bluuebunny/crossref_metadata_2025 huggingface dataset:
Ore Genesis of the Kalatongke Cu–Ni Sulfide Deposits, Western China: Constraints from Volatile Chemical and Carbon Isotopic Compositions
Authors: Piaoer FU , Qingyan TANG , Mingjie ZHANG , Zhaowei ZHANG , Liwu LI , Wenyuan LI
Published: July 2012

The Kalatongke Cu–Ni sulfide deposits located in the East Junggar terrane, northern Xinjiang, western China are the largest magmatic sulfide deposits in the Central Asian Orogenic Belt (CAOB). The chemical and carbon isotopic compositions of the volatiles trapped in olivine, pyroxene and sulfide mineral separates were analyzed by vacuum stepwise‐heating mass spectrometry. The results show that the released volatiles are concentrated at three temperature intervals of 200–400°C, 400–900°C and 900–1200°C. The released volatiles from silicate mineral separates at 400–900°C and 900–1200°C have similar chemical and carbon isotopic compositions, which are mainly composed of H2O (av. ∼92 mol%) with minor H2, CO2, H2S and SO2, and they are likely associated with the ore‐forming magmatic volatiles. Light δ13CCO2 values (from –20.86‰ to –12.85‰) of pyroxene indicate crustal contamination occurred prior to or synchronous with pyroxene crystallization of mantle‐derived ore‐forming magma. The elevated contents of H2 and H2O in the olivine and pyroxene suggest a deep mantle‐originated ore‐forming volatile mixed with aqueous volatiles from recycled subducted slab. High contents of CO2 in the ore‐forming magma volatiles led to an increase in oxygen fugacity, and thereby reduced the solubility of sulfur in the magma, then triggered sulfur saturation followed by sulfide melt segregation; CO2 contents correlated with Cu contents in the whole rocks suggest that a supercritical state of CO2 in the ore‐forming magma system under high temperature and pressure conditions might play a key role in the assemblage of huge Cu and Ni elements. The volatiles released from constituent minerals of intrusion 1* have more CO2 and SO2 oxidized gases, higher CO2/CH4 and SO2/H2S ratios and lighter δ13CCO2 than those of intrusions 2# and 3#. This combination suggests that the higher oxidation state of the volatiles in intrusion 1# than intrusions 2# and 3#, which could be one of key ore‐forming factors for large amounts of ores and high contents of Cu and Ni in intrusion 1#. The volatiles released at 200–400°C are dominated by H2O with minor CO2, N2+CO and SO2, with δ13CCO2, values (–25.66‰ to –22.98‰) within the crustal ranges, and are considered to be related to secondary tectonic– hydrothermal activities.
Geology and Geochemistry of the Bianbianshan Au‐Ag‐Cu‐Pb‐Zn Deposit, Southern Da Hinggan Mountains, Northeastern China
Authors: Qingdong ZENG , Jianming LIU , Hongtao LIU
Published: July 2012

The Bianbianshan deposit, the unique gold‐polymetal (Au‐Ag‐Cu‐Pb‐Zn) veined deposit of the polymetal metallogenic belt of the southern segment of Da Hinggan Mountains mineral province, is located at the southern part of the Hercynian fold belt of the south segment of Da Hinggan Mountains mineral province, NE China. Ores at the Bianbianshan deposit occur within Cretaceous andesite and rhyolite in the form of gold‐bearing quartz veins and veinlet groups containing native gold, electrum, pyrite, chalcopyrite, galena and sphalerite. The deposit is hosted by structurally controlled faults associated with intense hydrothermal alteration. The typical alteration assemblage is sericite + chlorite + calcite + quartz, with an inner pyrite – sericite – quartz zone and an outer seicite – chlorite – calcite – epidote zone between orebodies and wall rocks. δ34 S values of 17 sulfides from ores changing from –1.67 to +0.49‰ with average of –0.49‰, are similar to δ34 S values of magmatic or igneous sulfide sulfur. 206Pb/204Pb, 207Pb/204Pb and 208Pb/204Pb data of sulfide from ores range within 17.66–17.75, 15.50–15.60, and 37.64–38.00, respectively. These sulfur and lead isotope compositions imply that ore‐forming materials might mainly originate from deep sources. H and O isotope study of quartz from ore‐bearing veins indicate a mixed source of deep‐seated magmatic water and shallower meteoric water. The ore formations resulted from a combination of hydrothermal fluid mixing and a structural setting favoring gold‐polymetal deposition. Fluid mixing was possibly the key factor resulting in Au‐Ag‐Cu‐Pb‐Zn deposition in the deposit. The metallogenesis of the Bianbianshan deposit may have a relationship with the Cretaceous volcanic‐subvolcanic magmatic activity, and formed during the late stage of the crust thinning of North China.
Geophysical‐Geological Interpretation and Deep‐Seated Gold Deposit Prospecting in Sanshandong‐Jiaojia Area, Eastern Shandong Province, China
Authors: Mingchun SONG , Guopu WAN , Chunguo CAO , Chunyan HE
Published: July 2012

