bluuebunny/crossref_metadata_2025 huggingface dataset:
Microbiological findings of culture‐positive preservation fluid in liver transplantation
Authors: Janny S. , Bert F. , Dondero F. , Durand F. , Guerrini P. , Merckx P. , Nicolas‐Chanoine M.H. , Belghiti J. , Mantz J. , Paugam‐Burtz C.
Published: August 2010

S. Janny, F. Bert, F. Dondero, F. Durand, P. Guerrini, P. Merckx, M.H. Nicolas‐Chanoine, J. Belghiti, J. Mantz, C. Paugam‐Burtz. Microbiological findings of culture‐positive preservation fluid in liver transplantation. Transpl Infect Dis 2011: 13: 9–14. All rights reserved

Abstract: Bacterial and fungal infections are the leading cause of mortality in liver transplant (LT) recipients. Few studies have examined the incidence of culture‐positive preservation fluid (PF) and the outcome of related recipients. The aim of this study was to determine the incidence and the microbiologic findings of PF positive cultures, and to evaluate the impact on morbidity and mortality of LT recipients. A retrospective analysis of PF cultures performed after 477 LTs from cadavaric grafts between January 2001 and February 2008 was conducted. Forty‐five (9.5%) PFs were found to be positive with 1 or 2 pathogens. The demographic profiles of recipients of PF with positive or negative cultures were similar. Enterobacteriaceae species were the most frequent organisms (n=30), followed by Staphylococcus aureus (n=5), coagulase‐negative staphylococci (n=5), enterococci (n=4), and yeasts (n=3). Mortality rate at 1 month was not significantly different in recipients with positive or sterile PF cultures (88.1% vs. 87.7%, respectively). The rate of bacteremia among LT recipients with positive or negative PF cultures was not statistically different. Systemic infections caused by the pathogen cultured from the PF occurred in 8 (18%) of the 45 recipients, including bacteremia (4/8) or intra‐abdominal sepsis (5/8). Causative organisms were Enterobacteriaceae species (n=5), Candida species (n=2), and Enterococcus faecium (n=1). Among the 8 patients who developed infection with the PF organism, 4 (50%) died in the intensive care unit (ICU) vs. an ICU mortality rate of 8% (3/37) in those who did not develop infection with the PF organism (P<0.05). Infection occurred less frequently in recipients who received antimicrobial therapy with activity against the PF isolate than in those without appropriate treatment (41% vs. 3.8%, P<0.005). Those who develop infection with organisms recovered from PF cultures appear to have high early mortality rates; therefore, appropriate antimicrobial therapy against organisms cultured from PF should be given.
Catheter‐associated aspergillosis of the chest wall following allogeneic hematopoietic stem cell transplantation
Authors: Kerl K. , Koch B. , Fegeler W. , Rossig C. , Ehlert K. , Groll A.H.
Published: August 2010

K. Kerl, B. Koch, W. Fegeler, C. Rossig, K. Ehlert, A.H. Groll. Catheter‐associated aspergillosis of the chest wall following allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2011: 13: 182–185. All rights reserved

Abstract: Invasive aspergillosis (IA) at the insertion site of central venous catheters is a rare event. Here we report the occurrence of chest wall aspergillosis at the insertion site of a Broviac catheter in a 5‐year‐old child undergoing allogeneic hematopoietic stem cell transplantation. The infection arose during profound granulocytopenia under conditions of reverse isolation with laminar air flow and high efficiency particulate air filtration and was successfully managed with repeat surgical debridement, voriconazole/caspofungin combination therapy guided by therapeutic drug monitoring, and adjunctive use of granulocyte colony‐stimulating factor. The case reflects the occurrence of IA despite reverse isolation and air decontamination, the principles of treatment of Aspergillus soft tissue infections in granulocytopenic patients, and the need for therapeutic drug monitoring of voriconazole particularly in young children.
Alternative parasite development in transmission strategies: how time flies!
Authors: BADETS M. , MORRISON C. , VERNEAU O.
Published: August 2010

Among parasitic platyhelminths with complex life cycles, it has been well documented that transmission opportunities are the main forces shaping the diversity of life‐history traits and parasite developmental strategies. While deviations in the development pathway usually involve shortening of life cycles, their extension may also occur following perception of remaining time by parasites. Polystoma gallieni, the monogenean parasite of Hyla meridionalis, is able to trigger two alternative developmental strategies depending on the physiological stage of the tadpoles upon which larvae attach. The distribution and reproductive outputs of both resulting phenotypes were surveyed to address questions about the dynamics of transmission in natural environments. Because modifications in the completion of life cycles can have drawbacks which may perturb the dynamic equilibrium of the resulting host–parasite systems, experimental infestations were also performed to assess parasite–parasite interactions. Our results suggest that the bladder adult phenotype, which involves transmission between frogs and tadpoles, is supplied secondarily by the branchial phenotype which involves transmission between tadpoles and metamorphs. They also support the occurrence of finely tuned trade‐offs between hosts and parasites and highlight positive trends behind the extension of direct life cycles, in which host‐derived signals account for the remaining time to achieve parasitic transmission.
Blood donors in Kenya: a comparison of voluntary and family replacement donors based on a population‐based survey
Authors: Kimani D. , Mwangi J. , Mwangi M. , Bunnell R. , Kellogg T. A. , Oluoch T. , Gichangi A. , Kaiser R. , Mugo N. , Odongo T. , Oduor M. , Marum L. ,   for the KAIS Study Group
Published: August 2010

Background and Objectives  Blood safety and sufficiency are major challenges in Kenya and other sub‐Saharan African countries forcing many countries to rely on family replacement donors (FRD). We analysed data from a national AIDS indicator survey to describe blood donors in Kenya and potential risks of transfusion transmissible infections (TTI) comparing voluntary donors and FRD.

