bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetomaternal alloimmune thrombocytopenia: a literature review and statistical analysis
Authors: Spencer Jillian A , Burrows Robert F
Published: February 2008

Exploring prognostic factors that determine outcomes in fetomaternal alloimmune thrombocytopenia (FMAIT), a search of Medline was performed covering the years 1966 to April 1998.376 articles were collected and reviewed; 140 articles contained the case histories of 297 mothers and 433 pregnancies that fulfilled entry criteria. More than 30 data variables were sought from these cases. The data were analysed using SPSS and Arcus Quickstat Biomedical.

Nineteen different antigen incompatibilities were documented, the majority being human platelet antigen (HPA)‐la (77.3%), HPA‐3a (3.5%) and HPA‐5b (3.5%). The relative risk reduction (RRR) in mortality with any intervention was 57% (0.19‐0.77) p = 0.009. Treatment of HPA‐la (P1A1) pregnancies with intravenous immunoglobulin (IVIG) increased the likelihood of a neurologically normal outcome, relative risk (RR) 1.68, confidence interval (1.3‐2.2) p = 0.0003. Treatment of HPA‐la (P1A1) pregnancies with only antenatal complementary platelet transfusions increased the likelihood of a neurologically normal outcome, RR 1.63 (1.1–2.1) p = 0.01.

Despite reviews of more than 400 cases of FMAIT, few prognostic variables are identifiable. Although IVIG appears to reduce the risk of intracranial haemorrhage (ICH), the dosage and timing of IVIG treatment was varied. This study highlights the need for standardised and directed research.
A randomised controlled trial comparing a dilating vaginal speculum with a conventional bivalve speculum
Authors: Thomas Anna , Weisberg Edith , Lieberman Devora , Fraser Ian S
Published: February 2008

Cervical smears are traditionally taken with the aid of a metal or disposable plastic bivalve speculum. Many women complain of discomfort with these specula. This study compares the efficacy and women's experiences of a new ‘dilating speculum’ called the Veda‐scope1‘11’, with a conventional metal bivalve speculum (Pederson).

The aims of this study were: to determine whether the Veda‐scope provides adequate visualisation of the cervix and vaginal walls and an adequate cervical cytology specimen; and to compare user acceptability and women's levels of comfort between the Veda‐scope and the bivalve speculum.

Sixty‐four women were randomised to be examined with the Veda‐scope and 60 with the bivalve speculum, by one of two operators. Each woman completed a questionnaire that included subjective views of their previous cervical smear experiences, and acceptability of the examination at the study consultation. Cytologists were blinded as to which speculum was used for cervical sampling.

Of women examined, 78–83% of women found Veda‐scope examinations comfortable, compared to 38–62% of women who found examinations with the bivalve comfortable; 94% of the women preferred the ‘comfort’ of the Veda‐scope. The Veda‐scope was as good as the bivalve speculum in providing samples for cytological analysis following the initial learning curve, and also provided markedly superior magnified views of the cervix and vaginal fornices.
Active management of the third stage at Caesarean section: a randomised controlled trial of misoprostol versus Syntocinon
Authors: Lokugamage AU , Paine M , Bassaw‐Balroop K , Sullivan KR , Refaey H El , Rodeck CH
Published: February 2008

The objective of this trial was to investigate whether 500 ug oraJ misoprostol given immediately after delivery of the neonate at Caesarean section is as effective as a bolus intravenous injection of 10 iu Syntocinon in stimulating uterine contractions and thereby reducing blood loss.

Forty women undergoing elective or emergency Caesarean section were included in a placebo‐controlled randomised trial.

Group 1 received oral misoprostol and a placebo intravenous bolus and Group 2 received intravenous Syntocinon and oral placebo tablets.

The main outcome measures were estimated blood loss at Caesarean section, drop in serum haemoglobin, and the need for additional uterotonic agents.

We found that there was no significant difference (p = 0.75) in estimated blood loss between the two groups. No differences were observed in the decrease in haemoglobin, requirement for additional oxytocics, the need for blood transfusion or the degree of shivering in each group (p > 0.05 in each case).

We concluded that oral misoprostol could be used as an alternative oxytocic agent for the third stage at Caesarean section. However, there is an obvious need for a larger randomised controlled trial to be undertaken. Previous published studies have concentrated on vaginal births and further studies should be extended to Caesarean deliveries.
Sonographic estimation of fetal weight in maerosomic fetuses: diabetic versus non‐diabetic pregnancies
Authors: Wong SF , Chan FY , Cincotta RB , Oats JJ , Mclntyre HD
Published: February 2008

The objective of this study is to compare the accuracy of sonographic estimation of fetal weight of maerosomic babies in diabetic vs non‐diabetic pregnancies. All babies weighing 4000 g or more at birth, and who had ultrasound scans performed within one week of delivery were included in this retrospective study. Pregnancies with diabetes mellitus were compared to those without diabetes mellitus. The mean simple error (actual birthweight ‐ estimated fetal weight); mean standardised absolute error (absolute value of simple error (g)/actual birthweight (kg)); and the percentage of estimated birthweight falling within 15% of the actual birthweight between the two groups were compared.

There were 9516 deliveries during the study period. Of this total 1211 (12.7%) babies weighed 4000 g or more. A total of 56 non‐diabetic pregnancies and 19 diabetic pregnancies were compared. The average sonographic estimation of fetal weight in diabetic pregnancies was 8% less than the actual birthweight, compared to 0.2% in the non‐diabetic group (p < 0.01). The estimated fetal weight was within 15% of the birthweight in 74% of the diabetic pregnancies, compared to 93% of the non‐diabetic pregnancies (p < 0.05). In the diabetic group, 26.3% of the birthweights were underestimated by more than 15 %, compared to 5.4% in the non‐diabetic group (p < 0.05).

