLT‐derived MPs were found in samples from the retransfusion bag than in patients' arterial blood. Conversely, RBC‐ and white blood cell–derived MP counts were increased in the retransfusion bag compared to the patient. Rotational thrombelastometry and the Impact‐R system (DiaMed) showed a pronounced impairment of PLT ability with regard to adhesion, aggregation, and clot formation. With the use of confocal microscopy, only a few free thrombocytes were detectable among the huge numbers of RBCs.

CONCLUSION: Only few free and thus active PLTs are detectable in processed RBCs. It seems very unlikely that these few PLTs can improve clot strength. Nevertheless, the impact of the detected MPs on thrombin generation needs to be clarified in further studies.
BLOOD DONORS AND BLOOD COLLECTION: Delayed adverse reactions to blood donation
Authors: Kamel Hany , Tomasulo Peter , Bravo Marjorie , Wiltbank Thomas , Cusick Robin , James Robert C. , Custer Brian
Published: October 2009

BACKGROUND: Blood donation is safe, but a small proportion of donors have delayed and/or off‐site reactions that have the potential to lead to serious injury. This retrospective study sought to identify risk factors for delayed reactions (DRs).

STUDY DESIGN AND METHODS: The records of 793,293 allogeneic whole blood and apheresis donations in 2007 were assessed for vasovagal reactions. Donor demographic, biometric, and clinical measurements were captured. Incidents related to needle insertion and mild reactions were excluded. Based on the reaction onset time relative to the procedure end time, reactions were classified as delayed (>15 min) or immediate (≤15 min). Reactions were analyzed by multivariable logistic regression comparing donors with immediate reactions (IRs) or DRs to donors without reactions and comparing donors with DRs to IRs. The clinical consequences of off‐site and on‐site reactions are reported.

RESULTS: The prevalence of reactions classified as moderate or severe was 41 in 10,000 donations; 24% of these reactions were delayed and 12% occurred off‐site. DRs were associated with female sex (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.21‐3.96) and with low estimated blood volume (EBV; OR, 3.91; 96% CI, 2.84‐5.51). Off‐site reactions, particularly in female donors, were more likely to be associated with a fall, with head trauma, with other injury, and with the use of outside medical care.

CONCLUSION: Low EBV, youth, and first‐time donor status are major risk factors for IRs and DRs. Women are more likely than men to report DRs. Delayed and off‐site reactions lead to potentially preventable morbidity. Understanding the physiologic basis of DRs may lead to the development of appropriate interventions to reduce their likelihood.
Many genetically defined ABO subgroups exhibit characteristic flow cytometric patterns
Authors: Hult Annika K. , Olsson Martin L.
Published: October 2009

BACKGROUND:A flow cytometric method for detection of low levels of A/B antigen had been developed previously in our laboratory. The aim of this study was to investigate if this approach could be utilized to characterize different ABO subgroups and constitute a useful tool in a reference laboratory.

STUDY DESIGN AND METHODS:Blood samples causing ABO discrepancies (n = 94) by routine serology were further analyzed byABOgenotyping and flow cytometry. To verify the specificity of the monoclonal anti‐A and ‐B reagents and to establish normal flow cytometric patterns, samples from 80 blood donors with common phenotypes were also assessed.

RESULTS:Distinguishable flow cytometric patterns were detected for several subgroups but were more apparent for Aweak(n = 80) samples than Bweak(n = 14). Two subgroups, Afinn(n = 11) and A3(n = 10) displayed diagnostic features and were used to establish reproduciblity over time and between donors. In general, the consistency within subgroups was remarkable. The allelic enhancement phenomenon was clearly visualized among Axsamples (n = 10) where different alleles intransresulted in high, low, or no A antigen expression. Nonsubgroup samples including O/A and O/B chimeras or Ahand Bhpara‐Bombay phenotypes displayed clearly distinguishable histograms. Samples from pregnant women (n = 10) displayed acquired A antigen loss, apparently accentuated during the third trimester.

