bluuebunny/crossref_metadata_2025 huggingface dataset:
Transabdominal scanning of the cervix at the 20‐week morphology scan: Comparison with transvaginal cervical measurements in a healthy nulliparous population
Authors: STONE Peter R. , CHAN Eliza H.Y. , MCCOWAN Lesley M. E. , TAYLOR Rennae S. , MITCHELL Jennifer M. ,   on behalf of the SCOPE Consortium
Published: September 2010

Background:  Healthy, nulliparous women at low risk for preterm birth would not usually undergo transvaginal scanning at the 20‐week morphology scan. The study aimed to determine whether transabdominal cervical measurement would be sufficient to exclude a short cervix in this population.

Aims:  To investigate the relationship between transabdominal (TA) and transvaginal (TV) ultrasound measurements of the cervix at 20 weeks’ gestation.

Methods:  At 20 weeks’ gestation, TA and TV cervical length was measured in 203 healthy nulliparous participants in the Screening for Pregnancy Endpoints (SCOPE) study. The TA and TV measurements were correlated and examined for variance.

Results:  Paired measurements were achieved in 203 cases. The shortest cervical length on TV scanning was 22 mm, the longest was 59 mm, with TA equivalents of 21 mm and 56 mm respectively. The mean TV cervical length was 39.1 (SD 6.2) mm and mean TA 36.6 (SD 5.8) mm. The average difference between the measurements was 2.6 (SD 5.2) mm, the TA length being the shorter of the two. A TA on the 25th percentile (33 mm length) was associated with a 25th percentile TV length of 36 mm. The intraclass correlation coefficient between TV and TA measurements was 0.77, but the actual difference between the two measurements was not constant.

Conclusions:  Transabdominal measurements are consistently less than TV measurements. As the measurements are correlated, TA scanning could be used to assess cervical length in most cases initially. Where the TA length is <5th percentile (27 mm), this measure could be used as an indication to perform a TV scan as this correlates with a 5th percentile TV measurement of 28 mm.
Editorials: Ethical Conflicts for Physicians Treating ESRD Patients
Authors: Bennett William M.
Published: September 2010

Managing an end‐stage renal disease (ESRD) patient is complex and presents many ethical challenges for the physician. Ownership of dialysis facilities has shifted over the past decade from largely nonprofit organizations to large companies whose shareholders are primarily interested in the profitability of their investments rather than the well‐being of the patients being treated. Furthermore, market forces rather than scientific questions that need to be answered now drive much of the research regarding patients with ESRD. These developments have created ethical dilemmas for treating physicians. This editorial describes some of these ethical challenges and expresses the point of view that the doctor‐patient relationship and its ethical imperatives are more important than company profit and loss statements.
The Value of Vaccination in Chronic Kidney Disease
Authors: Kausz Annamaria , Pahari Dilip
Published: September 2010

There has been much attention directed toward the high mortality of patients with end‐stage renal disease (ESRD), with much of the focus on cardiovascular disease. However, infectious disease is the second most common cause of death in late‐stage chronic kidney disease (CKD) patients. Although CKD patients are immunocompromised, some vaccines such as influenza, retain their efficacy and reduce infection rates with a standard immunization schedule. Other vaccines, such as hepatitis B and pneumococcal vaccines, require more frequent and/or higher doses to produce and maintain protective antibody levels. Attention has recently been given to the efficacy of influenza vaccination in ESRD patients in reducing morbidity and mortality. Centers with vaccination protocols have demonstrated reduced infection rates and resultant decreased morbidity and mortality. It could be extrapolated from this that widespread vaccination would reduce the total cost of ESRD patient care, and potentially improve patient well‐being. However, vaccination appears to be underutilized in CKD patients, and it is a readily available intervention to improve outcomes.
Review Articles: Nondialytic Management of Hyperkalemia and Pulmonary Edema Among End‐Stage Renal Disease Patients: An Evaluation of the Evidence
Authors: Evans Kimberley , Reddan Donal N. , Szczech Lynda Anne
Published: September 2010

