bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological Changes of the Left Atrial Appendage After Catheter Ablation of Atrial Fibrillation
Authors: CHANG SHENG‐HSIUNG , TSAO HSUAN‐MING , WU MEI‐HAN , TAI CHING‐TAI , CHANG SHIH‐LIN , WONGCHAROEN WANWARANG , LIN YENN‐JIANG , LO LI‐WEI , HSIEH MING‐HSIUNG , SHEU MING‐HUEI , CHANG CHENG‐YEN , HOU CHARLES JIA‐YIN , CHEN SHIH‐ANN
Published: November 2006

Introduction: The left atrial appendage (LAA) has been proven to be the most important site of thrombus formation in patients with atrial fibrillation (AF). However, the information regarding the morphometric alteration of the LAA related to the outcome of AF ablation is still lacking. Thus, we evaluated the long‐term changes of the LAA morphology in patients undergoing catheter ablation of AF using magnetic resonance angiography (MRA).

Methods and Results: Group 1 included 15 controls without any AF history. Group 2 included 40 patients with drug‐refractory paroxysmal AF. They were divided into two subgroups: group 2a included 30 patients without AF recurrence after pulmonary vein (PV) ablation. Group 2b included 10 patients with late recurrence of AF. The LAA morphology before and after (20 ± 11 months) ablation was evaluated by three‐dimensional MRA. The group 2 patients had a larger baseline LAA size (including the LAA orifice, neck, and length) and less eccentric LAA orifice and neck. After the AF ablation, there was a significant reduction in the LAA size in the group 2a patients, and the morphology of the LAA neck became more eccentric during the follow‐up period. In group 2b, the LAA size increased and no significant change in the eccentricity of the orifice and neck could be noted.

Conclusions: The morphometric remodeling of the LAA in the AF patients could be reversed after a successful ablation of the AF. Progressive dilation of the LAA was noted in the patients with AF recurrence. These structural changes in the LAA may play a role in reducing the potential risk of cerebrovascular accidents.
Efficacy of Adjuvant Anterior Left Atrial Ablation During Intracardiac Echocardiography‐Guided Pulmonary Vein Antrum Isolation for Atrial Fibrillation
Authors: VERMA ATUL , PATEL DIMPI , FAMY TAMER , MARTIN DAVID O. , BURKHARDT J. DAVID , ELAYI S. CLAUDE , LAKKIREDDY DHANUMJAYA , WAZNI OUSSAMA , CUMMINGS JENNIFER , SCHWEIKERT ROBERT A. , SALIBA WALID , TCHOU PATRICK J. , NATALE ANDREA
Published: November 2006

Background:
Recent data have shown that the septum and anterior left atrial (LA) wall may contain “rotor” sites required for AF maintenance. However, whether adding ablation of such sites to standard ICE‐guided PVAI improves outcome is not well known.

Objective:
To determine if adjuvant anterior LA ablation during PVAI improves the cure rate of paroxysmal and permanent AF.

Methods:
One hundred AF patients (60 paroxysmal, 40 persistent/permanent) undergoing first‐time PVAI were enrolled over three months to receive adjuvant anterior LA ablation (Group I). These patients were compared with 100 randomly selected, matched first‐time PVAI controls from the preceding three months who did not receive adjuvant ablation (Group II). All 200 patients underwent ICE‐guided PVAI during which all four PV antra and SVC were isolated. In group I, a decapolar lasso catheter was used to map the septum and anterior LA wall during AF (induced or spontaneous) for continuous high‐frequency, fractionated electrograms (CFAE). Sites where CFAE were identified were ablated until the local EGM was eliminated. A complete anterior line of block was not a requisite endpoint. Patients were followed up for 12 months. Recurrence was assessed post‐PVAI by symptoms, clinic visits, and Holter at 3, 6, and 12 months. Patients also wore rhythm transmitters for the first 3 months. Recurrence was any AF/AFL >1 min occurring >2 months post‐PVAI.

Results:
Patients (age 56 ± 11 years, 37% female, EF 53%± 11%) did not differ in baseline characteristics between group I and II by design. Group I patients had longer procedure time (188 ± 45 min vs 162 ± 37 min) and RF duration (57 ± 12 min vs 44 ± 20 min) than group II (P < 0.05 for both). Overall recurrence occurred in 15/100 (15%) in group I and 20/100 (20%) in group II (P = 0.054). Success rates did not differ for paroxysmal patients between group I and II (87% vs 85%, respectively). However, for persistent/permanent patients, group I had a higher success rate compared with group II (82% vs 72%, P = 0.047).

Conclusions:
Adjuvant anterior LA ablation does not appear to impact procedural outcome in patients with paroxysmal AF but may offer benefit to patients with persistent/permanent AF.
Continuous Nonfluoroscopic Localization of the Esophagus During Radiofrequency Catheter Ablation of Atrial Fibrillation
Authors: SHERZER ALEX I. , FEIGENBLUM DAVID Y. , KULKARNI SUMEDHA , PINA JACQUELINE W. , CASEY JESSACA L. , SALKA KELLY A. , SIMONS GRANT R.
Published: November 2006

Introduction: Atrial‐esophageal fistula formation is a dreaded complication of radiofrequency catheter ablation for atrial fibrillation. Esophageal localization is of potential value in avoiding lesion placement where the left atrium is juxtaposed to the esophagus.