Materials and Methods  A population‐based, cross‐sectional survey was conducted in 2007 among 15‐ to 64‐ year‐olds. Consenting participants were interviewed about blood donation history and were tested for HIV, HSV‐2 and syphilis.

Results  Of the 17 940 people surveyed, 445 (2·3%) reported donating blood in the prior 12 months. Sixty‐four per cent were voluntary donors, and the rest were FRD. Compared to FRD, the majority of voluntary donors were < 25 years old (59% versus 18%), from the highest wealth quintile (57% versus 42%) and single (64% versus 23%). In addition, voluntary donors were less likely to have been sexually active than replacement donors (43% versus 13%). HIV prevalence was lower among voluntary donors than among FRD (2·6% versus 7·4%, P‐value = 0·07).

Conclusions  The majority of blood donors in Kenya are voluntary with lower potential risk of TTI.
Revalidation and update of the TASH‐Score: a scoring system to predict the probability for massive transfusion as a surrogate for life‐threatening haemorrhage after severe injury
Authors: Maegele M. , Lefering R. , Wafaisade A. , Theodorou P. , Wutzler S. , Fischer P. , Bouillon B. , Paffrath T. ,   the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (TR‐DGU)
Published: August 2010

Background  The Trauma Associated Severe Haemorrhage (TASH)‐Score has been recognized as an easy‐to‐calculate scoring system to predict the probability for massive transfusion (MT) as a surrogate for life‐threatening haemorrhage after injury. Changes with respect to management and outcome of these patients over time prompted a revalidation and an update of the TASH‐Score.

Methods  The performance of the TASH‐Score developed from the 1993–2003 TR‐DGU database (Trauma Registry Deutsche Gesellschaft für Unfallchirurgie/German Trauma Society) was revalidated on 5834 datasets from the 2004–2007 TR‐DGU database with respect to discrimination, precision and calibration. The performance of the TASH‐Score applied onto the 2004–2007 TR‐DGU database was compared to its initial performance, and the logistic function to calculate the probability for MT was modified for score adjustment.

Results/Conclusions  When the original TASH‐Score was applied onto the 2004–2007 TR‐DGU database, a slight increase in discrimination was observed while precision was considerably lower. The predicted rate for MT within the development dataset was 13·9% while the observed incidence was 14·1%. In contrast, the predicted rate for MT within the revalidation dataset was 11·7%, while the observed rate was 8·4%. The logistic function to calculate MT probability was modified, and the TASH‐Score was again evaluated against the most recent TR‐DGU 2004–2007 database. The high performance of the score was not only restored but enhanced reflected by an increased ROC/AUC of 0·905. The score can be calculated quickly upon arrival of the patient in the emergency department and may be supportive to correct coagulopathy, to activate logistics and for research.
In vitro assessment of apheresis and pooled buffy coat platelet components suspended in plasma and SSP+ photochemically treated with amotosalen and UVA for pathogen inactivation (INTERCEPT Blood System™)
Authors: Chavarin P. , Cognasse F. , Argaud C. , Vidal M. , De Putter C. , Boussoulade F. , Ripaud C. , Acquart S. , Lin L. , Garraud O.
Published: August 2010

Background and Objectives  INTERCEPT Blood System™ is a pathogen inactivation system for blood components. The initial approval required a platelet component to be suspended in a combination of plasma and Platelet additive Solution/PAS‐III. Improved platelet storage has been reported with Mg++ and K+ supplementation (PAS‐IIIM). This study validated the use of INTERCEPT™/PAS‐IIIM for apheresis and pooled buffy‐coat platelet components.

Materials and Methods  The platelet dose and pH throughout 5 days of storage met the European and French requirements for quality standards.

Results and Conclusion  Additional metabolic and activation assessments of the treated platelets confirmed the previously reported superiority of PAS‐IIIM over PAS‐III, but extended it to the INTERCEPT™ process.
Growth, yield and tuber quality ofSolanum tuberosumL. under supplemental ultraviolet‐B radiation at different NPK levels
Authors: Singh S. , Kumari R. , Agrawal M. , Agrawal S. B.
Published: August 2010

In many areas, decreases in the stratospheric ozone layer have resulted in an increase in ultraviolet‐B (UV‐B, 280–315 nm) radiation reaching the Earth’s surface. The present study was conducted to evaluate the interactive effects of supplemental UV‐B (sUV‐B) and mineral nutrients on a tuber crop, potato (Solanum tuberosumL. var Kufri Badshah), under natural field conditions in a dry tropical environment. The nutrient treatments were the recommended dose of NPK (Fo), 1.5 times the recommended dose of NPK (F1), 1.5 times the recommended dose of N (F2) and 1.5 times the recommended dose of K (F3). The response of potato plants to sUV‐B varied with nutrient treatment and concentration. sUV‐B adversely affected growth, yield and quality of tubers, causing an increase in reducing sugars in the tubers and thus reducing the economic value. Growth and fresh weight of tubers was maximal with sUV‐B at 1.5 times recommended NPK, but the dry weight of tubers were highest with the recommended NPK dose. Reducing sugar content was lower in potato plants treated with sUV‐B and the recommended NPK than with sUV‐B and 1.5 times the recommended NPK. This study thus clearly shows that growing potato with 1.5 times the recommended NPK or 1.5 times the recommended dose of N/K does not alleviate the sUV‐B induced changes in yield and quality of tubers compared to the recommended NPK dose.
Experimental studies on pollen‐mediated gene flow in Sorghum bicolor (L.) Moench using male‐sterile bait plants
Authors: Rabbi I. Y. , Parzies H. K. , Kiambi D. , Haussmann B. I. G. , Folkertsma R. , Geiger H. H.
Published: August 2010