Integrated gravitational, electrical‐magnetic surveys and data processing carried out in the Sanshandao–Jiaojia area, Eastern Shandong Province, northeast China, aim to illuminate the geological characteristics of this shallow‐covered area and delineate deep‐seated gold prospecting targets. In this region, altogether 12 faults exert critical control on distribution of three types of Early Precambrian metamorphic rock series, i.e. those in the metamorphic rock area, in the granitic rock area underlying the metamorphic rock, and in the remnant metamorphic rock area in granites, respectively. Additionally, the faults have major effects on distribution of four Mesozoic Linglong rock bodies of granite, i.e. the Cangshang, Liangguo, Zhuqiao‐Miaojia and Jincheng granites. The Sanshandao and Jiaojia Faults are two well‐known regional ore‐controlling faults; they have opposite dip direction, and intersect at a depth of 4500 m. Fracture alteration zones have striking geophysical differences relative to the surrounding county rocks. The two faults extend down along dip direction in a gentle wave form, and appear at some steps with different dips. These steps comprise favorable gold prospecting areas, consistent with a step metallogenic model. Six deep‐seated gold‐prospecting targets are delineated, i.e. Jincheng‐Qianchenjia, Xiaoxizhuang‐Zhaoxian, Xiyou‐Wujiazhuangzi, Xiangyangling‐Xinlicun, Panjiawuzi and Miaojia‐Pinglidian.
Geological Characteristics and Ore‐forming Time of the Dexing Porphyry Copper Ore Mine in Jiangxi Province
Authors: Shuo GUO , Yuanyi ZHAO , Huanchun QU , Dexin WU , Hong XU , Chao LI , Yan LIU , Xiaoyun ZHU , Zengke WANG
Published: July 2012

The Dexing porphyry copper ore mine is located in the Qin‐Hang metallogenic belt between the Yangtze block and the Cathaysia block. It is a giant porphyry copper mine in China, including 3 ore districts: Tongchang, Fujiawu and Zhushahong. Our analyses of Re in molybdenite indicate that the ore‐forming material of the copper ore deposits in Dexing should be mainly mantle‐derived. Our study fills in a gap in the study of formation time of the Dexing copper mine, and further proves that the copper ore deposits in the three ore districts should be formed simultaneously, about 170 Ma, belonging to the early Yanshan period, and that the formation time of the copper ore deposits should be consistent with the formation time of granodiorite porphyry in which the copper ore deposits are hosted. Promising areas for seeking porphyry copper ore deposits is predicated to be the west or southwest of Dexing.
Late Mesozoic Ore‐forming Events in the Ningwu Ore District, Middle‐Lower Yangtze River Polymetallic Ore Belt, East China: Evidence from Zircon U‐Pb Geochronology and Hf Isotopic Compositions of the Granodioritic Stocks
Authors: Chao DUAN , Yanhe LI , Kejun HOU , Shunda YUAN , Jialin LIU , Cheng ZHANG
Published: July 2012

Late Mesozoic volcanic‐subvolcanic rocks and related iron deposits, known as porphyry iron deposits in China, are widespread in the Ningwu ore district (Cretaceous basin) of the middle—lower Yangtze River polymetallic ore belt, East China. Two types of Late Mesozoic magmatic rocks are exposed: one is dioritic rocks closely related to iron mineralization as the hosted rock, and the other one is granodioritic (‐granitic) rocks that cut the ore bodies. To understand the age of the iron mineralization and the ore‐forming event, detailed zircon U‐Pb dating and Hf isotope measurement were performed on granodioritic stocks in the Washan, Gaocun‐Nanshan, Dongshan and Heshangqiao iron deposits in the basin. Four emplacement and crystallization (typically for zircons) ages of granodioritic rocks were measured as 126.1±0.5 Ma, 126.8±0.5 Ma, 127.3±0.5 Ma and 126.3±0.4 Ma, respectively in these four deposits, with the LA‐MC‐ICP‐MS zircon U‐Pb method. Based on the above results combined with previous dating, it is inferred that the iron deposits in the Ningwu Cretaceous basin occurred in a very short period of 131–127 Ma. In situ zircon Hf compositions of εHf(t) of the granodiorite are mainly from –3 to –8 and their corresponding 176Hf/177Hf ratio are from 0.28245 to 0.28265, indicating similar characteristics of dioritic rocks in the basin. We infer that granodioritic rocks occurring in the Ningwu ore district have an original relationship with dioritic rocks. These new results provide significant evidence for further study of this ore district so as to understand the ore‐forming event in the study area.
Geochronology of the Gabbro–mafic Microgranular Enclaves–granite Associations in the Gejiu District, Yunnan Province and Their Geodynamic Significance
Authors: Yanbo CHENG , Jingwen MAO
Published: July 2012

Many igneous rocks distribute in Gejiu tin polymetallic ore‐field at Yunnan province, rocks including basalt, gabbro, mafic microgranular enclaves, granites (porphyritic granite and equigranular granite) and akaline rocks. The ages of the granites and akaline rocks which are considered to have genetic connecting with the mineralization have been comfirmed, but the gabbro‐mafic microgranular enclaves‐granite assemblage's ages are still unknown. By means of LA‐ICP‐MS zircon U‐Pb dating, the data of Shenxianshui equigranular granite, the mafic microgranular enclave in Jiasha area, the host rock of the mafic microgranular enclaves and the Jiasha gabbro are around ∼80 Ma. Besides the above mentioned data, a group of new ages at ∼30 Ma were discovered in this study, which is from gabbro and mafic microgranular enclaves. Based on the previous data and the new data gained this time, we suggest the major geochronology framework of the magmatism and mineralization events in Gejiu area is ∼80 Ma, which is consistent with the Late Cretaceous magmatism and mineralization events in the whole southeast Yunnan and west Guangxi area and they were suggested to belong to the same geotectonic setting in late Yenshannian. And the new ages of the ∼30 Ma obtained in this study is considered to represent a responding to the complicate tectonic evolution history of the Tibetan orogenic events in Cenozoic.
Hydrothermal Sedimentary Mineralization of the Super‐large Bamianshan Fluorite Deposit in Zhejiang Province, China
Authors: Yuchuan HAN , Xuehui XIA , Siyu PANG , Shaokang XU
Published: July 2012