Methods and Results: Twenty‐seven patients underwent 33 pulmonary vein encirclement procedures. All the patients received general anesthesia with inhalational agents and either a fenestrated laryngeal mask airway or an endotracheal tube. A diagnostic electrophysiologic catheter was inserted into the esophagus, and a virtual esophageal tube was created using an electroanatomic mapping system. In all cases, the catheter was placed without difficulty and satisfactory virtual esophageal images were created. The catheter remained in the esophagus until the end of each ablation procedure. Esophageal catheter location during and after the ablation was compared with the initial location. Areas of close proximity between the left atrium and esophagus were easily identified. Change in esophageal location was not observed. Identification of esophageal proximity to the pulmonary veins allowed for identification of high‐risk cases. In such cases, the planned procedure was modified to avoid esophageal injury (12 of 27 patients).

Conclusions: (1) Real‐time localization of esophageal position using a nonfluoroscopic mapping system during atrial fibrillation ablation is safe, practical, and straightforward. (2) Among patients who receive general anesthesia, esophageal position appears to be static, suggesting that one initial virtual image is sufficient for the duration of an ablation procedure.
Initial Clinical Experience with the Protégé EverFlex™ Long Self‐Expanding Nitinol Stent in the Superficial Femoral Artery
Authors: RUEF JOHANNES , HOFMANN MANFRED , HAASE JÜRGEN
Published: November 2006

Aims: Clinical results following stent implantation in the superficial femoral artery (SFA) are limited due to restenosis, often caused by stent fractures. Therefore new stent devices are desirable. The present study details our initial experience with the routine use of the novel Protégé EverFlex™ long self‐expanding nitinol stent for treatment of long SFA total occlusions or stenoses.

Methods and Results: Between February and March 2006 a total of 15 EverFlex™ nitinol stents were implanted in 12 patients with either total SFA occlusions (n = 9) or long stenoses (n = 3), mean lesion length 14.9 cm (± 10.4 cm). All patients presented with claudication stage Fontaine IIb (Rutherford category 3). Stent lengths were 10 cm (n = 6), 12 cm (n = 1), or 15 cm (n = 8), stent diameters were 6 mm (n = 14) and 7 mm (n = 1). Access was gained either by the crossover (n = 9), antegrade (n = 2), or popliteal approach (n = 1). After predilatation, stent placement and postdilatation were performed with 100% technical success. Clinical and apparative follow‐up after 6–8 weeks indicated the absence of restenosis or reocclusion in all cases.

Conclusion: The novel long self‐expanding EverFlex™ nitinol stent (10 cm/12 cm/15 cm in length) exhibits excellent technical handling characteristics with good short‐term clinical results. Mid‐term and long‐term clinical results as well as potential stent fractures need to be further examined.
New Developments in Coronary Stent Technology
Authors: SMITH ELLIOT J. , JAIN AJAY K. , ROTHMAN MARTIN T.
Published: November 2006

Coronary stent technology has rapidly evolved from a mechanical solution to abrupt vessel closure and elastic recoil following plain balloon angioplasty, to become a vector for local drug delivery and modification of coronary plaque pathophysiology. The advent of drug‐eluting stents (DES) has significantly reduced restenosis, although there is increasing concern over the risk of late stent thrombosis, particularly following cessation of antiplatelet therapy. Here we consider the limitations of the current generation of DES, and review recent advances in platform, carrier, and pharmacological technology, and their place in future clinical practice.
Hybrid Treatment for Complex Aortic Problems Combining Surgery and Stenting in the Integrated Operating Theater
Authors: BRUECK MARTIN , HEIDT MARTIN C. , SZENTE‐VARGA MICHAEL , BANDORSKI DIRK , KRAMER WILFRIED , VOGT PAUL R.
Published: November 2006

Objectives: Conventional surgical treatment of complex aortic pathologies involving several thoracoabdominal aortic segments necessitates extended incisions or subsequent surgeries, resulting in significant mortality and morbidity rates. The combination of surgery and simultaneous stenting in the operating theater may reduce the surgical trauma.

Methods: A total of nine patients (62 ± 10 years, range 44–70) underwent a combined surgical and endovascular treatment of thoracic or thoracoabdominal aortic aneurysms or chronic dissection. Five patients were treated with viscero‐renal artery translocation followed by transfemoral stenting of the entire thoracoabdominal aorta. Two patients underwent debranching of the supraaortic vessels followed by immediate transfemoral stenting of the aortic arch, and two patients with a history of an ascending aortic aneurysm repair were treated with open surgical debranching of the supraaortic trunks and repair of the ascending aorta and aortic arch with elephant trunk technique. Preoperatively, magnetic resonance imaging was used to check supraaortic and intracranial vessels as well as the completeness of the Circle of Willisi prior to arch stenting and/or supraaortic vessel surgery. Cerebrospinal fluid drainage and induced mild hypertension have been used for one‐step thoracoabdominal aortic stenting.

Results: Thirty‐day mortality rate and incidence of paraplegia was 0%. There was a single reversible perioperative stroke after aortic arch stenting. One patient required temporary renal replacement therapy using continuous arterio‐venous hemofiltration. There was one early reoperation at the superior mesenteric artery after viscero‐renal translocation. Four type I endoleaks occurred in three patients requiring two interventions. All patients have been discharged to home.