In conclusion, the prediction accuracy of fetal weight estimation using standard formulae in maerosomic fetuses is significantly worse in diabetic pregnancies compared to non‐diabetic pregnancies. When sonographic fetal weight estimation is used to influence the mode of delivery for diabetic women, a more conservative cut‐off needs to be considered.
Symptoms and HPV infection of the vulva: clinical manifestations or mere coincidence?*
Authors: Ayer Bhuvana , Fischer Arthur , Spurrett Brian , Houghton Roger
Published: February 2008

Two hundred women with abnormal Pap smears and/or vulvar symptoms and 30 with normal Pap smears were investigated to determine the association between symptoms and (i) human papilloma virus infection of the vulva, and (ii) a spongiotic tissue reaction or a spongiotic dermatitis of the vulva. All had vulvar colposcopy and biopsy.

Human papilloma virus infection was diagnosed by histopathology and in situ hybridisation technique. HPV infection was present in biopsies of 48% of asymptomatic women and 33% with symptoms (p = 0.13) and HPV DNA in 37% of asymptomatic women and 31% with symptoms (p = 0.72). Spongiotic tissue reaction was diagnosed in 53.5% of asymptomatic women compared to 74% of symptomatic women (p = 0.007). This study suggests that vulvar symptoms are not clinical manifestations of HPV infection, but may be caused by dermatitis rather than HPV infection per se.
Wernicke's encephalopathy due to hyperemesis gravidarum: an under‐recognised condition
Authors: Togay‐Isikay Canan , Yigit Aytac , Mutluer Nermin
Published: February 2008

We present a case of a 25‐year‐old woman with drowsiness, nystagmus, severe ataxia and areflexia, which developed six weeks after admission to an obstetric clinic for hyperemesis gravidarum.

She had been treated with intravenous dextrose and electrolyte solutions and antiemetics. Magnetic resonance imaging (MR1) performed on the fifth day of her neurologic symptoms showed increased intensity in both thalami, periaqueductal grey matter, the floor of the fourth ventricle and superior cerebellar vermis in T2 weighted and FLAIR images.

Clinical signs and MRI findings were consistent with the diagnosis of Wernicke's encephalopathy. On the third day of thiamine replacement, neurologic signs improved dramatically.

In addition to our case, we review 29 previously reported cases of Wernicke's encephalopathy associated with hyperemesis gravidarum, and emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy, especially if they are given intravenous or parenteral nutrition.
Assessing Conservation Action for Substitution of Missing Dynamics on Former Military Training Areas in Central Europe
Authors: Jentsch Anke , Friedrich Silke , Steinlein Thomas , Beyschlag Wolfram , Nezadal Werner
Published: February 2008

Disproportionately large numbers of threatened and endangered species and unusually high biodiversity have been documented on former military training areas. However, throughout the world, nature protection areas on former military grounds are faced with the dilemma of preserving ecosystems that must change. In central Europe, many of these areas are characterized by dry acidic grasslands on sandy soils. However, these resource‐limited ecosystems are faced with two interacting threats: missing disturbance dynamics and increasing atmospheric nitrogen deposition from urban agglomerations. The goal of this study was to assess the effectiveness of conservation action for substitution of missing dynamics. Impacts on plant species assembly, performance of functional groups, soil nutrient availability, and successional trajectory are analyzed. Of particular concern is mimicking beneficial effects of military maneuver on pioneer species such as Corynephorus canescens, which is endangered in many countries. In a controlled field experiment, we manipulated mechanical disturbances representing conservation measures—harrowing, topsoil removal, tilling, and tank driving. Our findings suggest that only topsoil removal and tank driving effectively remove organic material and create self‐sustaining vegetation dynamics. Topsoil removal affects both filters in community assembly: the abiotic filter related to soil resources and the biotic filter related to competition between species. We further demonstrate that plant functional groups based on growth form show different rates of recruitment after disturbance with graminoids‐dominating initial dynamics. This study provides basic information on effective conservation strategies for dry acidic grasslands on former military training areas.
Molecular detection of the brevetoxin‐producing dinoflagellate Karenia brevis and closely related species using rRNA‐targeted probes and a semiautomated sandwich hybridization assay1
Authors: Haywood Allison J. , Scholin Christopher A. , Marin Roman , Steidinger Karen A. , Heil Cynthia , Ray Jason
Published: February 2008

Brevetoxins produced by the marine dinoflagellate Karenia brevis (C. C. Davis) G. Hansen et Moestrup cause neurotoxic shellfish poisoning (NSP) in human consumers and also endanger a variety of coastal wildlife. In the eastern Gulf of Mexico the presence and abundance of this species have traditionally been monitored using light microscopy (LM) observations of whole water samples. Various molecular probe methods now enable detection of multiple species from a single sample, allowing rapid sample analysis. We describe the development of sandwich hybridization assays (SHAs) for Karenia brevis, K. selliformis Haywood, Steid. et L. MacK., K. mikimotoi (Miyake et Kominami ex M. Oda) G. Hansen et Moestrup, K. papilionacea Haywood et Steid., the Karlotoxin‐producer Karlodinium veneficum (D. Ballant.) J. Larsen (=K. micrum), and Gymnodinium aureolum (Hulburt) G. Hansen, comb. nov. The assays require no nucleic acid purification and use LSU rRNA‐targeted probes and a semiautomated, 96‐well plate format. Probes tested in matrix format were specific relative to rRNAs of all nontarget species used. The response of the SHA for a constant number of K. brevis cells per unit volume of homogenate depended on the growth status of a culture, decreasing for senescent cells relative to actively growing cells. The results of preliminary field tests of the K. brevis SHA indicated that cells collected from natural populations tended to return a lower signal than those harvested from laboratory cultures, but these results are nonetheless very encouraging. These preliminary field studies show that robust standards are required for cell identification and enumeration, with which new methods can be compared.
Phylogenetic relationships within the tribe Janieae (Corallinales, Rhodophyta) based on molecular and morphological data: a reappraisal ofJania1
Authors: Kim Ji Hee , Guiry Michael D. , Oak Jung Hyun , Choi Do‐Sung , Kang Sung‐Ho , Chung Hosung , Choi Han‐Gu
Published: February 2008