With 4 figures and 1 table

Information on the potential of pollen mediated gene flow (PMGF) in sorghum is required for ensuring varietal purity and to mitigate risk transgenic gene flow. Replicated trials were conducted in Kenya using a local landrace, ‘Ochuti’ as pollen donor surrounded by male‐sterile pollen baits. Frequency of PMGF decreased with the increase of distance from pollen sources and was significantly influenced by wind direction and speed. Anther dehiscence correlated with increase in vapour pressure deficit in the morning. A negative exponential regression model with logarithmic transformation of PMGF and square‐root transformation of distance from source field best fitted the data. Up to 50% of female florets on a male sterile (MS) plant were pollinated at 1 m from pollen source and declined to 14% at 10 m. The maximum distance of PMGF using the PMGF model, based on a threshold of one seed per MS plant, was 203 m when data above the 95th percentile is considered. However, in the presence of self‐produced pollen of male‐fertile target plants, the possibility of long‐distance cross‐pollination may be very low.
Matrix metalloproteinase‐2 regulates the expression of tissue inhibitor of matrix metalloproteinase‐2
Authors: Kimura Kaoru , Cheng Xian Wu , Nakamura Kae , Inoue Aiko , Hu Lina , Song Haizhen , Okumura Kenji , Iguchi Akihisa , Murohara Toyoaki , Kuzuya Masafumi
Published: August 2010

1. Matrix metalloproteinases (MMP) are associated with the vascular remodelling seen in atherosclerosis and aneurysm. The activation and activity of MMP‐2 are regulated by the intrinsic tissue inhibitor of MMP‐2 (TIMP‐2). The aim of the present study was to examine whether, conversely, MMP‐2 can affect the gene and protein expression of TIMP‐2.

2. In the present study, we examined the mRNA and protein expression of MMP‐2 and TIMP‐2 in cultured smooth muscle cells (SMC) from the aortas of MMP‐2+/+ and MMP‐2−/− mice. We also examined the roles of MMP‐2 in SMC cellular events.

3. Western blotting showed that less TIMP‐2 protein was present in the conditioned medium of MMP‐2−/− SMC than in that of MMP‐2+/+ SMC. Real‐time reverse transcription polymerase chain reaction analysis showed that MMP‐2 deficiency reduced TIMP‐2 mRNA expression in SMC. Recombinant MMP‐2 enhanced the expression of TIMP‐2 protein in cultured SMC from MMP‐2−/− mice. Furthermore, a siRNA targeting MMP‐2 impaired the gene and protein expression of MMP‐2 in cultured SMC from MMP‐2+/+ mice. MMP‐2 deficiency impaired SMC invasion, but not their proliferation, adhesion or migration.

4. Our findings suggest that MMP‐2 is likely to be responsible, at least in part, for regulating TIMP‐2 expression and is thus a potential target, in addition to TIMP‐2, for therapeutics aimed at preventing cardiovascular remodelling in response to injury.
Leptin induces hypertrophy through activating the peroxisome proliferator‐activated receptor α pathway in cultured neonatal rat cardiomyocytes
Authors: Hou Ning , Luo Miao‐Shan , Liu Shi‐Ming , Zhang Hai‐Ning , Xiao Qing , Sun Pu , Zhang Gen‐Shui , Luo Jian‐Dong , Chen Min‐Sheng
Published: August 2010

1. Our previous study has shown that leptin induces cardiomyocyte hypertrophy; however, the mechanisms are poorly understood. Recent studies have shown that peroxisome proliferator‐activated receptor α (PPARα) activation might be responsible for pathological remodeling and severe cardiomyopathy. Leptin, as an endogenous activator of PPARα, regulates energy metabolism through activating PPARα in many cells. Therefore, we hypothesized that leptin induces cardiomyocyte hypertrophy through activating the cardiac PPARα pathway.

2. Cultured neonatal rat cardiomyocytes were used to evaluate the effects of PPARα on hypertrophy. The selective PPARα antagonist GW6471 concentration‐dependently decreased atrial natriuretic factor mRNA expression by 23%, 36%, 44% and 59%, and significantly decreased total RNA levels, protein synthesis and cell surface areas, all of which were elevated by 72 h of leptin treatment. The augmentation of reactive oxygen species levels in leptin treated cardiomyocytes was reversed by 0.1–10 μmol/L GW6471 (40%, 52% and 58%). After 24 h of treatment, leptin concentration‐dependently enhanced mRNA expression by 7%, 93%, 100% and 256%, and protein expression by 31.2%, 64.2%, 143% and 199%, and the activity of PPARα. Meanwhile, cardiomycytes receiving 72 h of treatment with the PPARα agonist, fenofibrate, concentration‐dependently increased total RNA levels, atrial natriuretic factor mRNA expression, protein synthesis and cell surface area. Treatment of fenofibrate for 4 h also elevated oxygen species levels in a concentration‐dependent manner.