Conclusion: The innovative combination of simultaneous conventional surgery and stenting reduces the operative burden for patients with complex aortic pathologies involving several segments of the thoracic and thoracoabdominal aorta. Arch debranching and viscero‐renal artery translocation may avoid the use of thoracoabdominal incisions, cardiopulmonary bypass techniques, deep hypothermia, and circulatory arrest.
Transcatheter Closure of Patent Foramen Ovale in Patients with Migraine Headache
Authors: SPIES CHRISTIAN , SCHRÄDER RAINER
Published: November 2006

Our objective is to review the epidemiology and pathophysiology of migraine headache, its association with patent foramen ovale (PFO), and the impact of PFO closure on migraine. Upon reviewing English‐language publications listed in MEDLINE relating to migraine headache, PFO, and transcatheter closure of PFO, we selected case series, retrospective and prospective studies relevant to the topic.Primarily retrospective case‐control studies demonstrate a link between PFO closure and improvement of migraine headache. Few prospective data confirm the initial results. However, the only randomized, controlled trial finished to date analyzing the effect of PFO closure on migraine failed to reach its primary outcome of resolution of migraine following the intervention. The evidence of a benefit on migraine headache following PFO closure is not convincing, but certainly intriguing. With currently ongoing trials, more information related to this topic can be expected.
In vitro assessment of motility and proliferation of human osteogenic cells on different isolated extracellular matrix components compared with enamel matrix derivative by continuous single‐cell observation
Authors: Klein Marcus Oliver , Reichert Christoph , Koch Dorothee , Horn Sigrid , Al‐Nawas Bilal
Published: November 2006

Objectives: The composition of the extracellular matrix (ECM) plays a substantial role in bone remodelling, fracture healing and osseointegration of dental implants by regulating proliferation, migration and finally differentiation of osteogenic cell populations. Emdogain®, a composition of an enamel matrix derivative (EMD), has been introduced as a potential candidate to promote tissue regeneration. We investigated whether EMD could serve as a potential promoter of cell proliferation and motility as a dynamic cell response and compared the results with the ubiquitous single ECM components type I collagen and laminin.

Material and methods: In the investigation presented, we used a continuous observation method for the analysis of migratory and proliferative patterns of individual cells. We analyzed the response of four osteoblastic cell lines to specific extracellular ligands (type I collagen, laminin and EMD) over a period of 24 h compared with untreated glass surface and bovine serum albumin (BSA) as control groups.

Results: Type I collagen and laminin promoted cell motility significantly compared with the control groups and, in part, compared with EMD as well. The analysis of all 451 investigated cells revealed the following mean values for cell motiliy: untreated glass (n=99): 5.46±2.74 μm/h, BSA (n=89): 6.35±2.43 μm/h, type I collagen (n=108): 8.77±3.42 μm/h, laminin (n=74): 9.89±5.10 μm/h and EMD (n=81): 7.92±3.35 μm/h. Proliferation rates on the different surfaces were heterogenous for all investigated cell lines and varied from 0% to 50% within 24 h without a correlation to cell motility.

Conclusion: In our study, EMD promotes cell motility better than the control groups. The two investigated single ECM components type I collagen and laminin promoted cell motility superior to EMD. This supports the hypothesis that EMD promotes a less mobile but more differentiated osteogenic phenotype.
Effects of ipriflavone on augmented bone using a guided bone regeneration procedure
Authors: Ito Koichi , Minegishi Tadashi , Takayama Tadahiro , Tamura Takanori , Yamada Yutaka , Sato Shuichi
Published: November 2006

Abstract: This study investigated the effects of ipriflavone (IP) on augmented bone using a guided bone regeneration (GBR) procedure. In 15 rabbits, two titanium caps were placed into calvarial bone for GBR. The animals were divided into three groups: the No‐IP (no intake of IP), Post‐IP (IP orally, 10 mg/kg/day after GBR), and Pre‐IP (IP intake beginning before GBR) groups. One cap was removed from each rabbit after 3 months, and the remaining site was a control. One month after one cap removal, all the animals were euthanized, and histologic and histomorphometric analyses were performed. In all of the groups, the newly generated tissue was of varying size, and it consisted of thin pieces of mineralized bone and large marrow spaces with fat cells and some hematopoietic cells. In all of the control sites, the newly generated tissue was noted and almost filled the space under the cap. There was a significant difference between groups No‐IP and Pre‐IP (93.8±4.6% vs. 98.5±0.8%, P<0.05). The tissue generated at the test sites in all of the groups was resorbed, and its original shape and volume were not maintained 1 month after one cap removal. In particular, the greatest percentage, approximately 20% of the newly generated tissue, was resorbed in the No‐IP group (93.8±4.6% vs. 73.9±3.7%, P<0.05), and approximately 11% and 15% in groups Post‐IP and Pre‐IP, respectively. The relative amount of mineralized bone generated at the control and test sites was significantly larger in groups Post‐IP and Pre‐IP when compared with group No‐IP, except for the test site between groups No‐IP and Post‐IP (P<0.05). Therefore, the amount of mineralized tissue generated appeared to increase with an increase in the total IP dose. Within the limitations of this rabbit experimental model, we conclude that the daily intake of IP before or after GBR inhibits the resorption of augmented tissue and would be useful for improving the quality of newly generated bone beyond the skeletal envelope.
Le Fort I osteotomy with interpositional bone grafts and delayed oral implants for the rehabilitation of extremely atrophied maxillae: a 1–9‐year clinical follow‐up study on humans
Authors: Chiapasco Matteo , Brusati Roberto , Ronchi Paolo
Published: November 2006

Aim: The purpose of this clinical follow‐up study was to report the clinical outcome of osseointegrated implants placed in extremely atrophied edentulous maxillae after Le Fort I osteotomy and interpositional autogenous iliac bone grafts.

Patients and methods: In a 10‐year period (1995–2004), 39 patients, 18 males and 21 females, aged from 32 to 76 years, presenting with severely atrophied edentulous maxillae were treated with Le Fort I osteotomy and interpositional iliac bone grafts. Four to 8 months after the reconstructive procedure, 281 osseointegrated implants were placed in the reconstructed maxillae. Four to 8 months afterwards, abutments were connected and the prosthetic rehabilitation started. The mean follow‐up period of implants after the start of prosthetic loading was 45.9 months (range: 12–108 months).