Generic boundaries among the generaCheilosporum,Haliptilon, andJania—currently referred to the tribe Janieae (Corallinaceae, Corallinales, Rhodophyta)—were reassessed. Phylogenetic relationships among 42 corallinoidean taxa were determined based on 26 anatomical characters and nuclear SSU rDNA sequence data for 11 species (with two duplicate plants) referred to the tribe Corallineae and 15 species referred to the tribe Janieae (two species ofCheilosporum, seven ofHaliptilon, and six ofJania, with five duplicate plants). Results from our approach were consistent with the hypothesis that the tribe Janieae is monophyletic. Our data indicate, however, thatJaniaandHaliptilonas currently delimited are not monophyletic, and thatCheilosporumshould not be recognized as an independent genus within the Janieae. Our data resolved two well‐supported biogeographic clades for the included Janieae, an Indian‐Pacific clade and a temperate North Atlantic clade. Among anatomical characters, reproductive structures reflected the evolution of the Janieae. Based on our results, three genera,Cheilosporum,Haliptilon, andJania, should be merged into a single genus, withJaniahaving nomenclatural priority. We therefore propose new combinations where necessary of some species previously included inCheilosporumandHaliptilon.
Organic and inorganic nutrient effects on growth rate–irradiance relationships in the Texas brown‐tide alga Aureoumbra lagunensis (Pelagophyceae)1
Authors: Muhlstein Harris I. , Villareal Tracy A.
Published: February 2008

Pelagophyte species in the genera Aureococcus and Auroumbra form brown tides in coastal bays that cause food‐web disruption and extensive shading of benthic primary producers. Organic nutrients have been suggested as key factors in the origination and persistence of the East Coast (USA) brown‐tide alga Aureococcus anophagefferens Hargraves et Sieburth. To evaluate this finding for the Texas brown‐tide alga Aureoumbra lagunensis D. A. Stockw., DeYoe, Hargraves et P. W. Johnson, we grew strain TBA‐2 with dissolved inorganic nitrogen (DIN; or ) or dissolved organic nitrogen (DON; urea or glutamate) as the nitrogen (N) source under eight light intensities. Maximum growth rates decreased with N source from (1.0 div · d−1) to (0.48 div · d−1). Neither growth rate efficiency (α) nor Ik varied significantly between N treatments. Both inorganic phosphorus (P) and β‐glycerophosphate supported growth. Aureoumbra lagunensis can utilize at least some forms of organic N and P and can use them to persist or grow when inorganic forms become limiting. We found no evidence to support the hypothesis that organic utilization enhances or supplements growth at low light levels.
Comparative effects of the quality and quantity of light and temperature on the growth of Planktothrix agardhii and P. rubescens1
Authors: Oberhaus L. , Briand J. F. , Leboulanger C. , Jacquet S. , Humbert J. F.
Published: February 2008

The effects of temperature, light intensity, and quality on the growth of the cyanobacteria Planktothrix agardhii (Gomont) Anag. et Komárek and P. rubescens (Gomont) Anag. et Komárek were assessed in batch cultures. The relative competitiveness of the green‐pigmented P. agardhii and the red‐pigmented P. rubescens was evaluated in separate and mixed cultures, under different light intensities and qualities (green, red, and white), and at two different temperatures, chosen as representative of the natural conditions favoring the respective blooms of each species. In monocultures, the P. rubescens strain appeared to be particularly well adapted to low intensities of green light and displayed a strong photoinhibition under high irradiance levels. The P. agardhii strain appeared less specialized with regard to light quality and also less sensitive to photoinhibition at higher irradiances. In competition experiments, temperature (15°C vs. 25°C) was the most important parameter in determining relative fitness of the species and competitive success. At 15°C, P. rubescens appeared to be much more competitive than P. agardhii, while P. agardhii was more competitive at 25°C. Under low irradiance, however, the pigmentation of these strains was of primary importance in determining the outcomes of the competition experiments. On the basis of our experimental results and on field observations, we propose that the successful growth leading to the proliferation of these two differently pigmented strains may largely depend on the combined conditions of light and temperature. The two strains, being genetically close relatives, could therefore be considered as two ecotypes that are adapted to different light and temperature environments. Competition experiments showed that the combination of these parameters largely controls the success of one strain in comparison to the other.
Annual cycle and diversity of species and infraspecific taxa ofCeratium(Dinophyceae) in the Ligurian Sea, northwest Mediterranean1
Authors: Tunin‐Ley Alina , Labat Jean‐Philippe , Gasparini Stéphane , Mousseau Laure , Lemée Rodolphe
Published: February 2008