CONCLUSIONS:Genetically defined ABO subgroups and other anomalous phenotypes displayed flow cytometric profiles that may contribute valuable information to the investigation of ABO discrepancies. We conclude that the presented assay may complement traditional serology and genetic analysis in the reference laboratory setting.
Improved plasma removal efficiency for therapeutic plasma exchange using a new apheresis platform
Authors: Tormey Christopher A. , Peddinghaus Marie E. , Erickson Michelle , King Karen E. , Cushing Melissa M. , Bill Jerry , Goodrich Tay , Snyder Edward L.
Published: October 2009

BACKGROUND: The Spectra Optia (SPO; CaridianBCT) is a new apheresis device based on the COBE Spectra (CSP; CaridianBCT) platform. This study was designed to evaluate the safety and efficiency of the SPO in comparison to the predicate CSP device.

STUDY DESIGN AND METHODS: Twenty patients were recruited for a randomized, nonblinded, paired (crossover) clinical trial comparing the SPO to the CSP (pivotal trial). The primary outcome measure was plasma removal efficiency (PRE); secondary outcomes included platelet (PLT) content and hemolysis in the waste plasma, changes in patient cellular counts, patient coagulation and complement cascade activation, accuracy of machine fluid balance measurement, and review of significant adverse events (SAEs).

RESULTS: Overall SPO demonstrated 87% PRE with 1.0% PLT loss; these variables were statistically different from CSP (79 and 3.0%, respectively). The accuracy of anticoagulant usage, plasma removal, and fluid replacement as measured by the SPO fluid pumps was 97% or more; fluid balance was within 2% of the measured value. After apheresis there were no statistical changes in patient cellular counts with respect to the initial values. Patient d‐dimer and prothrombin fragment 1.2 assays showed no activation of the coagulation system with either device. Measurement of patient C3a, C5a, and plasma free hemoglobin showed no significant differences between the SPO and the CSP. No SAEs were reported.

CONCLUSION: The SPO has improved performance characteristics over the CSP. Based on our results, the SPO is acceptable for use in therapeutic plasma exchange programs.
Prospective monitoring of plasma and platelet transfusions in a large teaching hospital results in significant cost reduction
Authors: Sarode Ravindra , Refaai Majed A. , Matevosyan Karen , Burner James D. , Hampton Scott , Rutherford Cynthia
Published: October 2009

BACKGROUND: Plasma and platelets (PLTs) are often transfused to correct mild to moderately abnormal laboratory values. Our objective was to reduce unnecessary plasma and PLT transfusions to nonbleeding patients by prospective triage and education of end users in evidence‐based hemostasis and transfusion medicine practices.

STUDY DESIGN AND METHODS: Using the Parkland Memorial Hospital's transfusion service and admission database as the data source, this study comprises the comparison of transfusion data on plasma and PLT use between pre‐ (2000‐2002) and posttriage (2003‐2006) periods. Yearly transfusion and wastage data on red blood cells (RBCs), plasma, and PLTs and yearly hospital admissions, trauma visits, and surgical procedures were extracted retrospectively for the study.

RESULTS: The study revealed that implementation of triage resulted in a significant reduction of plasma (60%) and PLT (25%) transfusions, saving more than $3,000,000 over 4 years.

CONCLUSIONS: Prospective triage and evidence‐based transfusion practice education reduced unnecessary plasma and PLT transfusions and health care costs.
Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients
Authors: Shaz Beth H. , Dente Christopher J. , Nicholas Jeffrey , MacLeod Jana B. , Young Andrew N. , Easley Kirk , Ling Qiang , Harris Robert S. , Hillyer Christopher D.
Published: October 2009

BACKGROUND: Recent data from military and civilian centers suggest that mortality is decreased in massive transfusion patients by increasing the transfusion ratio of plasma and platelet (PLT) products, and fibrinogen in relationship to red blood cell (RBC) products during damage control resuscitation and surgery. This study investigates the relationship of plasma:RBC, PLT:RBC, and cryoprecipitate:RBC transfusion ratios to mortality in massively transfused patients at a civilian Level 1 trauma center.

STUDY DESIGN AND METHODS: Demographic, laboratory, transfusion, and outcome data were collected prospectively from February 1, 2007, to January 31, 2009, and retrospectively from February 1, 2005, to January 31, 2007, on all injured patients who underwent massive transfusion (defined as ≥10 RBC products within 24 hr). Mortality was analyzed in relation to the plasma:RBC, PLT:RBC, and cryoprecipitate:RBC transfusion ratios using both univariate and multivariate analyses.