3. In conclusion, these findings show that leptin induces hypertrophy through the activation of the PPARα pathway in cultured neonatal rat cardiomyocytes.
Increased intestinal permeability as a predictor of bacterial infections in patients with decompensated liver cirrhosis and hemorrhage
Authors: Kim Byung Ik , Kim Hong Joo , Park Jung Ho , Park Dong Il , Cho Yong Kyun , Sohn Chong Il , Jeon Woo Kyu , Kim Hong Soo , Kim Dong Joon
Published: August 2010

Background and Aim:  There have been no trials comparing the prophylactic effect of oral quinolone and intravenous cephalosporin antibiotics and elucidating the predictive factors for the occurrence of bacterial infections in cirrhotic patients with gastrointestinal bleeding in Asian‐Pacific region.

Methods:  One hundred and thirteen patients with advanced liver cirrhosis and active gastrointestinal hemorrhage were enrolled in our study. The patients were randomly allocated into either the oral ciprofloxacin group (n = 50, 500 mg every 12 h) or the intravenous ceftriaxone group (n = 63, 2.0 g per day for 7 days).

Results:  Proven or possible infections were significantly more frequent in the patients in the oral ciprofloxacin group (34.0%) than the intravenous ceftriaxone group (14.3%, P = 0.002). The intestinal permeability index (IPI, mean [SD]) measured the day after admission was significantly higher in the patients with proven or possible infections (1.45 [0.96]) compared with the no infection group (0.46 [0.48], P < 0.01). By multivariate analysis, oral ciprofloxacin prophylaxis and higher IPI at the time of inclusion were independent and significant predictors for proven or possible infections. By receiver operating characteristic curve analysis, the best cutoff value of IPI for the prediction of the occurrence of bacterial infection was 0.62%.

Conclusions:  The frequency of proven or possible infections was significantly lower in the intravenous ceftriaxone group compared with the oral ciprofloxacin group. The IPI measured the day after admission is a good clinical parameter predicting the occurrence of infection in these patients.
Ubiquitin‐proteasome profiling for enhanced detection of hepatocellular carcinoma in patients with chronic liver disease
Authors: Qu Kevin Z , Zhang Ke , Ma Wanlong , Li Hairong , Wang Xiuqiang , Zhang Xi , Giles Francis , Lai Michelle , Afdhal Nezam H , Albitar Maher
Published: August 2010

Background and Aim:  A reliable test for the detection of hepatocellular carcinoma (HCC) could improve disease management. Recent reports suggested a link between abnormalities in the ubiquitin‐proteasome system (UPS) and HCC. We investigated the potential of using UPS markers, along with HCC markers, to differentiate HCC from chronic liver disease (CLD).

Methods:  Sera from 135 HCC and 262 CLD patients were retrospectively analyzed for levels of UPS markers (proteasome, ubiquitin, and proteasome enzymatic activities) and the conventional HCC markers alpha fetoprotein (AFP), AFP‐L3, and des‐gamma‐carboxyprothrombin (DCP). Multivariate logistic regression analysis was used to develop a model for differentiating HCC from CLD. The model was developed using a subset of 98 HCC patients and 104 CLD patients with advanced fibrosis or cirrhosis (Metavir F3‐4) and then validated using an independent set (37 HCC and 44 CLD (F3‐4)).

Results:  A UPS signature model incorporating six markers (trypsin‐like, caspase‐like, chymotrypsin‐like, and normalized chymotrypsin‐like activities of proteasomes; AFP; and DCP) accurately differentiated HCC from CLD (area under the curve = 0.938 [95% confidence interval, 0.884–0.991]). When analysis was restricted to patients with tumors ≤ 3 cm, the UPS model exhibited higher sensitivity (83.1% vs 51.8%) and specificity (90.2% vs 83.7%) than the three conventional markers, with good positive predictive values (34.2% vs 15.1%). These results were confirmed in the independent validation set.

Conclusion:  The UPS signature in combination with AFP and DCP provides sensitive and specific differentiation of HCC in patients with CLD. The importance of the UPS in HCC suggests that therapeutic approaches targeting the UPS should be explored.
Six‐minute walk test in pulmonary rehabilitation: Do all patients need a practice test?
Authors: JENKINS Sue , CECINS Nola M.
Published: August 2010

Background and objective:  The six‐minute walk test (6MWT) is widely used as an outcome measure in pulmonary rehabilitation programs (PRP). A learning effect for the test has been reported in COPD; however, limited data exist in patients with other respiratory diagnoses. The objectives of this study were to: (i) report the magnitude of change in 6MWD with test repetition in patients referred to an outpatient PRP, and (ii) compare the magnitude of change in 6MWD with test repetition in patients with COPD, interstitial lung disease (ILD), bronchiectasis and asthma.

Methods:  Retrospective study of 349 patients with stable COPD (n = 245), ILD (n = 21), bronchiectasis (n = 33) or asthma (n = 50) who performed two 6MWT at enrolment into a PRP.

Results:  6MWD increased in all groups on the second test (all P < 0.001). At least 80% of patients in each diagnostic group walked further on their second 6MWT. The magnitude of change (mean, 95% CI) was greater (P < 0.05) in the COPD (37 m, 95% CI: 33–41 m) and ILD (41 m, 95% CI: 27–55 m) cohorts compared with the bronchiectasis (22 m, 95% CI: 14–31 m) and asthma (19 m, 95% CI: 11–27 m) cohorts.