We examined the well‐documented and species‐rich dinoflagellate genusCeratiumSchrank in the northwest Mediterranean Sea as a possible model for marine phytoplankton diversity and as a biological indicator of global climate change. First, we investigated the influence of counting effort; we then documented temporal changes inCeratiumspecific and infraspecific taxa over 2 years (2002 and 2003) in the Villefranche Bay based on a monthly net sampling. Finally, we tried to identify factors associated with shifts in biodiversity. The calculation of taxonomic diversity, regularity, and richness were highly dependent on counting effort. We determined that a minimal sample volume of ∼70 L was needed to obtain a good estimation of species richness. The annual cycle was characterized by a seasonal trend of high winter species richness followed by low spring biodiversity. Infraspecific variability not only appeared to depend on water temperature but also seemed to be influenced by bottom‐up control and was strongly affected by top‐down control. Thus, the occurrence of high concentrations of salps (Thalia democratica) and copepods larger than 2 mm (Calanus helgolandicus) coincided with a drastic decrease ofCeratiumabundance and diversity during spring 2003.Ceratiumis sensitive to both abiotic and biotic factors and could prove to be a good candidate as a biological indicator of global change.
Interspecific differences in the response of juvenile stages to physical stress: fluorometric responses of fucoid embryos to variation in meteorological conditions1
Authors: Lamote Morgane , Johnson Ladd E. , Lemoine Yves
Published: February 2008

Chl fluorescence during and immediately after low tide under four meteorological conditions was measured in embryos of three fucoid algae [Ascophyllum nodosum (L.) Le Jol., Fucus vesiculosus L., and Fucus distichus subsp. edentatus Bach. (Pyl.) H. T. Powell] vertically distributed in the intertidal zone in Québec, Canada. Artificial substrata with attached embryos of each species were outplanted into each zone and into two different microhabitats: under and outside an adult canopy. Several fluorescence measurements were made using pulse‐amplitude‐modulated (PAM) fluorometry, from which maximum quantum yield (Fv/Fm), effective quantum yield (φPSII), relative electron transport rate (rETR), and nonphotochemical quenching (NPQ) were calculated. Fv/Fm, φPSII, and rETR decreased, and NPQ increased during low tide, most rapidly under the most desiccating meteorological conditions (i.e., sunny‐windy weather). The species occurring lowest in the vertical distribution, F. distichus subsp. edentatus, was the most affected, and the two highest species, A. nodosum and F. vesiculosus, only rarely differed. Tidal height itself also influenced the decline in fluorescence parameters, with more gradual declines in lower zones, except under the least desiccating conditions (i.e., cloudy‐calm weather). Recovery upon reimmersion was rapid in all circumstances. Under a canopy, decreases in maximum and effective quantum yields were more gradual than in exposed locations. Although the young stages of these species were affected by physical conditions experienced during low tide and their exact response depended on the precise meteorological conditions, differences in responses among species were surprisingly small. The abilities of young stages to withstand aerial conditions were, however, consistent with the zonation patterns of adults, and conditions under an adult canopy offered some protection.
Species boundaries and global biogeography of the Alexandrium tamarense complex (Dinophyceae)1
Authors: Lilly Emily L. , Halanych Kenneth M. , Anderson Donald M.
Published: February 2008

Alexandrium catenella (Whedon et Kof.) Balech, A. tamarense (M. Lebour) Balech, and A. fundyense Balech comprise the A. tamarense complex, dinoflagellates responsible for paralytic shellfish poisoning worldwide. The relationships among these morphologically defined species are poorly understood, as are the reasons for increases in range and bloom occurrence observed over several decades. This study combines existing data with new ribosomal DNA sequences from strains originating from the six temperate continents to reconstruct the biogeography of the complex and explore the origins of new populations. The morphospecies are examined under the criteria of phylogenetic, biological, and morphological species concepts and do not to satisfy the requirements of any definition. It is recommended that use of the morphospecies appellations within this complex be discontinued as they imply erroneous relationships among morphological variants. Instead, five groups (probably cryptic species) are identified within the complex that are supported on the basis of large genetic distances, 100% bootstrap values, toxicity, and mating compatibility. Every isolate of three of the groups that has been tested is nontoxic, whereas every isolate of the remaining two groups is toxic. These phylogenetic groups were previously identified within the A. tamarense complex and given geographic designations that reflected the origins of known isolates. For at least two groups, the geographically based names are not indicative of the range occupied by members of each group. Therefore, we recommend a simple group‐numbering scheme for use until the taxonomy of this group is reevaluated and new species are proposed.
Biooptical characteristics of PSII and PSI in 33 species (13 pigment groups) of marine phytoplankton, and the relevance for pulse‐amplitude‐modulated and fast‐repetition‐rate fluorometry1
Authors: Johnsen Geir , Sakshaug Egil
Published: February 2008