RESULTS: A total of 214 patients received massive transfusion secondary to traumatic injury. High versus low transfusion ratios were associated with improved 30‐day survival: plasma:RBC 59% versus 44%, p = 0.03; PLT:RBC 63% versus 33%, p < 0.01; and cryoprecipitate:RBC 66% versus 41%, p < 0.01. By multivariable stepwise logistic regression analysis, increased plasma:RBC (p = 0.02) and PLT:RBC (p = 0.02), and decreased age (p = 0.02), ISS (p < 0.01) and total RBCs (p = 0.03) were statistically associated with improved 30‐day survival.

CONCLUSIONS: In the civilian setting, plasma, PLT, and cryoprecipitate products significantly increased 30‐day survival in trauma patients. Future prospective randomized clinical trials are required to determine the optimal transfusion ratios.
Electrophysiological Anatomy of Typical Atrial Flutter: The Posterior Boundary and Causes for Difficulty with Ablation
Authors: GAMI APOOR S. , EDWARDS WILLIAM D. , LACHMAN NIRUSHA , FRIEDMAN PAUL A. , TALREJA DEEPAK , MUNGER THOMAS M. , HAMMILL STEPHEN C. , PACKER DOUGLAS L. , ASIRVATHAM SAMUEL J.
Published: October 2009

Electrophysiological Anatomy of Typical Atrial Flutter.

Background:
The electrophysiological anatomy of cavotricuspid isthmus‐dependent atrial flutter (CVTI‐AFL) has not been fully elucidated.

Methods:
We studied 602 autopsied human hearts from individuals aged 0 to 103 years. We measured morphological features of the right atrium, including the crista terminalis (CT), pectinate muscles, sub‐Eustachian pouch, Thebesian valve (TV), and the coronary sinus (CS) ostium.

Results:
In adults, the mean right atrium dimensions were 4.7 cm × 4.5 cm × 4.4 cm. Pectinate muscles extended medial to the CT in 54% of hearts. In 19% of hearts, these ended in another ridge termed the second CT. Pectinate muscles extended into the CVTI in 70% of hearts. A sub‐Eustachian pouch was present in 16% of hearts, was always located on the septal CVTI, and was more likely when a prominent TV was also present. A TV, present in 62% of all hearts, covered the inferior quadrant of the CS ostium in 9% of these hearts.

Conclusion:
The posterior boundary of the reentrant circuit of CVTI‐AFL comprises the Eustachian ridge and CT, but in some patients may also include a second CT. Sub‐Eustachian pouches on the septal CVTI are strongly associated with a prominent TV. The lateral CVTI can have prominent pectinate muscles. This comprehensive characterization of the electrophysiological anatomy of the reentrant circuit of CVTI‐AFL may provide guidance and improve success during difficult ablations. (J Cardiovasc Electrophysiol, Vol. 21, pp. 144‐149, February 2010)
Are MADIT II Criteria for Implantable Cardioverter Defibrillator Implantation Appropriate for Chinese Patients?
Authors: SIU CHUNG‐WAH , PONG VINCENT , HO HEE‐HWA , LIU SHASHA , LAU CHU‐PAK , LI SHEUNG‐WAI , TSE HUNG‐FAT
Published: October 2009

MADIT II Criteria for Implantable Cardioverter. Background: MADIT‐II demonstrated that prophylactic implantation of an implantable cardioverter‐defibrillator (ICD) device prevents sudden cardiac death (SCD) in patients with myocardial infarction (MI) and impaired left ventricular ejection fraction (LVEF). It remains unclear whether the MADIT‐II criteria for ICD implantation are appropriate for Chinese patients.

Methods and Results:
We compared the clinical characteristics and outcome for a cohort of consecutive Chinese patients who satisfied MADIT‐II criteria for ICD implantation with the original published MADIT‐II population. Seventy consecutive patients who satisfied MADIT‐II criteria but did not undergo ICD implantation (age: 67 years, male: 77%) were studied. Their baseline demographics were comparable with the original MADIT‐II cohort with the exception of a higher incidence of diabetes mellitus. After follow‐up of 35 months, most deaths (78%) were due to cardiac causes (72% due to SCD). The 2‐year SCD rate (10.0%) was comparable with that of the MADIT‐II conventional group (12.1%), but higher than the MADIT‐II defibrillator group (4.9%). Similarly, the 2‐year non‐SCD rate was 3.0%, also comparable with the MADIT‐II conventional group (4.6%), but lower than the MADIT‐II defibrillator group (7.0%). Cox regression analysis revealed that advance NYHA function class (Hazard Ratio [HR]: 3.5, 95% Confidence Interval [CI]: 1.48–8.24, P = 0.004) and the lack of statin therapy (HR: 3.7, 95%CI: 1.35–10.17, P = 0.011) were independent predictors for mortality in the MADIT‐II eligible patients.