The Bamianshan fluorite deposit is a super‐large one recently discovered in Zhejiang Province of China. This paper presents an analysis of its geological background, orebody and ore characteristics, petrochemical characteristics of host rocks, rare earth elements (REE) of rocks and ores, fluid inclusions in fluorite and Sm‐Nd isotopic features in an effort to study its sedimentary mineralization. The result shows that the super‐large Bamianshan fluorite deposit is of hydrothermal sedimentation genesis, deformed by the later hydrothermal fluid. Integrated with host rocks and orebody characteristics, it is inferred that the deposit originates from the Cambrian sedimentary rocks. And the later magmatic activities deformed some orebodies in different degrees, forming steeply dipping vein orebodies in the tectonic belts regionally.
Diabetes mellitus: A significant co‐morbidity in the setting of lung cancer?
Authors: Washington Iman , Chino Junzo P. , Marks Lawrence B. , D'Amico Thomas A. , Berry Mark F. , Ready Neal E. , Higgins Kristin A. , Yoo David S. , Kelsey Chris R.
Published: July 2012

Background:  To evaluate the effect of diabetes mellitus (DM) on clinical outcomes in patients managed surgically for non‐small cell lung cancer (NSCLC).

Methods:  Patients who underwent surgery for pathological I‐IIIA NSCLC at Duke University from 1995–2005 were analyzed. Postoperative mortality was defined as any death occurring within 30 days of resection or during the initial hospitalization after surgery. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was considered a local/regional recurrence (LRR). Survival and LRR rates were estimated using the Kaplan‐Meier method and compared using a log rank test. A multivariate regression analysis assessed the association between candidate factors, including DM, and disease recurrence and survival.

Results:  Of 957 patients, DM was present in 122 (13%). DM was associated with an increased risk of postoperative mortality (7.4% vs. 3.2%, P= 0.04). However, the proportion of patients undergoing sublobar resections, mediastinal lymph node dissection, and receiving adjuvant chemotherapy, was no different among patients with or without DM. Five‐year LRR rates were 27% in patients with DM, versus 21% in patients without DM (P= 0.23). Survival at five years was 43% for patients with DM, and 47% for patients without DM (P= 0.10). On multivariate analysis, DM was not independently associated with a higher risk of LRR (hazard ratio [HR] 1.33, P= 0.34), distant recurrence (HR 0.86, P= 0.58), or overall survival (HR 1.08, P= 0.63).

Conclusions:  Although a higher risk of postoperative mortality was noted in patients with DM, a detriment in local or distant disease control or overall survival was not observed.
Intranasal delivery of insulin via the olfactory nerve pathway
Authors: Renner Dan B , Svitak Aleta L , Gallus Nathan J , Ericson Marna E , Frey William H , Hanson Leah R
Published: July 2012

Objectives

Intranasal delivery has been shown to target peptide therapeutics to the central nervous system (CNS) of animal models and induce specific neurological responses. In an investigation into the pathways by which intranasal administration delivers insulin to the CNS, this study has focused on the direct delivery of insulin from the olfactory mucosa to the olfactory bulbs via the olfactory nerve pathway.

Methods

Nasal and olfactory tissues of mice were imaged with fluorescent and electron microscopy 30 min following intranasal administration.

Key findings

Macroscopic analysis confirmed delivery to the anterior regions of the olfactory bulbs. Confocal microscopy captured delivery along the olfactory nerve bundles exiting the nasal mucosa, traversing the cribriform plate and entering the bulbs. With electron microscopy, insulin was found within cells of the olfactory nerve layer and glomerular layer of the olfactory bulbs.

Conclusions

These results demonstrated that intranasal administration of labelled insulin targeted the CNS through the olfactory nerve pathway in mice.
Isolation, modification and cytotoxic evaluation of flavonoids from Rhododendron hainanense
Authors: Zhao Jie , Ding Huan-Xing , Zhao Deng-Gao , Wang Chun-Ming , Gao Kun
Published: July 2012

Objectives

The aim of this study was to search for antitumour activity of flavonoid compounds. The cytotoxic activity of these compounds in vitro was evaluated against the human leukaemia (HL-60) and human hepatoma (SMMC-7721) cell lines.

Methods

Eight natural flavonoids (1–8) were isolated from the aerial parts of Rhododendron hainanense and a series of modified flavonoid derivatives (9–18) were obtained from the natural product matteucinol (1), using simple synthetic methods. Antitumour inhibitory activity of these flavonoids was assessed using the sulforhodamine B method.

Key findings

Most of the compounds exhibited good pharmacological activity and the preliminary structure–activity relationships were described. Within the series of flavonoid derivatives in this study, compounds 3 (2,3-dihydro-5-hydroxy-7-methoxy-2-(4-methoxyphenyl)-6,8-dimethyl-4H-1-benzopyran-4-one) and 16 (5-hydroxy-7, 4′-dimethoxy-6, 8-dimethylflavan) exhibited strong inhibitory activity against the HL-60 cell line with IC50 values (the drug concentration that resulted in a 50% reduction in cell viability or inhibition of the biological activity) of 15.2 and 13.2 µm, respectively.