Results: The reconstructive procedure was successful in 38 of 39 patients. In one patient, partial loss of the inlay graft occurred before implant placement. Six patients (42 implants) dropped out of the study. Fifteen implants were removed during the follow‐up period, due to loss of integration. Thirty‐two implants, although integrated, presented with peri‐implant bone‐level changes higher than those proposed for successful implants. Cumulative survival and success rates of implants were 94.5% and 82.9%, respectively.

Conclusion: Results from this study showed that Le Fort I osteotomy with interpositional bone grafts followed by delayed implant placement is an acceptable means to rehabilitate edentulous patients affected by extremely atrophied edentulous maxillae. Survival rates of implants are consistent with those related to implants placed in native, non‐reconstructed bone. Conversely, the success rate of implants resulted to be lower as compared with those obtained for implants placed in native bone.
Effect ofl‐N6‐(1‐iminoethyl)‐lysine, an inducible nitric oxide synthase inhibitor, on murine immune response induced byActinobacillus actinomycetemcomitanslipopolysaccharide
Authors: Sosroseno W. , Musa M. , Ravichandran M. , Fikri Ibrahim M. , Bird P. S. , Seymour G. J.
Published: November 2006

Background and Objectives: Inducible nitric oxide synthase (iNOS) activity is known to regulate the immune response. The present study was carried out to determine the effect ofl‐N6‐(1‐iminoethyl)‐lysine (l‐nil), an iNOS inhibitor, on the induction of immune response toActinobacillus actinomycetemcomitanslipopolysaccharide in mice.

Material and Methods: BALB/c mice were sham‐immunized (group I), immunized withA. actinomycetemcomitanslipopolysaccharide (group II) or treated withl‐nil andimmunized withA. actinomycetemcomitanslipopolysaccharide (group III). All animals were then challenged with viableA. actinomycetemcomitans. The levels of serum nitric oxide (NO), specific immunoglobulin G (IgG) isotypes and both interferon‐γ and interleukin‐4, as well as spleen cell‐derived iNOS activity, before and after bacterial challenge, were assessed. The diameter of skin lesions was also determined. Serum and spleen cells from the above groups were adoptively transferred to the recipients that were then subsequently challenged with live bacteria.

Results: Treatment withl‐nilsuppressed serum NO and splenic iNOS activity, but enhanced serum‐specific IgG2a antibody and interferon‐γ levels. The lesions inl‐nil‐treated mice healed much more rapidly. Transfer with serum and cells froml‐nil‐treated andA. actinomycetemcomitanslipopolysaccharide‐immunized donors resulted in rapid healing of the lesions in the recipients.

Conclusion: It is suggested that treatment withl‐NIL in mice immunized withA. actinomycetemcomitanslipopolysaccharide may shift the immune response towards a protective T helper 1‐like immunity againstA. actinomycetemcomitans‐induced infection.
Functional characterization of ecdysone receptor gene switches in mammalian cells
Authors: Panguluri Siva K. , Kumar Prasanna , Palli Subba R.
Published: November 2006

Regulated expression of transgene is essential in basic research as well as for many therapeutic applications. The main purpose of the present study is to understand the functioning of the ecdysone receptor (EcR)‐based gene switch in mammalian cells and to develop improved versions of EcR gene switches. We utilized EcR mutants to develop new EcR gene switches that showed higher ligand sensitivity and higher magnitude of induction of reporter gene expression in the presence of ligand. We also developed monopartite versions of EcR gene switches with reduced size of the components that are accommodated into viral vectors. Ligand binding assays revealed that EcR alone could not bind to the nonsteroidal ligand, RH‐2485. The EcR's heterodimeric partner, ultraspiracle, is required for efficient binding of EcR to the ligand. The essential role of retinoid X receptor (RXR) or its insect homolog, ultraspiracle, in EcR function is shown by RXR knockdown experiments using RNAi. Chromatin immunoprecipitation assays demonstrated that VP16 (activation domain, AD):GAL4(DNA binding domain, DBD):EcR(ligand binding domain, LBD) or GAL4(DBD):EcR(LBD) fusion proteins can bind to GAL4 response elements in the absence of ligand. The VP16(AD) fusion protein of a chimera between human and locust RXR could heterodimerize with GAL4(DBD):EcR(LBD) in the absence of ligand but the VP16(AD) fusion protein of Homo sapiens RXR requires ligand for its heterodimerization with GAL4(DBD):EcR(LBD).
WORK–FAMILY CONFLICT AND EMOTIONS: EFFECTS AT WORK AND AT HOME
Authors: JUDGE TIMOTHY A. , ILIES REMUS , SCOTT BRENT A.
Published: November 2006

This study investigated the effect of work–family conflict on the emotions of guilt and hostility, and the implications of work–family conflict and these emotions for job satisfaction and marital satisfaction. Using experience‐sampling methodology, data were collected from a sample of 75 individuals over a period of 2 weeks (producing 625 data points). Results revealed that within individuals, family‐to‐work conflict experienced at work, and work‐to‐family conflict experienced at home, were positively associated with guilt and hostility at work and at home, respectively. In addition, state hostility mediated the negative effect of work‐to‐family conflict at home on daily marital satisfaction. Finally, cross‐level interaction effects were observed such that work–family conflict more strongly affected the emotions of those scoring high on trait guilt and trait hostility.
AN INVESTIGATION OF THE RELATIONSHIP BETWEEN SAFETY CLIMATE AND MEDICATION ERRORS AS WELL AS OTHER NURSE AND PATIENT OUTCOMES
Authors: HOFMANN DAVID A. , MARK BARBARA
Published: November 2006