We studied the variability of in vivo absorption coefficients and PSII‐scaled fluorescence excitation (fl‐ex) spectra of high light (HL) and low light (LL) acclimated cultures of 33 phytoplankton species that belonged to 13 different pigment groups (PGs) and 10 different phytoplankton classes. By scaling fl‐ex spectra to the corresponding absorption spectra by matching them in the 540–650 nm range, we obtained estimates for the fraction of total chl a that resided in PSII, the absorption of light by PSII, PSI, and photoprotective carotenoids. The in vivo red peak absorption maxima ranged from 673 to 679 nm, reflecting bonding of chl a to different pigment proteins. A simple approach is presented for quantifying intracellular self‐shading and evaluating the impact of photoacclimation on biooptical characteristics of the different PGs examined. In view of these results, parameters used in the calculation of oxygenic photosynthesis based on pulse‐amplitude‐modulated (PAM) and fast‐repetition‐rate (FRR) fluorometers are discussed, showing that the ratio between light available to PSII and total absorption, essential for the calculation of the oxygen release rate (using the PSII‐scaled fluorescence spectrum as a proxy) was dependent on species and photoacclimation state. Three subgroups of chromophytes exhibited 70%–80%, 60%–80%, and 50%–60% chl a in PSII‐LHCII; the two subgroups of chlorophytes, 70% or 80%; and cyanobacteria, only 12%. In contrast, the mean fraction for chromo‐ and chlorophytes of quanta absorbed by PSII was 73% in LL‐ and 55% in HL‐acclimated cells; thus, the corresponding ratios 0.55 and 0.73 might be used as correction factors adjusting for quanta absorbed by PSII for PAM and FRR measurements.
Evaluation of gene expression profiles of immature dendritic cells prepared from peripheral blood mononuclear cells
Authors: Shin Jeong Won , Jin Ping , Fan Yong , Slezak Stefanie , David‐Ocampo Virginia , Khuu Hanh M. , Read Elizabeth J. , Wang Ena , Marincola Francesco M. , Stroncek David F.
Published: February 2008

BACKGROUND: Dendritic cells (DCs) generated ex vivo from peripheral blood monocytes or mobilized CD34+ cells and intended for clinical immunotherapy are typically characterized by morphologic, phenotypic, and functional assays. Assay results are highly dependent on conditions used to prepare the cells, so there is no standard assay battery for clinical DC products. This study evaluated gene expression profiling for characterization of immature DCs prepared from monocytes that had been elutriated from normal donor peripheral blood mononuclear cells (PBMNCs) immediately after collection or after storage at 4°C for 48 hours.

STUDY DESIGN AND METHODS: RNA was isolated from fresh and 48‐hour‐stored PBMNCs, elutriated monocytes, elutriated lymphocytes, and immature DCs from five healthy subjects and was analyzed with a cDNA gene expression microarray with 17,500 genes.

RESULTS: Unsupervised hierarchical clustering separated the 40 products into four groups: one with all 10 immature DCs, one with all 10 elutriated lymphocytes, one with 7 PBMNCs, and one with 10 elutriated monocytes and 3 PBMNCs. Within each of the four groups, however, fresh and stored products, or products derived from fresh or stored products, clustered together. Comparison of genes differentially expressed by fresh versus stored products (paired t tests, p < 0.005) found 273 genes that differed between fresh and stored PBMCs, 429 between lymphocytes elutriated from fresh versus stored PBMNCs, 711 between monocytes elutriated from fresh versus stored PBMNCs, and 3 between immature DCs prepared from monocytes elutriated from fresh versus stored PBMCs.

CONCLUSIONS: This study demonstrates the potential utility of gene expression profiling for characterization of cell therapy products.
Arrhythmia Recurrence After Atrial Fibrillation Ablation: Can Magnetic Resonance Imaging Identify Gaps in Atrial Ablation Lines?
Authors: REDDY VIVEK Y. , SCHMIDT EHUD J. , HOLMVANG GODTFRED , FUNG MAGGIE
Published: February 2008

After pulmonary vein isolation for the treatment of atrial fibrillation, clinical arrhythmia recurrence is often a result of vein reconnection. By selectively visualizing scarred tissue, delayed enhancement magnetic resonance imaging may provide for a noninvasive means to identify gaps in radiofrequency ablation lines. This report correlates three‐dimensional magnetic resonance imaging with invasive electroanatomical mapping in a patient with recurrent atrial arrhythmia after multiple unsuccessful ablations for atrial fibrillation.
The Primary Arrhythmia Syndromes: Same Mutation, Different Manifestations. Are We Starting to Understand Why?
Authors: SCICLUNA BRENDON P. , WILDE ARTHUR W. , BEZZINA CONNIE R.
Published: February 2008

The discovery of pathogenic mutations primarily in genes encoding cardiac ion‐channel proteins underlying the primary cardiac arrhythmia syndromes has had a remarkable impact on the management of these disorders, especially in patients with the long‐QT syndrome. The availability of a genetic diagnostic test has added an important diagnostic tool, providing new opportunities for patient management such as early (presymptomatic) identification and treatment of patients at risk of developing fatal arrhythmias, risk stratification, and installation of gene‐specific therapy. However, the fact that the identification of the causal mutation within a family allows diagnosis in other family members independently from the ECG features and arrhythmic manifestations quickly led to the recognition that extensive variability in clinical manifestations (e.g., extent of ECG abnormality and/or symptomatology) may be observed among family members carrying an identical mutation in a single ion channel gene. It is commonly held that this clinical variability stems from interactions between environmental and genetic modifiers with the particular pathogenic mutation. This Molecular Perspectives article reviews current knowledge on these modifiers of disease expression in the cardiac arrhythmia syndromes with particular reference to genetic modifiers.
Effects of Wall Stress on the Dynamics of Ventricular Fibrillation: A Simulation Study Using a Dynamic Mechanoelectric Model of Ventricular Tissue
Authors: HIRABAYASHI SATOKO , INAGAKI MASASHI , HISADA TOSHIAKI
Published: February 2008

Introduction: To investigate the mechanisms underlying the increased prevalence of ventricular fibrillation (VF) in the mechanically compromised heart, we developed a fully coupled electromechanical model of the human ventricular myocardium.