Conclusions

Renewed attention to flavonoid derivatives revealed the possibility that compounds 3 and 16 could be considered as lead compounds for the development of new antitumour agents. Our results have not only enriched the family of active flavonoids from natural sources, but have encouraged the synthesis of flavonoid analogues for improving cytotoxic activity.
Role of fetuin-A in atherosclerosis associated with diabetic patients
Authors: Singh Monika , Sharma Pramod Kumar , Garg Vipin Kumar , Mondal Shambhu Charan , Singh Avnesh Kumar , Kumar Nikhlesh
Published: July 2012

Objectives

Fetuin-A is a circulating glycoprotein, formed in the liver. It regulates bone remodelling and calcium metabolism. Fetuin-A has adipogenic properties, so fat accumulation in the liver may be associated with higher levels of fetuin-A. Fetuin-A is an inhibitor of the phosphorylation of the insulin receptor tyrosine kinase.

Key findings

High concentrations of fetuin-A in humans causes insulin resistance. Insulin sensitivity is also found to be increased in fetuin-A knockout mice. Fetuin-A has been shown to cause insulin resistivity in type-2 diabetes mellitus and worsens the pro-atherogenic milieu.

Fetuin-A should be considered as a hepatic bio-marker. Vascular diseases like atherosclerosis are major causes of disability in patients with diabetes mellitus.
Paying Patients for Their Tissue: The Legacy of Henrietta Lacks
Authors: Truog Robert D. , Kesselheim Aaron S. , Joffe Steven
Published: July 2012

The intuition that tissue donors are owed financial compensation is mistaken as a matter of policy and ethics.
Network Interventions
Authors: Valente Thomas W.
Published: July 2012

Network, Network, Network

The fact that our interactions with others influence many of our decisions has led to research on characterizing the networks to which we belong and, more recently, on interventions that can change networks thereby changing behavior. This can have a variety of purposes, including promoting information flow through an organization or finding vulnerable points in bioterrorist networks.
Valente
(p.
49
) reviews a variety of strategies for affecting networks.
Eddy-Driven Stratification Initiates North Atlantic Spring Phytoplankton Blooms
Authors: Mahadevan Amala , D’Asaro Eric , Lee Craig , Perry Mary Jane
Published: July 2012

Early Bloom Trigger

Springtime phytoplankton blooms occur when high nutrient concentrations are combined with abundant sunlight and a stratified upper ocean layer. It has been thought that stratification occurs because in the spring, seasonal warming causes the water to expand, making it less dense, which creates a layer resistant to mixing from below. Now,

Mahadevan
et al.

(p.
54
; see the Perspective by

Martin

) have combined observations of the upper water column from the subpolar North Atlantic with ocean model simulations, which demonstrate that the initial stratification can be triggered by the dynamic effects of passing ocean eddies. These eddies can advance the time of the bloom by 20 to 30 days.
Cavity Cooling Below the Recoil Limit
Authors: Wolke Matthias , Klinner Julian , Keßler Hans , Hemmerich Andreas
Published: July 2012

Mr. Cool

Laser cooling of atoms relies on the presence of electronic transitions of specific structure, making it practical for a limited number of atomic species at relatively low densities. Alternative methods include those involving optical cavities, where atom-cavity interaction enables cooling without the need for resonant transitions.

Wolke
et al.

(p.
75
) present such a cooling scheme that was used to heat and then cool a Bose-Einstein condensate of Rb atoms. The method should be applicable to hotter samples where a sequence of laser pulses of different frequencies would need to be used.
Large Volcanic Aerosol Load in the Stratosphere Linked to Asian Monsoon Transport
Authors: Bourassa Adam E. , Robock Alan , Randel William J. , Deshler Terry , Rieger Landon A. , Lloyd Nicholas D. , Llewellyn E. J. (Ted) , Degenstein Douglas A.
Published: July 2012

Indirect Injection

Aerosols in the stratosphere, especially submicron-hydrated sulfuric acid droplets, are an important factor influencing climate variability. Stratospheric sulfate aerosols can form from sulfur dioxide that has been transported from the underlying troposphere. Large volcanic eruptions can inject sulfur dioxide and other material into the stratosphere, but smaller volcanoes have been thought not to be energetic enough to do so.

Bourassa
et al.

(p.
78
) used satellite data to show that sulfur dioxide from the 2011 eruption of the Nabro stratovolcano in Eritrea was lofted into the stratosphere by deep convection associated with the Asian summer monsoon.
A Distinct Role of the Temporal-Parietal Junction in Predicting Socially Guided Decisions
Authors: Carter R. McKell , Bowling Daniel L. , Reeck Crystal , Huettel Scott A.
Published: July 2012

You Must Be Human

Are there specific brain structures associated with social cognition or with aspects of information processing that frequently occur together with social cognition?

Carter
et al.

(p.
109
) invited subjects to play a simplified virtual poker game against either a human or a computer and examined brain scans collected during the game. The brains scans when the cards shown were used to predict the participant's decision 6 seconds later. Activity in one region, the temporal-parietal junction, was one of the best predictors of future decisions against a human opponent, but the single worst predictor against a computer opponent.
Looking to Learn

Histories of Scientific Observation
Lorraine Daston and Elizabeth Lunbeck, Eds.