Safety climate has been shown to be associated with a number of important organizational outcomes. In this study, we take a broad view of safety climate—one that includes not only the development and adherence to safety protocols, but also open and constructive responses to errors—and investigate correlates within the health care industry. Drawing on a random, national sample of hospitals, the results revealed that safety climate predicted medication errors, nurse back injuries, urinary tract infections, patient satisfaction, patient perceptions of nurse responsiveness, and nurse satisfaction. As hypothesized, the relationship between safety climate and both medication errors and back injuries was moderated by the complexity of the patient conditions on the unit. Specifically, the effect of the overall safety climate of the unit was accentuated when dealing with more complex patient conditions.
PUBLICATION BIAS: A CASE STUDY OF FOUR TEST VENDORS
Authors: McDANIEL MICHAEL A. , ROTHSTEIN HANNAH R. , WHETZEL DEBORAH L.
Published: November 2006

This article has 2 goals. First, we discuss publication bias and explain why it presents a potential problem for industrial and organizational psychology. After reviewing the traditional failsafe N, or file drawer analysis, we introduce a more sophisticated method of publication bias analysis (trim and fill), which has been developed in the medical literature but is largely unfamiliar to industrial and organizational psychology researchers. Second, we demonstrate trim and fill by applying it to validity information reported in the technical manuals of 4 test vendors. In doing so, we assess the likelihood that criterion‐related validity information provided by test publishers may overestimate test validity. In our analysis of 18 validity distributions, we found evidence of either no or minimal bias for 2 of the vendors' distributions and evidence of moderate‐to‐severe bias in at least 1 distribution from each of the other 2 vendors. In both cases in which publication bias was found, we noted instances in which the publishers tended to report only statistically significant correlations and that this practice was detected using publication bias methodology.
Can a Decreasing Ultrafiltration Profile Affect the Dialytic Dose Administered?
Authors: Ramunni Alfonso , Brescia Paola , Ranieri Giuseppe , Ria Roberto , Coratelli Pasquate
Published: November 2006

Abstract:  During hemodialysis, ultrafiltration (UF) seems to affect the dialytic dose because of convective removal of urea and contraction of its distribution volume. We aimed to assess whether the adoption of a decreasing UF profile could yield a different dialytic dose from that obtained with a constant UF mode. Ten patients were randomly assigned to undergo 12 sessions with a constant UF mode (phase A) followed by 12 sessions with a decreasing UF rate (phase B), or the reverse. Kt/V and urea reduction ratio (URR) were 1.77 ± 0.26 and 70.02 ± 8.26% in phase A vs. 1.81 ± 0.36 and 71.02 ± 6.48% in phase B, respectively, showing no significant difference. Measurement of the differences in volemic variations between the two phases showed a statistically significant difference at the second hour (P < 0.001, the volemic reduction being greater in phase B than A) and at the fourth hour (P < 0.001, being greater in phase A than B). In standard bicarbonate dialysis, the adoption of a decreasing UF profile rather than a constant one does not alter the efficiency of the dialytic treatment.
Investigation of the Clinical Effect of Large Volume Leukocytapheresis on Methotrexate‐Resistant Rheumatoid Arthritis
Authors: Onuma Shin , Yamaji Ken , Kempe Kazuo , Ogasawara Michihiro , Ogawa Takasuke , Yang Kwangseok , Kanai Miki , Tsuda Hiroshi , Takasaki Yoshinari
Published: November 2006

Abstract:  Leukocytapheresis (LCAP) is already being used in a clinical setting for the treatment of autoimmune diseases such as inflammatory bowel disease and rheumatoid arthritis, and it has been reported to be effective. However, it is totally or partially ineffective in some patients, which has forced clinicians to rethink therapeutic strategies and concurrent treatment. With the aim of enhancing the therapeutic effect, we carried out large volume leukocytapheresis, with a throughput of 5000 mL instead of the 3000‐mL throughput of conventional leukocytapheresis in nine patients with rheumatoid arthritis resistant to methotrexate treatment. Using Cellsorba, the column filled with the unwoven fabric made of the polyethylene phthalate, a leukocyte removal filter, large volume leukocytapheresis was carried out once a week for a total of five sessions. The observation period was the 12‐week period following completion of treatment. The American College of Rheumatology (ACR) core set was used for assessment of efficacy. Eight weeks after completion of treatment, a 20% improvement in ACR was observed in 77.8% (7/9) of subjects, a 50% improvement in ACR was seen in 55.6% (5/9) of subjects, and a 70% improvement in ACR was observed in 22.2% (2/9) of subjects. C‐reactive protein decreased gradually as treatment progressed, and a significant decrease was observed 4 weeks after completion of treatment. The fact that some subjects had an ACR70 response, few reports of which are observed in the case of conventional leukocytapheresis, and the fact that the effect continued up to 12 weeks after completion of treatment suggests that the degree and duration of the effect of large volume leukocytapheresis might be longer than those of conventional leukocytapheresis.
Hemoperfusion With an Immobilized Polymyxin B Fiber Column Reduces Circulating Interleukin‐8 Concentrations
Authors: Kushi Hidehiko , Miki Takahiro , Nakahara Jun , Okamoto Kazuhiko , Kawahara Yayoi , Saito Takeshi , Tanjoh Katsuhisa
Published: November 2006