Methods and Results: The model formulated the biophysics of specific ionic currents, excitation–contraction coupling, anisotropic nonlinear deformation of the myocardium, and mechanoelectric feedback (MEF) through stretch‐activated channels. Our model suggests that sustained stretches shorten the action potential duration (APD) and flatten the electrical restitution curve, whereas stretches applied at the wavefront prolong the APD. Using this model, we examined the effects of mechanical stresses on the dynamics of spiral reentry. The strain distribution during spiral reentry was complex, and a high strain‐gradient region was located in the core of the spiral wave. The wavefront around the core was highly stretched, even at lower pressures, resulting in prolongation of the APD and extension of the refractory area in the wavetail. As the left ventricular pressure increased, the stretched area became wider and the refractory area was further extended. The extended refractory area in the wavetail facilitated the wave breakup and meandering of tips through interactions between the wavefront and wavetail.

Conclusions: This simulation study indicates that mechanical loading promotes meandering and wave breaks of spiral reentry through MEF. Mechanical loading under pathological conditions may contribute to the maintenance of VF through these mechanisms.
Long‐Term Outcome Following Successful Pulmonary Vein Isolation: Pattern and Prediction of Very Late Recurrence
Authors: SHAH ARTI N. , MITTAL SUNEET , SICHROVSKY TINA C. , COTIGA DELIA , ARSHAD AYSHA , MALEKI KATANEH , PIERCE WALTER J. , STEINBERG JONATHAN S.
Published: February 2008

Background: Despite encouraging results of pulmonary vein isolation (PVI) ablation for atrial fibrillation (AF), it is unclear whether there is genuine cure or there is an important attrition rate. We sought to determine the long‐term outcome of the initial responders who experienced a prolonged AF‐free complete response.

Methods: From a series of 350 consecutive patients who underwent PVI for AF, 264 patients (75%) (males 71%, age 57 ± 12 years, paroxysmal AF 87%) who demonstrated ≥1 year AF‐free follow‐up on no antiarrhythmic drugs were followed for 1–5 years.

Results: During 28 ± 12 months follow‐up, 23 of 264 (8.7%) patients had recurrence of AF. The actuarial recurrence at 2 years postablation was 5.8% and increased to 25.5% at 5 years. Compared with long‐term responders, more patients with late recurrence had hypertension (HR = 2.18, P = 0.009) and hyperlipidemia (HR = 4.01, P = 0.0005). Among 18 patients with recurrent AF necessitating repeat PVI, 15 (83%) required re‐isolation of > 1 PV and 28 of 45 (58%) PVs showed reconnection. All PVs were re‐isolated and five (28%) patients had additional linear ablation. All 15 patients became AF‐free again.

Conclusions: Although most patients following PVI remain AF‐free, some patients develop “late” recurrence of AF. The “late” recurrence patients are more likely to have hypertension and hyperlipidemia. Most late recurrences are associated with PV reconnections. Our observations emphasize the importance of continued long‐term vigilance for AF recurrence, and also raise concerns regarding the need for long‐term anticoagulation therapy.
Validation of a New Noninvasive Device for the Monitoring of Peak Endocardial Acceleration in Pigs: Implications for Optimization of Pacing Site and Configuration
Authors: BORDACHAR PIERRE , LABROUSSE LOUIS , PLOUX SYLVAIN , THAMBO JEAN‐BENOIT , LAFITTE STEPHANE , REANT PATRICIA , JAIS PIERRE , HAISSAGUERRE MICHEL , CLEMENTY JACQUES , SANTOS PIERRE DOS
Published: February 2008

Introduction: The peak of endocardial acceleration (PEA) is an index of myocardial contractility. We aimed to (1) demonstrate that the PEA measured by the noninvasive cutaneous precordial application of an accelerometer sensor is related to left ventricular (LV) dP/dt max and (2) assess the usefulness of PEA monitoring during graded ischemia and during different configurations of sequential biventricular pacing.

Methods and Results: Measurements of invasive LV dP/dt max were compared with measurements of transcutaneous PEA in seven pigs at baseline and during acute drug infusions; increased heart rate; right, left, biventricular and sequential biventricular pacing before and after graded ischemia induced by the constriction of the left anterior descending coronary artery. A consistent PEA signal was obtained in all animals. PEA changes were highly related to LV dP/dt max changes (r= 0.93; P < 0.001). The changes of LV contractility induced by the different pacing configurations were detected by PEA analysis in the absence of ischemia (r= 0.94; P < 0.001) and in the presence of ischemic LV dysfunction (r= 0.91; P < 0.001).

Conclusion: Noninvasive PEA measurement allows monitoring of left ventricular contractility and may be a useful tool to detect global effect of ventricular ischemia and to optimize the choice of both pacing site and pacing configuration.
Imaging the Ascending Aorta and Aortic Arch Using Transesophageal Echocardiography: The Expanded Aortic View
Authors: Mahajan Aman , Crowley Ryan , Ho Jonathan K. , Sanchez Elizabeth , Trivedi Puja , Natterson Barbara , Shivkumar Kalyanam
Published: February 2008

Transesophageal echocardiography (TEE) imaging of the aorta requires multiple views and is limited by its inability to visualize the distal ascending aorta and proximal aortic arch (“blind spot”). Recent advances in ultrasound technology allow improved imaging of cardiac structures. In this study we describe the ability to image the aortic valve, entire ascending aorta, and aortic arch in one view, the “expanded aortic view” obtained from a novel proximal transgastric window. In 22 patients, an expanded aortic view was acquired with the transducer positioned in a proximal transgastric position using new generation ultrasound system with a TEE probe that incorporates increased range of mobility. Fluoroscopy imaging was performed to confirm the position of transducer in relation to the cardiac anatomy. In 7 of 22 patients, the ability to achieve this view was also tested using an older echocardiography system. The novel proximal transgastric plane allowed reliable images of the aortic valve, ascending aorta including the “blind spot,” and aortic arch in a single view–the expanded aortic view.
Current Issues with Emergency Cardiac Ultrasound Probe and Image Conventions
Authors: Moore Chris
Published: February 2008