Conclusion:
Chinese patients who satisfy MADIT‐II criteria for ICD implantation are at similar risk of SCD and non‐SCD as the original MADIT‐II subjects. Implantation of an ICD in Chinese patients is appropriate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 231–235, March 2010)
Catheter‐Based Cryoablation of Postinfarction and Idiopathic Ventricular Tachycardia: Initial Experience in a Selected Population
Authors: TIMMERMANS CARL , MANUSAMA RANDY , ALZAND BECKER , RODRIGUEZ LUZ‐MARIA
Published: October 2009

Cryoablation of Ventricular Tachycardia. Introduction: Transvenous cryoablation has proven to be safe and effective for the treatment of supraventricular arrhythmias. The aim of this prospective study was to report the feasibility and safety of catheter‐based cryoablation for the treatment of postinfarction and idiopathic ventricular tachycardia (VT).

Methods and Results:
Catheter‐based cryoablation was performed in 17 patients (15 men, 58 ± 18 years). VT occurred after a prior myocardial infarction in 10 and was idiopathic in 7 patients. Cryoablation was performed with a 10‐F, 6.5‐mm tipped catheter. The ablation site was selected using entrainment mapping techniques for postinfarction VT. The site of the earliest activation time with optimal pace mapping was used for ablation of idiopathic VT. All targeted VTs (12 postinfarction and 7 idiopathic) were acute successfully ablated after a median number of 2 applications of 5 minutes with an average temperature of –82 ± 4°C. Mean procedure and fluoroscopy times were 204 ± 52 and 52 ± 20 minutes for postinfarction VT and 203 ± 24 and 38 ± 15 minutes for idiopathic VT. No cryocatheter or cryoenergy complications were observed. After a follow‐up of 6 months, 4 of the 10 patients with postinfarction VT had a recurrence. In 1 of the 7 patients with idiopathic VT the index arrhythmia recurred.

Conclusion:
In this small patient population, catheter‐based cryoablation of VT was safe and effective. Future studies are needed to evaluate the effect of cryothermy in a larger group of patients, especially those with postinfarction VT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 255–261, March 2010)
Image‐Integration of Intraprocedural Rotational Angiography‐Based 3D Reconstructions of Left Atrium and Pulmonary Veins into Electroanatomical Mapping: Accuracy of a Novel Modality in Atrial Fibrillation Ablation
Authors: NÖLKER GEORG , ASBACH STEFAN , GUTLEBEN KLAUS J. , RITTGER HARALD , RITSCHER GUIDO , BRACHMANN JOHANNES , SINHA ANIL. M.
Published: October 2009

DynaCT Cardiac Integration into Electroanatomical Mapping. 
Introduction: Exact visualization of complex left atrial (LA) anatomy is crucial for safety and success rates when performing catheter ablation of atrial fibrillation (AF). The aim of our study was to validate the accuracy of integrating rotational angiography‐based 3‐dimensional (3D) reconstructions of LA and pulmonary vein (PV) anatomy into an electroanatomical mapping (EAM) system.

Methods and Results: In 38 patients (62 ± 8 years, 25 females) undergoing catheter ablation of paroxysmal (n = 19) or persistent (n = 19) AF, intraprocedural rotational angiography of LA and PVs was performed. The subsequent 3D reconstruction and segmentation of LA and PVs was transferred to the EAM system and registered to the EAM. The distances of all EAM points to corresponding points on the LA syngo® DynaCT Cardiac surface were calculated.

Segmentation of LA with clear visualization of adjacent structures was possible in all patients. Also, the integrated segmentation of the LA was used to guide the encirclement of ipsilateral veins, which resulted in PV isolation in all patients. Integration into the 3D mapping system was achieved with a distance error of 2.2 ± 0.4 mm when compared with the EAM surface. Subgroups with paroxysmal and persistent AF showed distance errors of 2.3 ± 0.3 mm and 2.1 ± 0.4 mm, respectively (P = n.s.).