Abstract:  In the present study, we examined whether the performance of hemoperfusion with an immobilized polymyxin B fiber column (DHP‐PMX) reduces circulating interleukin‐8 concentration in patients with sepsis. Fifteen patients with sepsis satisfying the following criteria were enrolled in the study: (i) signs of systemic inflammatory response syndrome caused by infection; and (ii) mean arterial blood pressure ≥60 mm Hg (irrespective of the use of catecholamines). A thermodilution catheter was inserted prior to DHP‐PMX for appropriate intravenous infusion, and the DHP‐PMX was carried out twice at 24 h intervals (for 3 h each time). Circulating interleukin‐8 concentration was measured seven times. The sequential organ failure assessment (SOFA) score was calculated twice. Circulating interleukin‐8 concentration was 55 ± 15.7 pg/mL before DHP‐PMX, while it was 101 ± 58.8 pg/mL immediately after the first session of treatment. It was 24 ± 9.0 pg/mL before the second session of DHP‐PMX, and it was 28 ± 8.0 pg/mL immediately after the second session. The IL‐8 level was 17 ± 4.3 pg/mL at 48 h afterward, and 18 ± 4.3 pg/mL at 72 h afterward, showing a significant decrease from 48 h onwards, compared with before treatment (P < 0.05). The SOFA score was 9 ± 1.5 and the APACHE II score was 19 ± 2.0 before DHP‐PMX, while the SOFA score was 7.0 ± 0.9 at 72 h afterward, showing a significant decrease compared with before treatment (P < 0.05). The present findings indicate that DHP‐PMX indirectly reduces circulating interleukin‐8 concentration and improves SOFA score.
Hemoperfusion With an Immobilized Polymyxin B Fiber Column Improves Tissue Oxygen Metabolism
Authors: Kushi Hidehiko , Miki Takahiro , Nakahara Jun , Okamoto Kazuhiko , Kawahara Yayoi , Saito Takeshi , Tanjoh Katsuhisa
Published: November 2006

Abstract:  Recently, direct hemoperfusion with a polymyxin B‐coated fiber column (DHP‐PMX) has been increasingly used for the treatment of sepsis, and an improvement in outcomes has been reported. However, the mechanism of the method is not known in detail. In the present study, we examined whether the performance of DHP‐PMX improved tissue oxygen metabolism in patients with sepsis. Twenty‐two patients with sepsis, satisfying the following criteria, were enrolled in the study: (i) signs of systemic inflammatory response syndrome caused by infection; and (ii) mean arterial blood pressure ≥60 mm Hg (irrespective of the use of catecholamines). A thermodilution catheter was inserted prior to DHP‐PMX for appropriate intravenous infusion, and the DHP‐PMX was carried out twice within 24 h (for 3 h each time). Then, the gastric mucosal‐arterial PCO2 difference (PCO2 gap) was calculated as the gastric mucosal PCO2 minus arterial PCO2. A PCO2 gap ≥8 mm Hg was used to define abnormal tissue oxygen metabolism. PCO2 gap was measured before PMX‐DHP, as well as 24, 48, and 72 h afterward. PCO2 gap was 20 ± 4.9 mm Hg before DHP‐PMX vs. 16 ± 2.7 mm Hg (P = 0.189) at 24 h, 12 ± 2.8 mm Hg (P = 0.046) at 48 h, and 11 ± 2.2 mm Hg (P = 0.045) at 72 h afterward, showing a significant decrease from 48 h onward compared with before treatment. These findings suggest that DHP‐PMX improves tissue oxygen metabolism.
The Role of Apheresis Therapy for ABO Incompatible Living Donor Liver Transplantation: The Kyoto University Experience
Authors: Kozaki Koichi , Egawa Hiroto , Ueda Mikiko , Oike Fumitaka , Yoshizawa Atsushi , Fukatsu Atsushi , Takada Yasutsugu
Published: November 2006

Abstract:  Liver transplantation is a radical surgical therapy for end‐stage liver disease. Although in Japan organ transplantation from brain‐dead donors (BDD) has been allowed since October 1997, to date, only 29 liver grafts from BDD have been obtained. Thus, most of the liver transplantations carried out use living‐donor liver transplantation (LDLT), and BDD liver transplantation is only used in rare cases. In order to carry out LDLT more safely, apheresis (plasmapheresis: PE) plays a major role in our country because of the prevalence of LDLT wherein later re‐transplantation is difficult. Thus, because of a limited donor supply and because the needs of patients with end‐stage liver disease is critical, use of grafts from ABO‐incompatible (ABO‐I) donors might be the only available option. From June 1990 to November 2005, 1100 patients underwent 1151 LDLT cases at Kyoto University Hospital. Additionally, 159 LDLT cases (13.8%) received ABO‐I living‐donor liver grafts. The role of apheresis in ABO‐I LDLT is the reduction of antibody titers such as anti‐A or anti‐B antibody. We carry out preoperative PE as a general rule for ABO‐I cases, and the recipient’s antibody level against the donor’s blood type is decreased to one eighth of the baseline value before LDLT. Until now, baseline immunosuppressive agents included steroids, tacrolimus and cyclophosphamide. At first, splenectomy was carried out during surgery to suppress antibody production, and intraportal (PV) infusion therapy was carried out to control local disseminated intravascular coagulation (DIC) occurring in ABO‐I grafts. At that time, three drugs‐methylprednisolone, prostaglandin E1 (PGE1), and gabexate mesylate (FOY) were infused continuously for 3 weeks after LDLT. At present, instead of PV infusion therapy, hepatic artery infusion therapy without splenectomy is adopted because of portal thrombosis, and two drugs— methylprednisolone and PGE1‐ are infused continuously for 3 weeks following LDLT. Recently, we introduced anti‐CD20 monoclonal antibody (Rituximab) instead of splenectomy for B cell deletion before ABO‐I LDLT. In the present article, we describe the role of apheresis around ABO‐I LDLT based on our recent experiences.
2005 Japanese Society for Dialysis Therapy Guidelines for Vascular Access Construction and Repair for Chronic Hemodialysis
Authors: Ohira Seiji , Naito Hidemune , Amano Izumi , Azuma Nakanobu , Ikeda Kiyoshi , Kukita Kazutaka , Goto Yasuo , Sakai Shinji , Shinzato Takahiro , Sugimoto Tokuichiro , Takemoto Yoshiaki , Haruguchi Hiroaki , Hino Ichiro , Hiranaka Toshiyuki , Mizuguchi Jun , Miyata Akira , Murotani Noriyoshi
Published: November 2006