As emergency physicians (EPs) and other noncardiologists incorporate bedside ultrasound (US) and bedside echocardiography (echo) into their practice, confusion has resulted from the differing imaging conventions used by cardiac and general imaging. The author discusses the origin of these differences, current cardiac imaging conventions, and controversies in emergency medicine (EM) regarding adoption of imaging conventions. Also discussed in detail are specific echo windows and experience with different approaches. While there is no perfect solution to merging the differing conventions, it is important that those performing and teaching bedside US and echo have a thorough understanding of the issues involved, and adopt a consistent approach.
Geographic variation in host‐selection behaviour in the Drosophila parasitoid Leptopilina clavipes
Authors: Pannebakker B. A. , Garrido N. R. T. , Zwaan B. J. , Van Alphen J. J. M.
Published: February 2008

In parasitoid wasps, the process of locating and selecting suitable oviposition sites is under strong selection due to the direct linkage of successful host selection and female fitness. Leptopilina clavipes Hartig (Hymenoptera: Figitidae) is a parasitoid wasp of larvae of several Drosophila species that occurs over Western Europe, where it shows genetic differentiation between populations from northern and southern Europe. It is expected to experience differential selection pressures on both physiological (survival) and behavioural (host selection) components of foraging, because it occurs over a broad geographic range. We investigated whether the genetic differentiation in L. clavipes is linked to differentiation in both the physiological and behavioural components of foraging. We compared survival and host‐selection behaviour of two L. clavipes strains, one originating from northwestern Europe and one from southern Europe. In a series of choice experiments, females were offered pairs of larvae from three host species that are present in both regions, but use different breeding substrates: Drosophila phalerata Meigen (fungi), Drosophila subobscura Collin (rotting plant material, fungi, and fermenting fruits), and Drosophila melanogaster Meigen (fermenting fruits) (all Diptera: Drosophilidae). Survival patterns across the three host species were similar for both L. clavipes strains. Host‐selection behaviour did differ, where parasitoids from southern Europe accepted all hosts offered, while parasitoids from northwestern Europe were more specialists and accepted hosts breeding in fungi, but were reluctant towards D. melanogaster. This differentiation in host‐selection behaviour reflects the genetic differentiation present in European L. clavipes and shows adaptation to local differences in host communities.
Host‐feeding of three parasitoid species on Bemisia tabaci biotype B and implications for whitefly biological control
Authors: Zang Lian‐Sheng , Liu Tong‐Xian
Published: February 2008

Parasitoids in the genera Encarsia and Eretmocerus (Hymenoptera: Aphelinidae) are important biological control agents of whiteflies through their reproductive as well as host‐feeding activities. The feeding capacities of female parasitoids of three species with different reproductive strategies [Encarsia sophia (Girault & Dodd), Encarsia formosa Gahan, and Eretmocerus melanoscutus Zolnerowich & Rose] on their host, sweetpotato whitefly, Bemisia tabaci (Gennadius) biotype B (Homoptera: Aleyrodidae), were evaluated on cabbage in a single‐instar no‐choice experiment in the laboratory and a mixed‐instar choice experiment in the greenhouse. In both single‐ and mixed‐instar experiments, significant differences in host‐feeding capacities were found among the three parasitoid species. Encarsia sophia exhibited superior capacity of host‐feeding compared to E. formosa and E. melanoscutus. In the single‐instar experiment, parasitoids fed more on younger (smaller) hosts than older (larger) hosts. In the mixed‐instar experiments, all three parasitoid species exhibited a clear preference for feeding on older hosts compared to younger hosts. Total number of whitefly nymphs fed on by E. sophia was approximately three times that of the other two parasitoid species. Whitefly mortality accounted for by host‐feeding by E. sophia was up to 59.7%, and, thus, equivalent to parasitization. The significance of host‐feeding of E. sophia for biological control of B. tabaci is discussed.
Caspase‐related apoptosis in chronic ischaemic microangiopathy following experimental vein occlusion in mini‐pigs
Authors: Donati Guy , Kapetanios Anastasios , Dubois‐Dauphin Michel , Pournaras Constantin Jean
Published: February 2008

Purpose:  Acute brain ischaemia (stroke) causes a central area of coagulation necrosis. Peripheral to it and after a few hours, apoptosis causes neurons throughout the entire area to die progressively. However, this sequence of events is related to the reperfusion of regenerated capillaries or collateral circulation, and is considered to be potentially salvageable. Similar findings have been reported in the retina after ischaemia−reperfusion injury in rats. In the present study, we intended to investigate whether delayed cell death is involved in neuronal injuries to the inner retina during chronic retinal ischaemia.

Methods:  Experimental branch retinal vein occlusion (BRVO) was induced in miniature pigs using indirect argon laser. The eyes were prelevated at 4, 24 and 48 hours and at 1 and 3 weeks following BRVO. The caspase inhibitor Z‐VAD was injected intravitreally 24 hours after BRVO. Affected retinas were examined 24 hours later for any protective effect from apoptotic cell death. Histological examination with cresyl violet staining and TUNEL (TdT‐mediated dUTP−biotin nick‐end labelling) was performed on the samples.