Conclusions:  Respiratory diagnosis influences the magnitude of the learning effect for the 6MWT. The findings support the recommendation of a practice 6MWT at baseline assessment in order to provide an accurate measure of the effects of rehabilitation on 6MWD.
The debate on CXR utilization and interpretation is only just beginning: A Pro/Con Debate
Authors: MEHTA Atul C. , CHUA Ai‐Ping , GLEESON Fergus , MEZIANE Moulay
Published: August 2010

The CXR is the most commonly performed radiographic examination worldwide. Its ease of performance, apparent ease of interpretation and low radiation dose, alongside its great spatial resolution would suggest that it should be the first investigation performed in all patients presenting with thoracic disease. But, the advent of ever‐improving multislice CT and increasing scanner availability has resulted in some patients being referred directly for scanning, bypassing the CXR. This has resulted in an inexorable rise in the number of scans performed, with an increase in patient radiation exposure and concerns among legislators and physicians that the number of scans needs to be regulated. A key role in the reduction of unnecessary scanning in patients with thoracic disease is the understanding of the place of the CXR, its ability to help in disease detection and monitoring, and its limitations.
Respiratory health issues in the Asia–Pacific region: An overview
Authors: JAMROZIK Euzebiusz , MUSK Arthur William
Published: August 2010

The Asia–Pacific region is home to a large heterogeneous population whose respiratory health is influenced by diverse social, economic and environmental factors. Despite this variability, the most prevalent causes of respiratory morbidity and mortality are tobacco smoking, infection, and air pollution. This review aims to summarize current respiratory health issues in the region including smoking‐related diseases especially COPD, lung cancer and infectious problems such as pandemic influenza, the severe acute respiratory syndrome coronavirus, bacterial pneumonia and tuberculosis, as well as the contribution of air pollution to respiratory disease. Published data on trends in the epidemiology and management of respiratory diseases and are summarized; finally, the limitations of available data and projections for the future of respiratory health in the region are discussed.
Acute fibrinous and organizing pneumonia in a patient with HIV infection and Pneumocystis jiroveci pneumonia
Authors: HEO Jung Yeon , SONG Joon Young , NOH Ji Yun , YONG Hwan Seok , CHEONG Hee Jin , KIM Woo Joo
Published: August 2010

Acute fibrinous and organizing pneumonia (AFOP) is a disease of the small airways that is characterized by deposition of fibrin within the alveolar spaces. The histological pattern is described as a variant of cryptogenic organizing pneumonia (COP). Although COP has been occasionally described in patients with HIV infection, the variant form, AFOP, has not been previously reported in such patients. This report describes an intriguing case of AFOP in a patient with HIV infection and Pneumocystis jiroveci pneumonia. AFOP was diagnosed after tapering of corticosteroid therapy. This case illustrates that non‐infectious pulmonary infiltrates should be considered in the differential diagnosis of lung disease in patients with HIV infection.
Haemodynamic effects of proportional assist ventilation during high‐intensity exercise in patients with chronic obstructive pulmonary disease
Authors: CARRASCOSSA Cláudia R. , OLIVEIRA Cristino C. , BORGHI‐SILVA Audrey , FERREIRA Eloara M.V. , MAYA Joyce , QUEIROGA Fernando , BERTON Danilo C. , NERY Luiz E. , NEDER J. Alberto
Published: August 2010

Background and objective:  Proportional assist ventilation (PAV) has been proposed as a more physiological modality of non‐invasive ventilation, thereby reducing the potential for deleterious cardio‐circulatory effects during exercise, in patients with COPD. We therefore evaluated whether PAV modulates the kinetic and ‘steady‐state’ haemodynamic responses to exercise in patients with moderate‐to‐severe COPD.

Methods:  Twenty patients underwent constant‐load (75–80% peak work rate) cycle ergometer exercise testing to the limit of tolerance (Tlim), while receiving PAV or breathing spontaneously. Stroke volume (SV), heart rate (HR) and cardiac output (CO) were monitored by impedance cardiography.

Results:  Compared with unassisted breathing, PAV increased Tlim in 8/20 patients (median improvement 113% (range 8 to 212) vs −20% (range −40 to −9)). PAV had no significant effects on ‘steady‐state’ haemodynamic responses either in patients with or those without increased Tlim (P > 0.05). However, at the onset of exercise, SV kinetics were slowed with PAV, in 13/15 patients with analysable data. HR dynamics remained unaltered or failed to accelerate sufficiently in nine of these patients, thereby slowing CO kinetics (T1/2 61 s (range 81–30) vs 89 s (range 100–47)). These deleterious effects were not, however, associated with PAV‐induced changes in Tlim (P > 0.05).

Conclusions:  PAV slowed the SV and CO kinetics at the onset of high‐intensity exercise in selected patients with moderate‐to‐severe COPD. However, these adverse effects of PAV disappeared during the stable phase of exercise, and were not related to the ergogenic potential of PAV in this patient population.
Measurement of exhaled nitric oxide: Comparison of different analysers
Authors: KORN Stephanie , TELKE Ina , KORNMANN Oliver , BUHL Roland
Published: August 2010

Background and objective:  Exhaled nitric oxide (NO) is used as a surrogate marker to monitor eosinophilic airway inflammation, assist in diagnosis, and support treatment decisions for asthma patients. The aim of this study was to compare five NO analysers: Medisoft (M), Aerocrine Niox (N), Aerocrine Niox flex (NF), Aerocrino Niox mino (NM) and EcoMedics (E).

Methods:  In 85 subjects (25 asthma patients, 25 COPD patients, 35 healthy volunteers; median age 36.5 years, range 23–79, 47% female), three NO measurements per individual were performed, using each analyser according to the American Thoracic Society/European Respiratory Society guidelines. Subjects evaluated the devices on the basis of comfort and ease of performing the measurement.