University of Chicago Press, Chicago, 2011. 472 pp. $75, £48.50. ISBN 9780226136776. Paper, $27.50, £18. ISBN 9780226136783.
Authors: Nappi Carla
Published: July 2012

Using a series of case studies, the authors consider scientific observation as practice and as epistemic category.
Comment on “Impacts of the Cretaceous Terrestrial Revolution and KPg Extinction on Mammal Diversification”
Authors: Bininda-Emonds Olaf R. P. , Purvis Andy
Published: July 2012

Meredith
et al
. (Reports, 28 October 2011, p. 521) question three findings of our delayed-rise hypothesis for present-day mammals made with reference to the Cretaceous-Paleogene (KPg) boundary, based on their new time tree of the group. We show that their own data do not support their objections and that the macroevolutionary patterns from the respective phylogenies are not statistically different.
Response to Comment on “Impacts of the Cretaceous Terrestrial Revolution and KPg Extinction on Mammal Diversification”
Authors: Murphy William J. , Janecka Jan E. , Stadler Tanja , Eizirik Eduardo , Ryder Oliver A. , Gatesy John , Meredith Robert W. , Springer Mark S.
Published: July 2012

Bininda-Emonds and Purvis reanalyzed our mammalian phylogenetic supermatrix and claim that our results are not significantly different from their delayed-rise hypothesis. We show that our divergence times are ~11 million years later for placental inter- and intraordinal divergences—consistent with a post–Cretaceous-Paleogene (KPg) radiation of most modern mammalian orders—and find no support for the early Eocene delayed-rise hypothesis.
Heralded Entanglement Between Widely Separated Atoms
Authors: Hofmann Julian , Krug Michael , Ortegel Norbert , Gérard Lea , Weber Markus , Rosenfeld Wenjamin , Weinfurter Harald
Published: July 2012

Entanglement On Cue

Quantum entanglement between particles lies at the core of quantum mechanics. For practical applications such as long-distance quantum communications, cryptography, and quantum networks, entanglement must be heralded. That is, a signal flags the existence of the entangled state so that it can be manipulated and transferred.

Hofmann
et al.

(p.
72
; see the Perspective by

Volz and Rauschenbeutel

) excited trapped single atoms in different laboratory rooms 20 meters apart and were able to show that manipulation, interference, and detection of the photons from the excited atoms could signal when the atoms are entangled. The extent of the observed entanglement may be sufficient to start to probe fundamental questions relating to the entanglement process and thus address the foundations of quantum mechanics.
Interferometric Identification of a Pre–Brown Dwarf
Authors: André Philippe , Ward-Thompson Derek , Greaves Jane
Published: July 2012

A Dwarf in the Making

It is a mystery how brown dwarfs, which have masses in between those of planets and stars, form. Based on observations with the Institut de Radioastronomie Millimétrique Plateau de Bure Interferometer, located in the French Alps,

André
et al.

(p.
69
; see the Perspective by

Basu

) report the detection of a brown dwarf that is still in the process of forming. The results lend support to models that suggest that brown dwarfs form in the same way as nuclear-burning stars, like our Sun, but do not rule out other models.
Two Atoms Announce Their Long-Distance Relationship
Authors: Volz Jürgen , Rauschenbeutel Arno
Published: July 2012

The quantum entanglement of two atoms 20 m apart, verified by a secondary process, can enable long-distance quantum communications.
Brown-Dwarf Origins
Authors: Basu Shantanu
Published: July 2012

Observations reveal the possible formation of a brown dwarf through the collapse of an interstellar cloud fragment.
Haploinsufficient Gene Selection in Cancer
Authors: Greenman Chris D.
Published: July 2012

Cell proliferation experiments suggest that cancer can gain an advantage by partially inactivating several genes simultaneously with single deletion events.
Calculating the need for intensive care beds
Authors: Pearson Gale A , Reynolds Fiona , Stickley John
Published: July 2012

Aim

Prompted by high refused admission rates, we sought to model demand for our 20 bed paediatric intensive care unit.

Methods

We analysed activity (admissions) and demand (admissions plus refused admissions). The recommended method for calculating the required number of intensive care beds assumes a Poisson distribution based upon the size of the local catchment population, the incidence of intensive care admission and the average length of stay. We compared it to the Monte Carlo method which would also include supra-regional referrals not otherwise accounted for but which, due to their complexity, tend to have a longer stay than average. For the new method we assigned data from randomly selected emergency admissions to the refused admissions. We then compared occupancy scenarios obtained by random sampling from the data with replacement.

Results

There was an increase in demand for intensive care over time. Therefore, in order to provide an up-to-date model, we restricted the final analysis to data from the two most recent years (2327 admissions and 324 refused admissions). The conventional method suggested 27 beds covers 95% of the year. The Monte Carlo method showed 95% compliance with 34 beds, with seasonal variation quantified as 30 beds needed in the summer and 38 in the winter.

Conclusion

Both approaches suggest that the high refused admission rate is due to insufficient capacity. The Monte Carlo analysis is based upon the total workload (including supra-regional referrals) and predicts a greater bed requirement than the current recommended approach.
Opportunistic adolescent health screening of surgical inpatients
Authors: Wilson Hayden , Bostock Nancy , Phillip Nicola , Shannon Penny , Payne Donald , Kennedy Andrew
Published: July 2012

Purpose

Opportunistic health screening has long been promoted by advocates of adolescent health. However, there are few objective data documenting the outcomes in an inpatient setting.

Methods

The authors performed opportunistic health screening on 114 surgical inpatients, median age 14 (range 10–18) years, admitted to a general adolescent ward in a tertiary children's hospital. A four-page paper document with a formatted list of questions, based on the Home, Education, Activities, Drugs, Sexual Health, Suicide framework, was developed to standardise screening and documentation.

Results

Areas of concern requiring intervention were identified in 34 (30%) patients. Specific interventions included referrals to the Adolescent Medicine clinic (n=6), Hospital School Services (n=7) and Psychological Medicine (n=7).