Results:  A progressive oedema of the nerve fibre, ganglion cell and inner plexiform layers, related to a widely diffused cell necrosis, was observed in the affected territory within 4–24 hours after BRVO. This was followed by a wave of apoptosis localized at the periphery of the affected territory, which peaked approximately 48 hours after BRVO and was associated with a diffuse oedema of the inner nuclear layer. A progressive atrophy of the inner retina was observed 1–3 weeks after BRVO. Injection of the caspase inhibitor Z‐VAD (24 hours after BRVO) decreased the amount of apoptotic cell bodies 48 hours after BRVO.

Conclusions:  This study shows that although necrosis is the predominant form of neuronal death in the early phase, massive delayed neuronal cell death caused by apoptosis occurs on a widespread basis as a result of chronic ischaemia after BRVO in the retina. Further studies are needed to evaluate the possibility of rescuing retinal neurons from death by neuroprotective treatments.
Influence of skin peeling procedure in allergic contact dermatitis
Authors: Kim Jung Eun , Park Hyun Jeong , Cho Baik Kee , Lee Jun Young
Published: February 2008

Background:  The prevalence of allergic contact dermatitis in patients who have previously undergone skin peeling has been rarely studied.

Objectives:  We compared the frequency of positive patch test (PT) reactions in a patient group with a history of peeling, to that of a control group with no history of peeling.

Patients/Methods:  The Korean standard series and cosmetic series were performed on a total of 262 patients. 62 patients had previously undergone peeling and 200 patients did not.

Results:  The frequency of positive PT reactions on Korean standard series was significantly higher in the peeling group compared with that of the control group (P < 0.05, chi‐square test). However, the most commonly identified allergens were mostly cosmetic‐unrelated allergens. The frequency of positive PT reactions on cosmetic series in the peeling group was higher than that of the control group, but lacked statistical significance. The frequency (%) of positive PT reactions on cosmetic series in the high‐frequency peel group was higher than that of the low‐frequency group, but lacked statistical significance.

Conclusion:  It appears peeling may not generally affect the development of contact sensitization. Further work is required focusing on the large‐scale prospective studies by performing a PT before and after peeling.
Recommendation to include fragrance mix 2 and hydroxyisohexyl 3‐cyclohexene carboxaldehyde (Lyral®) in the European baseline patch test series
Authors: Bruze Magnus , Andersen Klaus Ejner , Goossens An ,   on behalf of the ESCD and EECDRG
Published: February 2008

Background:  The currently used fragrance mix in the European baseline patch test series (baseline series) fails to detect a substantial number of clinically relevant fragrance allergies.

Objective:  To investigate whether it is justified to include hydroxyisohexyl 3‐cyclohexene carboxaldehyde (Lyral®) and fragrance mix 2 containing hydroxyisohexyl 3‐cyclohexene carboxaldehyde, citral, farnesol, coumarin, citronellol, and α‐hexyl cinnamal in the European baseline patch test series.

Methods:  Survey of the literature on reported frequencies of contact allergy and allergic contact dermatitis from fragrance mix 2 and hydroxyisohexyl 3‐cyclohexene carboxaldehyde (Lyral) as well as reported results of experimental provocation test.

Results:  Fragrance mix 2 has been demonstrated to be a useful additional marker of fragrance allergy with contact allergy rates up to 5% when included in various national baseline patch test series. Of the fragrance substances present in fragrance mix 2, hydroxyisohexyl 3‐cyclohexene carboxaldehyde is the most common sensitizer. Contact allergy rates between 1.5% and 3% have been reported for hydroxyisohexyl 3‐cyclohexene carboxaldehyde in petrolatum (pet.) at 5% from various European centres when tested in consecutive dermatitis patients.

Conclusions:  From 2008, pet. preparations of fragrance mix 2 at 14% w/w (5.6 mg/cm2) and hydroxyisohexyl 3‐cyclohexene carboxaldehyde at 5% w/w (2.0 mg/cm2) are recommended for inclusion in the baseline series. With the Finn Chamber® technique, a dose of 20 mg pet. preparation is recommended. Whenever there is a positive reaction to fragrance mix 2, additional patch testing with the 6 ingredients, 5 if there are simultaneous positive reactions to hydroxyisohexyl 3‐cyclohexene carboxaldehyde and fragrance mix 2, is recommended.
Cytogenetic studies at diagnosis in polycythemia vera: clinical and JAK2V617F allele burden correlates
Authors: Gangat Naseema , Strand Jacob , Lasho Terra L. , Finke Christy M. , Knudson Ryan A. , Pardanani Animesh , Li Chin‐Yang , Ketterling Rhett P. , Tefferi Ayalew
Published: February 2008

The prognostic significance of cytogenetic findings at diagnosis in polycythemia vera (PV) was investigated in a retrospective series of 137 patients. Cytogenetics were normal in 117 patients (85%) and displayed a −Y abnormality in five patients (7% of male patients), and other chromosomal abnormalities in 15 patients (11%). The most frequent cytogenetic anomalies were trisomy 8 (n = 4), trisomy 9 (n = 2), deletion 20q (n = 2) and chromosomal 1 abnormalities (n = 2). Parameters that were significantly associated with abnormal cytogenetics included age ≥60 yr (P = 0.02), but not JAK2V617F allele burden, thrombosis, hemorrhage, leukemic/fibrotic transformation, or survival. We conclude that cytogenetic anomalies occur infrequently at PV diagnosis and do not confer an adverse outcome.