Results:  Median NO concentrations were 24.8 parts per billion (ppb) (range 6.3–262.7) for M, 14.5 ppb (0.0–196.6) for N, 15.2 ppb (5.6–67.7) for NF, 16.3 ppb (5.0–208.3) for NM, and 13.1 ppb (4.0–103.0) for E. There was significant correlation among the absolute NO values measured with all the devices (0.743 for M vs NF < r < 0.979 for N vs NF). Bland–Altman plots suggested an acceptable degree of agreement among the results obtained with the three Niox analysers. Measurements obtained with the Medisoft and Ecomedics analysers were not directly comparable with those obtained with the other devices. The greatest differences in absolute NO levels for individual patients were between measurements with the M and E analysers (8.3 ppb, range 27.4–159.7, P < 0.001). Acceptance of the measurements by patients was high, independent of the device used.

Conclusions:  Exhaled NO values obtained with different devices were not directly comparable and may differ to a clinically relevant extent, depending on which device is used.
Alveolar proteinosis with hypersensitivity pneumonitis: A new clinical phenotype
Authors: VERMA Hema , NICHOLSON Andrew G. , KERR Keith M. , DEMPSEY Owen J. , GIBBS Allen R. , CAMPBELL Ian , BLACK Fiona , RASSL Doris , RICE Alexandra J. , RENZONI Elizabeth A. , WELLS Athol U. , HANSELL David M.
Published: August 2010

Background and objective:  The aim of the present study was to report the features of five patients with concurrent histopathological features of pulmonary alveolar proteinosis (PAP) and hypersensitivity pneumonitis (HP) and their high‐resolution CT (HRCT) appearances.

Methods:  Patients with histopathological features of both HP and PAP on surgical lung biopsy referred for tertiary review were retrospectively identified. The pathology and HRCT images were semi‐quantitatively scored to evaluate the relative contribution to HP and PAP.

Results:  Five patients had histopathological features of HP and PAP but had varied HRCT appearances. All had imaging features of PAP to a varying degree with two patients also showing characteristics of HP but three patients had ill‐defined thickened interlobular septa, not typical of either disease.

Conclusions:  We describe the coexistence of PAP and HP in five patients and discuss possible linkages between these two distinct pathologies.
State of the art: How to set up a pulmonary rehabilitation program
Authors: JENKINS Sue , HILL Kylie , CECINS Nola M.
Published: August 2010

Pulmonary rehabilitation plays an essential role in the management of symptomatic patients with COPD. The benefits of rehabilitation include a decrease in dyspnoea and fatigue, and improvements in exercise tolerance and health‐related quality of life. Importantly, rehabilitation reduces hospitalization for acute exacerbations and is cost‐effective. Although most of the evidence for pulmonary rehabilitation has been obtained in patients with COPD, symptomatic individuals with other respiratory diseases have been shown to benefit. In this review we outline a stepwise approach to establish, deliver and evaluate a pulmonary rehabilitation program (PRP) that would be feasible in most settings. Throughout the review we have specified the minimum requirements for a PRP to facilitate the establishment of programs using limited resources. Recommendations for staffing and other resources required for a PRP are presented in the first section. Exercise training is a focus of the section on program delivery as this is the component of rehabilitation that has the strongest level of evidence for benefit. Program considerations for patients with respiratory conditions other than COPD are described. Different approaches for delivering the education component of a PRP are outlined and recommendations are made regarding topics for group and individual sessions. The problems commonly encountered in pulmonary rehabilitation, together with recommendations to avoid these problems and strategies to assist in their resolution, are discussed. The review concludes with recommendations for evaluating a PRP.
Lung function testing in health and disease: Issues pertaining to Asia–Pacific populations
Authors: IP Mary S.M.
Published: August 2010

The Asia–Pacific region comprise of diverse ethnic populations and healthcare systems of highly variable developmental stages. We face challenges in lung function testing, many of which are different from the issues encountered in the west. In some places, access to proper lung function testing facilities is very limited due to resource constraints or geographic inconvenience. It is important to note the potential differences of normative values in Asia–Pacific populations, compared with established values derived from populations of Caucasian ethnicity, hence the need to choose from available prediction formulae the ones that most closely approximate the subjects being tested. The criteria for defining abnormality is a hot topic globally. In the Asia–Pacific region, the trade‐off between simplicity and thus ease of application and the pitfall of under‐ or over‐diagnosis based on fixed cut‐off values has to be recognized. The promotion of wider availability and proper utilization of lung function testing will go a long way in the enhancement of respiratory health and disease management in the region.
Lecithinized superoxide dismutase treatment improves steroid‐refractory interstitial pneumonia
Authors: KAWASHIMA Tatsuo , WAKABAYASHI Toru , KURODA Toshihisa , NISHIDE Toshio , MATSUZAWA Yasuo , SHIRAI Kohji
Published: August 2010

Pulmonary fibrosis associated with amyopathic dermatomyositis is known to have a generally aggressive course and is ultimately fatal. We report the case of a 50‐year‐old patient with amyopathic dermatomyositis, who developed progressive interstitial pneumonia that was unresponsive to corticosteroids and multiple immunosuppressive agents, including cyclosporine and tacrolimus hydrate. Five courses of lecithinized superoxide dismutase were administered without adverse effects. Improvements in physiological parameters, such as pulmonary function and exercise tolerance, as well as the serum Krebs von den Lungen 6 level, were observed. This is the first report of a case of steroid‐refractory interstitial pneumonia treated with lecithinized superoxide dismutase.
Effect of the alveolar recruitment manoeuvre on haemodynamic parameters in patients with acute respiratory distress syndrome: Relationship with oxygenation
Authors: HUH Jin Won , HONG Sang‐Bum , LIM Chae‐Man , KOH Younsuck
Published: August 2010

Background and objective:  Although the alveolar recruitment manoeuvre (ARM) is considered to be an optimal method of recruiting collapsed alveoli in a short period, the haemodynamic effects of the ARM have not been investigated. The aim of this study was to assess whether the ARM causes haemodynamic instability in patients with ARDS, and any relationship this might have with arterial oxygenation.