Conclusion: Intraprocedural registration of LA and PV anatomy by contrast enhanced rotational angiography was feasible and accurate. There were no differences between patients with paroxysmal or persistent AF. Therefore, integration of rotational angiography‐based reconstructions into 3D EAM systems might be helpful to guide catheter ablation for AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 278–283, March 2010)
Canadian Registry of ICD Implant Testing Procedures (CREDIT): Current Practice, Risks, and Costs of Intraoperative Defibrillation Testing
Authors: HEALEY JEFF S. , DORIAN PAUL , MITCHELL L. BRENT , TALAJIC MARIO , PHILIPPON FRANCOIS , SIMPSON CHRIS , YEE RAYMOND , MORILLO CARLOS A. , LAMY ANDRE , BASTA MAGDY , BIRNIE DAVID H. , WANG XIAOYIN , NAIR GIRISH M. , CRYSTAL EUGENE , KERR CHARLES R. , CONNOLLY STUART J. ,   on Behalf of the CREDIT Investigators
Published: October 2009

Defibrillation Testing at ICD Implantation.
Background: There is uncertainty about the proper role of defibrillation testing (DT) at the time of implantable cardioverter defibrillator (ICD) insertion.

Methods: A prospective registry was conducted at 13 sites in Canada between January 2006 and October 2007.

Objectives: To document the details of DT, the reasons for not conducting DT, and the costs and complications associated with DT.

Results: DT was conducted at implantation in 230 of 361 patients (64%). DT was more likely to be conducted for new implants compared with impulse generator replacements (71% vs 32%, P = 0.0001), but was similar for primary and secondary prevention indications (64% vs 63%, P = NS). Among patients not having DT, the reason(s) given were: considered unnecessary (44%); considered unsafe, mainly due to persistent atrial fibrillation (37%); lack of an anesthetist (20%); and, patient or physician preference (6%).

When performed, DT consisted of a single successful shock ≥ 10J below maximum device output in 65% of cases. A 10J safety‐margin was met by 97% of patients, requiring system modification in 2.3%. Major perioperative complications occurred in 4.4% of patients having DT versus 6.6% of patients not having DT (P = NS). ICD insertion was $844 more expensive for patients having DT (P = 0.16), largely due to increased costs ($28,017 vs $24,545) among patients having impulse generator replacement (P = 0.02).

Conclusions: DT was not performed in a third of ICD implants, usually due to a perceived lack of need or relative contraindication. (J Cardiovasc Electrophysiol, Vol. 21, pp. 177‐182, February 2010)
Fragmented QRS Complexes on 12‐Lead ECG: A Marker of Cardiac Sarcoidosis as Detected by Gadolinium Cardiac Magnetic Resonance Imaging
Authors: Homsi Mohamed , Alsayed Lamaan , Safadi Bilal , Mahenthiran Jo , Das Mithilesh K.
Published: October 2009

Background: Fragmented QRS complexes (fQRS) on a 12‐lead ECG are a marker of myocardial scar in patients with coronary artery disease. Cardiac sarcoidosis is also associated with myocardial granuloma formation and scarring. We evaluated the significance of fQRS on a 12‐lead ECG compared to Gadolinium‐delayed enhancement images (GDE) in cardiac magnetic resonance imaging (CMR).

Method and results: The ECGs of patients (n = 17, mean age: 52 ± 11 years, male: 53%) with established diagnosis of sarcoidosis who underwent a CMR for evaluation of cardiac involvement were studied. ECG abnormalities included bundle branch block, Q wave, and fQRS. fQRS, Q wave, and bundle branch block were present in 9 (53%), 1 (6%), and 4 (24%) patients, respectively. The sensitivity and specificity of fQRS for detecting abnormal GDE were 100% and 80%, respectively. Sensitivity and specificity of Q waves were 11% and 100%, respectively.

Conclusions: fQRS on a 12‐lead ECG in patients with suspected cardiac sarcoidosis are associated with cardiac involvement as detected by GDE on CMR.
Impact of Preceding Ventricular Premature Beats on Heart Rate Turbulence
Authors: Chen Hung Yi
Published: October 2009

Background: Heart rate turbulence (HRT) has recently been introduced as a noninvasive tool for studying autonomic dysfunction. It presented short time fluctuation of sinus cycle length following single ventricular premature contraction (VPC). However, HRT parameters may be influenced by different factors. This study aimed to evaluate the possible influence of VPC frequency on HRT.