Conclusions

Consideration should be given to offer adolescent health screening to all surgical inpatients. Further research should involve the participation of young people and should focus on the outcomes, feasibility, acceptability and resource implications of such screening.
A disappearing left-sided neck mass: Figure 1
Authors: Lutwak Nancy , Dill Curt
Published: July 2012

The patient was a 48-year-old man who presented to the emergency department with complaints of a left-sided painful neck mass, which changed in size relative to ingestion of meals. He denied voice change, fever, chills, weight loss, dysphagia and hoarseness. Physical examination was unremarkable. CT scan demonstrated a 3.9 mm calculus of the submandibular gland duct. Therapeutic sialendocopy was successfully performed.
Multiple sclerosis-like neurological manifestations in a coeliac patient: nothing is as it seems
Authors: Mansueto Pasquale , Di Stefano Laura , D'Alcamo Alberto , Carroccio Antonio
Published: July 2012

Cobalamin (vitamin B12) deficiency occurs with several disorders, involving different organs and systems, including blood, bowel, nervous system and eyes. Although the most important features are usually haematological ones, presence of neurological involvement, in the absence of blood count alterations, has just been described in the literature. Here we report the case of a 48-year-old man, suffering from coeliac disease for approximately 5 years, vegetarian, who was admitted to our department, referring dysaesthesia of the left lower limb, decreased libido and erectile dysfunction. Vitamin B12deficiency was proved, even in the absence of blood count alteration, and treated with a vitamin supplement, resulting in complete remission.
Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys
Authors: Millard Peter S , Bru Juan , Berger Christopher A
Published: July 2012

Background

Point-of-care electronic medical records (EMRs) are a key tool to manage chronic illness. Several EMRs have been developed for use in treating HIV and tuberculosis, but their applicability to primary care, technical requirements and clinical functionalities are largely unknown.

Objectives

This study aimed to address the needs of clinicians from resource-limited settings without reliable internet access who are considering adopting an open-source EMR.

Study eligibility criteria

Open-source point-of-care EMRs suitable for use in areas without reliable internet access.

Study appraisal and synthesis methods

The authors conducted a comprehensive search of all open-source EMRs suitable for sites without reliable internet access. The authors surveyed clinician users and technical implementers from a single site and technical developers of each software product. The authors evaluated availability, cost and technical requirements.

Results

The hardware and software for all six systems is easily available, but they vary considerably in proprietary components, installation requirements and customisability.

Limitations

This study relied solely on self-report from informants who developed and who actively use the included products.

Conclusions and implications of key findings

Clinical functionalities vary greatly among the systems, and none of the systems yet meet minimum requirements for effective implementation in a primary care resource-limited setting. The safe prescribing of medications is a particular concern with current tools. The dearth of fully functional EMR systems indicates a need for a greater emphasis by global funding agencies to move beyond disease-specific EMR systems and develop a universal open-source health informatics platform.
Cause-specific infant mortality in a population-based Swedish study of term and post-term births: the contribution of gestational age and birth weight
Authors: Altman Maria , Edstedt Bonamy Anna-Karin , Wikström Anna-Karin , Cnattingius Sven
Published: July 2012

Objective

To investigate infant mortality and causes of infant death in relation to gestational age (GA) and birth weight for GA in non-malformed term and post-term infants.

Design

Observational, retrospective nationwide cohort study.

Setting

Sweden 1983–2006.

Participants

2 152 738 singleton non-malformed infants born at 37 gestational weeks or later.

Main outcome measures

Infant, neonatal and postneonatal mortality and causes of infant death.

Results

Infant mortality rate was 0.12% (n=2687). Compared with infants born at 40 weeks, risk of infant mortality was increased among early term infants (37 weeks, adjusted OR 1.70, 95% CI 1.43 to 2.02). Compared with infants with normal birth weight for GA, very small for gestational age (SGA; <3rd percentile) infants faced a doubled risk of infant mortality (adjusted OR 2.13, 95% CI 1.80 to 2.53), and corresponding risk was also increased among moderately SGA infants (3rd to <10th percentile; adjusted OR 1.46, 95% CI 1.26 to 1.68). Sudden infant death syndrome (SIDS) was the most common cause of death, accounting for 39% of all infant mortality. Compared with birth at 40 weeks, birth at 37 weeks was associated with increased risks of death by infections, cardiovascular disorders, SIDS and malignant neoplasms. Very and moderately SGA were associated with increased risks of death by neonatal respiratory disorders, infections, cardiovascular disorders, SIDS and neuromuscular disorders. High birth weight for GA was associated with increased risks of death by asphyxia and malignant neoplasms.

Conclusion

Early term birth and very to moderately low birth weight for GA are independent risk factors for infant mortality among non-malformed term infants.
Medium term outcome in Bell's palsy in children
Authors: McNamara Roisin , Doyle Jennifer , Mc Kay Mary , Keenan Peter , Babl Franz E
Published: July 2012

Objective

Bell's palsy is a non-life threatening disorder with important functional and psychosocial effects. While recent research has shown significant benefit from treatment with steroids in adults, there have been no conclusive studies demonstrating benefit in children. This study set out to explore the medium term resolution of symptoms in Bell's palsy presenting to the emergency department (ED).

Patients and Methods

This was a retrospective cohort study of children attending an Irish paediatric ED with a diagnosis of Bell's palsy. Patients were identified via the ED database. The primary outcome measure was resolution at follow-up call (6–18 months after presentation). Secondary outcome measures were ED treatment, imaging and time to resolution of symptoms.

Results

There were 48 presentations, involving 45 patients. Left and right-sided palsies were equally represented. Of these, 16 (33%) received prednisolone. MRI was performed in five cases (10%), four were normal and one did not change management. In follow-up telephone contact, of 35 presentations, 28 (80%, 95% CI 63% to 91%) had complete resolution, six (17%, 95% CI 7% to 34%) partial resolution to variable degrees and one patient showed no improvement. Of the 13 patients who had received prednisolone, nine (69%, 95% CI 39% to 91%) had complete resolution; of the 22 patients who were not treated with prednisolone 19 (86%, 95% CI 65% to 97%) had complete resolution (p=0.22).