Abstract:  The guideline committee of Japanese Society for Dialysis Therapy (JSDT), chaired by Dr Ohira, has published an original Japanese guideline, ‘Guidelines for Vascular Access Construction and Repair for Chronic Hemodialysis’. The guideline was created mainly because of the existence of numerous factors characteristic of Japanese hemodialysis therapy, which are described in this report, and because we recognized the necessity for standardization in vascular access‐related surgeries. This guideline consists of 10 chapters, each of which includes guidelines, explanations or comments and references. The first chapter discusses informed consent of vascular access (VA)‐related surgeries, which often resulted in trouble between dialysis staff and patients. The second chapter describes the fundamentals of VA construction and timing of the introduction of hemodialysis with emphasis on the avoidance of catheter indwelling if at all possible. In the third chapter, arteriovenous fistula (AVF) construction and management are discussed from the viewpoint of the most preferable type of VA. The fourth chapter deals with arteriovenous grafts (AVG) which has recently increased in clinical applications. The factors which improve the AVG patency rate are discussed and postoperative management methods are emphasized to avoid possible complications. The fifth chapter deals with short and long‐term vascular catheters. It is emphasized that these methods are definitely effective but, at the same time, are apt to be associated with several serious complications and might result in vascular damage. In the sixth chapter, superficialization of an artery is explained. This was originally for emergency use or backup but has been used permanently in 2–3% of Japanese hemodialysis patients. In the seventh chapter, methods for the use of VA are described and the buttonhole method is referred to as one of the options for patients who complain of intense pain at every cannulation. In the eighth chapter, the importance of continuous monitoring is stressed for maintaining appropriate function of VA. As a rule, the internal shunt type VA (AVF, AVG) places a burden on cardiac function. Thus, in the ninth chapter, it is stressed that VA construction, maintenance and repair should always be carried out with consideration of cardiac function which is not constant but variable. The 10th chapter forms one of the cores of this guideline and deals with repair and timing of VA. It is shown how to select a surgical or interventional repair method. In the final 11th chapter, VA types and resultant morbidity and mortality of hemodialysis patients are reviewed.
Inherited cortical HCN1 channel loss amplifies dendritic calcium electrogenesis and burst firing in a rat absence epilepsy model
Authors: Kole Maarten H.P. , Bräuer Anja U. , Stuart Greg J.
Published: November 2006

While idiopathic generalized epilepsies are thought to evolve from temporal highly synchronized oscillations between thalamic and cortical networks, their cellular basis remains poorly understood. Here we show in a genetic rat model of absence epilepsy (WAG/Rij) that a rapid decline in expression of hyperpolarization‐activated cyclic‐nucleotide gated (HCN1) channels (Ih) precedes the onset of seizures, suggesting that the loss of HCN1 channel expression is inherited rather than acquired. Loss of HCN1 occurs primarily in the apical dendrites of layer 5 pyramidal neurons in the cortex, leading to a spatially uniform 2‐fold reduction in dendritic HCN current throughout the entire somato‐dendritic axis. Dual whole‐cell recordings from the soma and apical dendrites demonstrate that loss of HCN1 increases somato‐dendritic coupling and significantly reduces the frequency threshold for generation of dendritic Ca2+ spikes by backpropagating action potentials. As a result of increased dendritic Ca2+ electrogenesis a large population of WAG/Rij layer 5 neurons showed intrinsic high‐frequency burst firing. Using morphologically realistic models of layer 5 pyramidal neurons from control Wistar and WAG/Rij animals we show that the experimentally observed loss of dendritic Ih recruits dendritic Ca2+ channels to amplify action potential‐triggered dendritic Ca2+ spikes and increase burst firing. Thus, loss of function of dendritic HCN1 channels in layer 5 pyramidal neurons provides a somato‐dendritic mechanism for increasing the synchronization of cortical output, and is therefore likely to play an important role in the generation of absence seizures.
Suppression of testosterone does not blunt mRNA expression of myoD, myogenin, IGF, myostatin or androgen receptor post strength training in humans
Authors: Kvorning Thue , Andersen Marianne , Brixen Kim , Schjerling Peter , Suetta Charlotte , Madsen Klavs
Published: November 2006