Methods: 24‐h Holter recording was performed in patients with VPCs initially detected by 12‐lead electrocardiography (ECG) in the outpatient department. The numbers of VPCs in 2‐ and 5‐minute durations preceding each VPC tachogram were calculated. The HRT parameters and the numbers of the VPCs preceding VPC tachograms were analyzed.

Results: There were 23,122 available VPC tachograms from 107 healthy subjects included in the study. The turbulence onset (TO) value increased and the turbulence slope (TS) value decreased as VPC's frequency increased. The TO values rapidly increased when the number of VPCs was >15 beats in the 2‐minute and >35 beats in the 5‐minute durations. There was also a prominent decrease in TS values when the VPCs reached 14 and 30 beats in the 2‐ and 5‐minute durations, respectively.

Conclusion: Physiologic baroreflex may be attenuated under intensive stimulation, which is evidenced by blunted HRT parameters by frequent VPCs. Physiologic response to VPC's frequency may be related to baroreflex fatigue and is demonstrated as a sigmoid curve.
Influence of Diabetes and/or Myocardial Infarction on Prevalence of Abnormal T‐Wave Alternans
Authors: Martin David T. , Shoraki Azadeh , Nesto Richard W. , Rutter Martin K.
Published: October 2009

Background: Subjects with microvolt‐level T‐wave alternans (TWA) in association with structural heart disease have an increased risk for sudden cardiac death. The presence of diabetes (DM) is associated with an increased risk of sudden death but there is limited data on the impact of DM and previous myocardial infarction (MI) on TWA prevalence.

Methods: We performed a case‐control cross‐sectional study in 140 patients referred for routine exercise testing within a large multispecialty clinic. All patients with a history of DM and MI status within the past year were eligible: group 1 (no DM or MI), group 2 (DM only), group 3 (MI only), group 4 (DM and MI). Patients performed a symptom‐limited Bruce protocol exercise test with assessment of TWA by the spectral method using commercially available equipment. We used published criteria for the blinded interpretation of TWA; all tests not unequivocally negative were considered abnormal.

Results: Age and gender were similar in all groups. The prevalence of abnormal TWA in groups 1–4 was 24%, 20%, 48%, and 62%, respectively (between group P = 0.002). Logistic regression analysis in all patients showed that abnormal TWA was related to prior MI [OR (95% CI): 4.0 (1.8–8.9), P < 0.001] but not to prevalent DM [0.9 (0.4–1.8), P = 0.72]. In patients with DM, the prevalence of abnormal TWA was related to reduced ejection fraction (P = 0.034) but not to BMI, DM duration, glycemic control, insulin use, or the presence of microvascular complications.

Conclusion: The presence of DM alone does not increase risk of abnormal TWA. Prospective studies are required to establish the prognostic value of TWA in patients with DM.
Assessment of Physiological Amplitude, Duration, and Magnitude of ECG T‐Wave Alternans
Authors: Burattini Laura , Zareba Wojciech , Burattini Roberto
Published: October 2009

Background: An association between T‐wave alternans (TWA) and malignant ventricular arrhythmias is generally recognized. Because relatively low levels of TWA have also been observed in healthy (H) subjects, the question arises as to whether these are ascribable to noise and artifacts, or can be given the relevance of a physiological phenomenon characterizing a preclinical condition.

Methods: To answer this question, in the present study 20‐minute not noisy, sinus ECG recordings, from 138 H‐subjects and 148 coronary artery diseased (CAD) patients, were submitted to our adaptive match filter (AMF) procedure to identify and parameterize TWA in terms of duration (TWAD), amplitude (TWAA), and magnitude (TWAM, defined as the product of TWAD times TWAA). The 99.5th percentiles of mean values of TWAA, TWAD, and TWAM over 20‐minute ECGs were used to define three threshold levels (THRD, THRA, and THRM), which allow discrimination of abnormal TWA levels.

Results: Nonstationary TWA was found in all our H‐subjects and CAD‐patients. TWAD, TWAA, and TWAM levels were classified as being physiological in 99% of H‐subjects and 87% of CAD‐patients. A linear correlation (r =−0.52, P < 0.001) was found between TWAA and RR interval in the H‐population.

Conclusions: Our results support the hypothesis of the existence of physiological TWA levels, which are to be considered in the effort to improve reliability of nonphysiological TWA levels discrimination.