Conclusions

The majority of children with Bell's palsy have complete resolution of the facial weakness. Steroid use is highly variable and warrants a placebo controlled randomised trial.
O-012 Long term angiographic follow-up of aneurysms treated with self-expandable stents
Authors: Nishido H , Piotin M , Bartolini B , Pistocchi S , Redjem H , Blanc R
Published: July 2012

Purpose

Stent-assisted coiling of intracranial aneurysms has proved to promote aneurysm occlusion and to reduce aneurysm recurrence. First reports were promising but longer follow-up are needed to confirm the benefits of stenting over coiling without stents.

Materials and Methods

Over the last 9 years, we treated selectively with coils 1621 aneurysms; 320 (including 38 in the setting of SAH) with stent-assistance, 1321 (628 in the setting of SAH) with coiling without stent-assistance, in 1253 patients. A retrospective review was conducted on patients that were followed at least for 18 months after endovascular treatment. Categorization was based on presence and type of stent assistance (none, single, X and Y-stenting). The rates of angiographic recanalization, rehemorrhage, and retreatment were analyzed.

Results

493 aneurysms were treated with coil embolization and 95 aneurysms with stent-assisted coiling (87 single-stent, 6 Y-stent, 2 X-stent). Mean angiographic follow-up was 34 months for stent-assisted coiled aneurysms, 38 months for coiled aneurysms (p=0.0542). Stent-assisted coiled aneurysms were larger (mean 7.7 mm) than coiled aneurysms (mean 6.6 mm) (p=0.0195). Stented aneurysms had significantly lower recanalization (12.6% vs 35.7%, p<0.0001). Retreatment rate was lower in the stented group (4.2%) (4/95) vs 8.9% (44/493) in the non-stented aneurysms (p=0.1527). Rehemorrhage occurred in two patients in the coiled group, whereas none were noted in the stented group (p=1). In multivariate analysis, larger aneurysms, non-stented aneurysms, and SAH at presentation were predictors of aneurysm recanalization.

Conclusion

Long-term follow-up demonstrate that stent-assisted coiled aneurysms have lower recurrence, retreatment, and rehemorrhage rates than aneurysms coiled without stent assistance.

Competing interests

None.
O-014 A new application of MRI fusion in angiographic percutaneous intervention for pediatric orbital lesions: Abstract O-014 Figure 1
Authors: Case D , Dion J , Wojno T , Tong F
Published: July 2012

Introduction/Purpose

MRI fusion is a recently developed image targeting technique that volumetrically overlays an MRI sequence onto a live fluoroscopic image updated in real time. The ability to utilize the superior soft tissue resolution of MRI for interventional lesion targeting without the practical constraints of an interventional MRI suite is potentially a powerful tool. Lesions that are well-visualized under MRI but possessing little fluoroscopic contrast are otherwise untreatable in the angio suite and ideally suited to this new technique. We present four consecutive cases involving small intraorbital masses in children where MRI-fusion volumetric overlay techniques were used to precisely target the lesions for the purposes of both percutaneous biopsy and venolymphatic malformation sclerotherapy.

Materials/Methods

Four pediatric patients were referred for percutaneous biopsy (n=1) and sclerotherapy (n=3) for small intraorbital masses. The DICOM MRI data sequences that best demonstrated the target lesions were imported to a Philips Allura fluoroscopy system. General anesthesia was administered and an XperCT scan of the head was obtained in the angiography suite. A multimodality matching overlay of the imported MRI data with the obtained XperCT data was performed to facilitate procedure planning with the MRI target superimposed over the live fluoroscopic images. Direct puncture of the target lesion was performed with a 23- or 25-gauge needle. Percutaneous sclerotherapy intralesional needle tip confirmation was assessed with aspiration and contrast injection. The targeted sclerotherapy lesions were then slowly injected manually with a mixture of Bleomycin and contrast with intermittent fluoroscopic evaluation to ensure intralesional placement. The biopsy case specimen was aspirated with a 23 gauge needle and a cell smear and core sample were submitted to Pathology.

Results

The treatment/biopsy needles were successfully placed in all four lesions in the angiographic suite using this technique. The needle was placed intralesional on the first pass in all four cases without complication with needle repositioning in the treatment cases as necessary for aspiration. No contrast extravasation or venous drainage was identified in the treatment group with intralesional contrast and Bleomycin/contrast injection. The biopsy patient had a diagnostic sample obtained while the sclerotherapy lesions were all decreased in size on follow-up imaging with resolution of their clinical symptoms. No sclerotherapy patient has required additional treatment.

Conclusion

MRI fusion with real-time fluoroscopic imaging allows for treatment of previously non-visualized lesions in the angiographic suite with sufficient soft tissue detail to perform precise percutaneous orbital interventions in a safe and therapeutic manner.

Competing interests

None.

Abstract O-014 Figure 1
O-019 Infarct volume thresholds for prediction of independent functional outcomes after acute ischemic stroke: Abstract O-019 Figure 1
Authors: Nogueira R , Jovin T
Published: July 2012

Background and Purpose

The main premise of reperfusion therapy in acute ischemic stroke (AIS) is to prevent the conversion of the salvable penumbra into irreversible infarct core thereby reducing the final stoke size. Indeed, previous studies have demonstrated a strong correlation between final infarct volumes and functional outcomes. We sought to establish the optimal final infarct thresholds that best correlate with independent functional outcomes.