We hypothesized that suppression of endogenous testosterone blunts mRNA expression post strength training (ST). Twenty‐two young men were randomized for treatment with the GnRH analogue goserelin (3.6 mg every 4 weeks) or placebo for a period of 12 weeks. The ST period of 8 weeks started at week 4. Strength test, blood sampling, muscle biopsies, and whole‐body dual‐energy X‐ray absorptiometry (DXA) scan were performed at weeks 4 and 12. Muscle biopsies were taken during the final ST session (pre, post 4 h, and post 24 h). Resting serum testosterone decreased significantly (P < 0.01) in the goserelin group from 22.6 ± 1.6 (mean ±s.e.m.) to 2.0 ± 0.1 nmol l−1 (week 4), whereas it remained unchanged in the placebo group. An acute increase of serum testosterone was observed during the final ST session in the placebo group (P < 0.05), whereas a decreased response was observed in the goserelin group (P < 0.05). mRNA expression of IGF‐IE(bc) and myogenin increased, while expression of myostatin decreased (P < 0.01); however, no differences were observed between the groups. Muscle strength and muscle mass showed a tendency to increase more in the placebo group than in the goserelin group (P= 0.05). In conclusion, despite blocked acute responses of testosterone and 10‐ to 20‐fold lower resting levels in the goserelin group, ST resulted in a similar mRNA expression of myoD, myogenin, IGF‐IE(abc), myostatin and androgen receptor as observed in the placebo group. Therefore, in the present study, the molecular events were the same, despite divergent muscle hypertrophy and strength gains.
PI(3,4,5)P
3
and PI(4,5)P
2
Lipids Target Proteins with Polybasic Clusters to the Plasma Membrane
Authors: Heo Won Do , Inoue Takanari , Park Wei Sun , Kim Man Lyang , Park Byung Ouk , Wandless Thomas J. , Meyer Tobias
Published: November 2006

Many signaling, cytoskeletal, and transport proteins have to be localized to the plasma membrane (PM) in order to carry out their function. We surveyed PM-targeting mechanisms by imaging the subcellular localization of 125 fluorescent protein–conjugated Ras, Rab, Arf, and Rho proteins. Out of 48 proteins that were PM-localized, 37 contained clusters of positively charged amino acids. To test whether these polybasic clusters bind negatively charged phosphatidylinositol 4,5-bisphosphate [PI(4,5)P
2
] lipids, we developed a chemical phosphatase activation method to deplete PM PI(4,5)P
2
. Unexpectedly, proteins with polybasic clusters dissociated from the PM only when both PI(4,5)P
2
and phosphatidylinositol 3,4,5-trisphosphate [PI(3,4,5)P
3
] were depleted, arguing that both lipid second messengers jointly regulate PM targeting.
Health-related job loss: findings from a community-based survey
Authors: Solomon Christine , Poole Jason , Palmer Keith T , Coggon David
Published: November 2006

Aims:To explore the frequency, nature, determinants and outcome of health-related job loss (HRJL) in men sampled from the general population of three rural areas.

Methods:Data on lifetime occupational history, including any HRJL, were obtained as part of a postal survey of men aged 24–70 years in three rural areas of England and Wales. Incidence rates were calculated for first health-related loss of a job that had been held for ⩾1 year. Associations with risk factors were examined by Poisson regression, and by application of conditional logistic regression in a nested case–control study.

Results:HRJL was reported by 1408 (13%) of the 10 559 men who had held long-term jobs. The incidence rose steeply with age for cardiorespiratory and neurological disorders, but for accidents and poisoning the trend was, if anything, in the reverse direction. An increase in incidence over time was most marked for musculoskeletal disorders and mental illness, and much less prominent for cardiorespiratory and neurological disease. In comparison with other occupations, the risk was lower in agricultural workers (odds ratio (OR) 0.6, 95% CI 0.5 to 0.8), and higher in policemen (OR 2.4, 95% CI 1.6 to 3.7) and teachers (OR 2.0, 95% CI 1.5 to 2.7), this differential being even greater for HRJL caused by mental illness. Risk was also increased in employees relative to the self-employed (OR 2.0, 95% CI 1.7 to 2.3). Shift work was associated with a higher incidence of job loss caused by mental illness (OR 1.5, 95%CI 1.1–2.2), and heavy lifting with HRJL caused by musculoskeletal disorders (OR 2.6, 95% CI 2.0 to 3.5). After HRJL, 61% of subjects had subsequently obtained further long-term employment, usually within 1 year.

Conclusions:In the population studied, HRJL has become increasingly common, especially in relation to musculoskeletal disorders and mental illness. In addition to being associated with ergonomic stresses in the workplace, it may be importantly influenced by cultural and economic factors. Future research should focus on the minority of workers who leave a job for health reasons and do not rapidly return to further work.
FRACTAL AND CHAOTIC PATTERNS OF GENERAL KORTEWEG–DE VRIES SYSTEM IN (2+1)-DIMENSIONS
Authors: ZHENG CHUN-LONG , ZHU HAI-PING , FANG JIAN-PING
Published: November 2006

With the aid of an extended projective method and a variable separation approach, new families of variable separation solutions (including solitary wave solutions, periodic wave solutions and rational function solutions) with arbitrary functions for (2+1)-dimensional general Korteweg–de Vries (GKdV) system are derived. Analytical investigation of the (2+1)-dimensional GKdV system shows the existence of abundant stable localized coherent excitations such as dromions, lumps, peakons, compactons and ring soliton solutions as well as rich fractal and chaotic localized patterns in terms of the derived solitary solutions or the variable separation solutions when we consider appropriate boundary conditions and/or initial qualifications.
PRESSURE DEPENDENCE OF OPTO-ELECTRONIC PROPERTIES INZnSxSe1-x
Authors: BENMAKHLOUF F. , BOUARISSA N.
Published: November 2006

We present an investigation of the electronic properties and optical constants of zinc-blende ZnSxSe1-xsemiconducting alloys at normal and under hydrostatic pressure up to 20 kbar. For this purpose, we used an empirical pseudopotential method within the virtual crystal approximation. The effects of alloy composition are taken into consideration in the calculation, which improves significantly the bandgap bowing parameters with respect to the experiment. Results regarding the composition and pressure dependences of energy bandgaps, electron valence and conduction charge distributions, optical high-frequency dielectric constant and its linear pressure coefficient are presented and discussed. The information derived from the present study may be useful for the development of opto-electronic devices that operate in the blue/green spectral range.