Methods:  Twenty‐eight patients with ARDS (16 responders and 12 non‐responders), who were admitted to the medical intensive care unit of a university‐affiliated hospital, were enrolled in the study. ARM, using the extended sigh method, was performed within 48 h of the onset of ARDS. Haemodynamic parameters were measured at baseline, during the ARM, and at 2 min, 30 min and 1 h after the ARM.

Results:  Responders and non‐responders showed no significant changes in blood pressure or cardiac index during or after ARM. Mean pulmonary artery pressure (MPAP), pulmonary vascular resistance index (PVRI) and right ventricular stroke work index (RVSWI) were transiently increased compared with baseline, in responders and non‐responders. During and after ARM, the systemic vascular resistance index was significantly higher in non‐responders than in responders.

Conclusions:  Some haemodynamic parameters (MPAP, PVRI and RVSWI) changed significantly during ARM. However, these haemodynamic changes were minimal, transient and probably have no clinical significance.
Iodine‐123 metaiodobenzylguanidine scintigraphic assessment of pulmonary vascular status in patients with chronic obstructive pulmonary disease
Authors: KOIZUMI Tomonobu , URUSHIHATA Kazuhisa , HANAOKA Masayuki , TSUSHIMA Kenji , FUJIMOTO Keisaku , FUJII Tadashige , KUBO Keishi
Published: August 2010

Background and objective:  Lung uptake of iodine‐123 metaiodobenzylguanidine (123I‐MIBG) is used as an indicator of pulmonary endothelial function. Decreased lung uptake of 123I‐MIBG has been demonstrated in patients with COPD as compared with normal subjects. The present study was performed to examine the relationship between lung uptake of 123I‐MIBG and pulmonary artery pressure (Ppa) at rest and during exercise, in patients with COPD.

Methods:  123I‐MIBG scintigraphy was performed in 19 patients with COPD. Anterior planar images were acquired 15 min after the injection of 123I‐MIBG, and the total lung to upper mediastinum ratio (LMR) was calculated for both lungs. Right heart catheters were used to monitor Ppa continuously at rest and during exercise. Exercise was performed on an electrically braked bicycle ergometer at a constant workload of 25 W for 3 min.

Results:  In COPD patients the LMR were not correlated with the pulmonary function parameters measured before exercise, including FEV1, PaO2, DLCO, or Ppa at rest. However, the percentage increase in Ppa during exercise was significantly correlated with LMR.

Conclusions:  Evaluation of the kinetics of lung uptake of 123I‐MIBG may be a novel scintigraphic tool for the assessment of exercise‐induced pulmonary hypertension in patients with COPD.
Therapeutic strategies of meconium obstruction of the small bowel in very‐low‐birthweight neonates
Authors: Koshinaga Tsugumichi , Inoue Mikiya , Ohashi Kensuke , Sugito Kiminobu , Ikeda Taro , Tomita Ryouichi
Published: August 2010

Background:  Meconium obstruction without cystic fibrosis in low‐birthweight neonates is a distinct clinical entity. We aimed to determine what therapeutic strategies work best in very‐low‐birthweight neonates with meconium obstruction of the small bowel under varied clinical conditions caused by the associated diseases of prematurity.

Methods:  Medical records of very‐low‐birthweight neonates with meconium obstruction of the small bowel treated from 1998 to 2008 were retrospectively reviewed. Pre‐ and postnatal data, treatments, and clinical outcomes were assessed.

Results:  Nine patients with perinatal complications were identified. Mean gestational age and birthweight were 26.9 weeks and 863 g, respectively. Abdominal distension developed from 1 to 7 days of life. Five patients were initially treated with Gastrografin enema, three of whom had successful outcomes. Two hemodynamically unstable patients failed to respond to Gastrografin treatment; they ultimately died of sepsis. The remaining four without Gastrografin treatment underwent enterostomy to resolve the obstructions with good results.

Conclusions:  Gastrografin and surgical treatments should be appropriately selected based on the underlying pathologies of meconium obstruction of the small bowel. Therapeutic Gastrografin enema is effective, safe and repeatable; however, it is not recommended for hemodynamically unstable patients. Surgical intervention is reserved for those who develop rapid abdominal distension that risks perforation.
Characteristic alteration in the second derivative of photoplethysmogram in children
Authors: Hasegawa Satoshi , Sato Seiichi , Numano Fujito , Park Jiksoo , Hoshina Satoshi , Endoh Hikosato , Suzuki Hiroshi , Uchiyama Makoto
Published: August 2010

Background:  The second derivative of the photoplethysmogram (SDPTG) has been verified as a useful method for analyzing pulse wave form in adults; however, there have been few studies on the SDPTG in children.

Methods:  We examined age‐related alteration of SDPTG (study 1) and the SDPTG response to a vasodilator (study 2). The subjects in study 1 were 36 healthy children aged 0.9–16.0 years. The subjects in study 2 were 13 children aged 5.4–18.9 years with a history of Kawasaki disease. Subjects received an i.v. infusion of 0.568 mg/kg dipyridamole. We assessed the SDPTG by d/a ratio, b/a ratio and aging index (AGI).