Methods

Multicenter retrospective analysis across five large academic centers. Consecutive patients meeting the following criteria were included: (1) anterior circulation stroke; (2) available final stroke imaging volumetric analysis; (3) available modified Rankin scale (mRS) score at 90 days. Receiver operating characteristic (ROC) curves were created to help defining the optimal final stroke volume points that discriminate a 90-day mRS ≤2.

Results

A total of 484 consecutive patients were identified. The mean age was 65.6±14.6 years. The mean baseline NIHSS was 14.2±7.1. The mean final stroke volume was 77.7±88.5 cc (median, 40.5 cc). A total of 201 out of the 484 (41.5%) of the patients achieved functional independence at 90 days. The ROC analysis demonstrated that final infarct volume (FIV) was a strong discriminator of independent outcomes with an area under the curve [AUC] of 0.778. The best cut-off point for discriminating 90-day mRS ≤2 was 35 cc of FIV (70% specificity; 70% sensitivity). The AUC could be improved by excluding older patients. In patient <65 years, the AUC was 0.844 with an optimal discriminating point at 53 cc (75% specificity; 75% sensitivity). The exclusion of patients >80 years yielded an AUC of 0.797 with an optimal FIV discriminating point at 40 cc (72% specificity; 72% sensitivity). In this population, FIV of 29 cc had 80% specificity and 62% sensitivity whereas FIV of 15 cc had 90% specificity but only 40% sensitivity for an independent functional outcome.

Conclusions

Final infarct volume is a strong surrogate for good outcomes after AIS. Our data suggest that the exclusion of patients with infarct volumes >35–40 cc on baseline imaging may enhance the chances of a positive confirmatory clinical trial of reperfusion in AIS.

Competing interests

R Nogueira: Concentric Medical; ev3 Neurovascular; Coaxia. T Jovin: None.

Abstract O-019 Figure 1

Receiver operating characteristic (ROC) curves of Final Stroke Volume (cc) and Independent Functional Outcome (mRS ≤2) at 90 days.
O-028 The LUNA aneurysm embolization system for treatment of intracranial aneurysms
Authors: Piotin M , Sourour N , Biondi A , Mounayer C , Blanc R
Published: July 2012

Purpose

The LUNA Aneurysm Embolization System (AES) is a self-expanding ovoid device that serves as an intra saccular flow diverter as well as a scaffold for endothelization across the neck. The objective of this prospective clinical study was to evaluate the ability of the AES to occlude intracranial aneurysms while maintaining patency of the parent artery.

Materials and Methods

15 patients with intracranial aneurysms were enrolled (intention to treat) in the study so far. Immediate post-implantation occlusion grade (complete (complete obliteration of the aneurysm including the neck), near-complete (persistence of any portion of the original defect of the arterial wall), or incomplete (any opacification of the sac) compared to baseline), and parent vessel compromise were evaluated. Patients underwent neurological and neurocognitive testing with the Modified Rankin Scale and the National Institute of Health Stroke Scale (NIHSS) at baseline and time of discharge. Follow-up included clinical assessment at 1 month and 3 months, clinical and angiographic follow-up at 6 months.

Results

15 patients (14 women, 1 man) with 14 unruptured and 1 ruptured saccular aneurysms (5 para-ophtalmic, 3 AcoA, 3 ICA-Pcom, 2 MCA, 1 ICA bifurcation, 1 A1; sizes from 5.0 to 6.7 mm) were enrolled to date in the study. In all but 1 aneurysm (1 failed procedure converted in coiling immediately after aneurysm dome perforation with the microcatheter of a recently ruptured aneurysm) 1 AES was deployed per aneurysm. In four cases, the AES embolization was carried out with balloon microcatheter assistance. In one case, the AES failed to detach and was exchanged for a second AES device that detached. In one case, AES placement led to aneurysm perforation that was controlled by temporary balloon occlusion and heparin reversion. In one case, thrombo-embolic complication was treated with i.a. injection of Abciximab. Immediate complete occlusion was obtained in one case, near complete occlusion was obtained in nine cases, no occlusion in four cases. Clinical follow-up was uneventful. To date, four patients with four aneurysms were followed with angiography at 6 months, showing complete occlusion in two cases, neck remnants in two cases. There was no parent artery stenosis or occlusion.

Conclusion

Preliminary results demonstrate good safety profile. The first short-term angiographic follow-up are promising. More and longer follow-up are pending.

Competing interests

None.
O-029 Results of prospective randomly allocated trial of novel acute thrombectomy device in a swine model of stroke
Authors: Mocco J
Published: July 2012

Introduction

We present the initial results evaluating a novel stroke thrombectomy device in a swine model of thromboembolic stroke. This new technology, termed the ReCover, maintains a number of critical advances in acute stroke thrombectomy, including improved clot grip and a novel proprietary distal embolic protection system.

Methods

Two swine were prepared for multiple separate targeted vessel clot extractions with either a Solitaire or the new ReCover. A total of 19 appropriate vessels were identified across two animals. Random allocation was used to identify which particular device was to be used in each vessel, prior to clot injection. After each attempted thrombectomy the target vessel was graded for successful TIMI recanalization.

Results

Both the Solitaire and ReCover thrombectomy devices were successful the majority of times. However, the ReCover achieved TIMI III recanalization eleven out of eleven times, whereas the Solitaire achieved TIMI III recanalization four out of eight times (p<0.05).

Conclusion

We present the results of a prospective randomly allocated animal stroke model demonstrating a high success rate of the new thrombectomy technology.

Competing interests

J Mocco: Edge Therapeutics, Nfocus, Lazarus Effect. Blockade Medical.