Results:  The d/a ratio increased with advance of age (r= 0.636, P < 0.001), and the b/a ratio and AGI decreased with advance of age (r=−0.343, P < 0.05 and r=−0.678, P < 0.001, respectively). The d/a ratio and AGI were correlated with height (r= 0.523, P < 0.01 and r=−0.623, P < 0.001, respectively), but the b/a ratio was not significantly correlated with height. In study 2, the d/a ratio increased significantly (P≤ 0.05), but the b/a ratio and AGI did not alter.

Conclusions:  The SDPTG indices in children show characteristic alterations with advance of age and react to a vasodilator.
Short‐term effects of crossover treatment with silodosin and tamsulosin hydrochloride for lower urinary tract symptoms associated with benign prostatic hyperplasia
Authors: Miyakita Hideshi , Yokoyama Eiji , Onodera Yasutada , Utsunomiya Takuji , Tokunaga Masatoshi , Tojo Takanori , Fujii Noriteru , Yanada Shuichi
Published: August 2010

Objectives: To compare the efficacy and safety of silodosin and tamsulosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) by a randomized crossover method.

Methods: BPH patients with the complaint of LUTS were included in this study, and were randomly divided into two groups: a silodosin‐preceding group (4 weeks of twice‐daily administration of silodosin at 4 mg, followed by 4 weeks of once‐daily administration of tamsulosin at 0.2 mg) or a tamsulosin‐preceding group (4 weeks' administration of tamsulosin, followed by 4 weeks' administration of silodosin). No drug withdrawal period was provided when switching the drug.

Results: In the first treatment period, both drugs significantly improved the International Prostate Symptom Score total score, but the improvement by silodosin was significantly superior to that by tamsulosin. After crossover treatment, significant improvement was observed only with silodosin treatment. Moreover, intergroup comparison of changes revealed that silodosin showed significant improvement of straining and nocturia with first and crossover treatments, respectively, compared with tamsulosin. Silodosin also significantly improved quality of life (QOL) score in both treatment periods, while tamsulosin significantly improved QOL score only in the first treatment period. The most frequent adverse drug reaction was ejaculatory disorder with silodosin; however, the incidence of dizziness with silodosin was similar to that with tamsulosin.

Conclusions: In BPH/LUTS patients, silodosin exhibits excellent efficacy in improving subjective symptoms in both initial and crossover treatment, and it appears to improve the QOL of patients.
Alternative antiandrogen therapy in patients with castration‐resistant prostate cancer: A single‐center experience
Authors: Okegawa Takatsugu , Nutahara Kikuo , Higashihara Eiji
Published: August 2010

Outcomes of alternative (second‐line) antiandrogen therapy in 112 patients with relapsing prostate cancer after first‐line hormonal therapy were analyzed. A good response (prostate‐specific antigen [PSA] decrease ≥50%) and a partial response (PSA decrease of 0–50%) by switching from bicalutamide (BCL) to flutamide (FLT) and from FLT to BCL were achieved in 35.4% (28/79) and 30.4% (24/79), and in 45.0% (9/20) and 20.0% (4/20) of cases, respectively. A good response and a partial response with the change from chlormadinone acetate (CMA) to a non‐steroidal antiandrogen (FLT or BCL) and from a non‐steroidal antiandrogen to CMA were obtained in 25.0% (2/8) and 37.5% (3/8), and in 20.0% (1/5) and 0% (0/5) of cases, respectively. In multivariate analyses, a second‐line good response was significantly predictive of cause‐specific survival from first therapy relapse to cancer death in all patients. Patients (52/112, 46.4%) with ≥30% decrease in PSA levels were associated with significantly better cause‐specific survival as measured from the start of first‐line treatment and first‐line relapse.
Reversible inactivation of the basolateral amygdala, but not the dorsolateral caudate putamen, attenuates consolidation of cocaine‐cue associative learning in a reinstatement model of drug‐seeking
Authors: Gabriele Amanda , See Ronald E.
Published: August 2010

Previous research has shown that the basolateral amygdala (BLA) mediates stimulus‐reward learning, including drug‐cue associations, whereas the dorsolateral caudate putamen (dlCPu) primarily mediates stimulus‐response (habit) learning. Recent evidence has indicated that the dlCPu may be critical in cocaine‐seeking following extended self‐administration, but it remains unknown whether the dlCPu plays a role in the early formation of drug‐cue associations. The current study used a model of Pavlovian learning to compare the roles of the BLA and dlCPu in the consolidation of cocaine‐cue associations that maintain cocaine‐seeking during cue‐induced reinstatement. Male Sprague‐Dawley rats self‐administered cocaine (0.2 mg/50 μL infusion, i.v.) in the absence of cues for 6 days (2 h/day). Immediately following a single 1‐h classical conditioning session in which passive cocaine infusions were paired with a light/tone cue, animals received bilateral infusions of the GABA receptor agonists, baclofen/muscimol (1.0/0.1 mm), or vehicle into the BLA or dlCPu. Following additional cocaine self‐administration (5 days) and subsequent extinction (no cocaine or cues, 7 days), the ability of the previously cocaine‐paired cues to reinstate cocaine‐seeking was assessed. Inactivation of the BLA, but not the dlCPu, immediately following the classical conditioning session impaired the consolidation of cocaine‐cue associations as seen by decreased cue‐induced reinstatement. These results extend previous findings that the BLA mediates the consolidation of learned associations that drive cocaine‐seeking during subsequent reinstatement and indicate that the dlCPu does not play a role during initial stimulus‐drug associative learning.