Congestive heart failure (CHF) and hyperkalemia are the two leading reasons for emergency dialysis among individuals with end‐stage renal disease (ESRD). While hemodialysis provides definitive treatment of both hyperkalemia and volume overload among ESRD patients, for those who present outside of “regular dialysis hours,” institution of dialysis may be delayed. Nondialytic management can be instituted immediately and should be the initial therapy in the management of hyperkalemia and CHF in these individuals. Current available evidence does not allow conclusions as to whether treatment with nondialytic strategies alone results in different outcomes than nondialytic strategies coupled with emergent hemodialysis. Therefore, whether or not nondialytic management alone is appropriate remains a matter of individual judgment that should be decided on a case‐by‐case basis.
Intravenous Iron and the Risk of Infection in End‐Stage Renal Disease Patients
Authors: Perazella Mark A. , Brewster Ursula C. , Perazella Mark A.
Published: September 2010

Oral iron is typically insufficient for the iron deficiency of hemodialysis patients. Intravenous (IV) iron is well tolerated by most patients and non‐dextran‐containing iron preparations are associated with few allergic reactions. However, there is the potential for an increased risk of infection with IV iron that appears to increase bacterial growth as well as inhibit the host's innate immune response to bacterial infection. Clinical studies suggest a link between iron therapy and infection. Practicing nephrologists should be aware of this issue, but should not hesitate to use IV iron in iron‐deficient patients while avoiding the development of iron overload and administration of iron to patients who have active infection.
American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Port Catheter Placement by Nephrologists in an Interventional Nephrology Training Program
Authors: Pervez Aslam , Zaman Fahim , Aslam Asim , Petty Suzie , Murphy Sara , Vachharajani Tushar , Abreo Kenneth
Published: September 2010

We retrospectively reviewed all subcutaneous single‐ and double‐lumen port catheters (PCs) inserted by interventional nephrologists at our institution to determine the success rate, immediate and late complications, and functional life. From January 2000 to August 2002, 187 PCs were placed in 187 patients (42% males, 51% Caucasians, mean age 50 ± 14 years). There were no immediate complications related to the procedure such as hemorrhage, pulmonary embolism, or pneumothorax. There were a total of 35,078 catheter‐days of follow‐up. Sixteen catheters were removed during the observation period: three because of infection, seven after completion of chemotherapy, and six for other reasons. The remaining PCs are either functioning or the patients have died. The initial success rate was 100%. Kaplan‐Meier analysis showed a 30‐day survival of 97% and a 1‐year survival of 92%. Interventional nephrologists, who have adequate training in central venous tunneled cuffed catheter placements, can successfully place PCs, with excellent success and minimal complications.
Increasing the Supply of Kidneys for Transplantation
Authors: O'Connor Kevin J. , Delmonico Francis L.
Published: September 2010

Kidney transplantation confers a survival advantage for patients with end‐stage renal disease (ESRD) when compared to dialysis and improves the quality of life in a cost‐effective manner. Currently there are more than 60,000 patients on the U.S. waiting list for kidney transplantation. In 2004, 16,879 kidney transplants, including 880 simultaneous kidney and pancreas transplants, were performed in this country. Recent strategies for increasing the supply of kidneys hold promise, such as systematic programs designed to improve consent rates for deceased donor organ procurement. Efforts to increase donation after cardiac death (DCD) have been highly successful and now account for more than 5% of all deceased organ donors. Transplantation of kidneys from DCD donors yields 1‐year graft and patient survival rates equivalent to kidneys from brain‐dead donors. Expanded criteria donor (ECD) kidneys from donors ≥ 60 years of age (or donors age 50–59 years with certain comorbidities) confer a survival benefit for end‐stage renal disease (ESRD) patients compared to remaining on dialysis on the waiting list. The number of live donor kidney transplants, both from biologically related and unrelated donors, is increasing. Paired live donor kidney transplants provide yet another transplantation opportunity for ESRD patients with willing but incompatible (by ABO or direct antibody) living donors.
Expanded Criteria Donors: Process and Outcomes
Authors: Ojo Akinlolu O.
Published: September 2010

Expanded criteria donor (ECD) kidneys are transplantable deceased donor (DD) kidneys for which the average patient, graft survival, and renal function are inferior when compared to standard criteria DD kidneys. Although the term ECD kidneys has been used since the early 1990s to describe kidneys with various characteristics associated with poorer outcomes, the concept has been formally implemented in U.S. organ allocation. A DD kidney is considered to be an ECD organ if the estimated adjusted risk of graft failure is ≥ 70% (RR ≥ 1.70) compared to DD kidneys with standard characteristics of transplant suitability. The donor characteristics that define an ECD kidney include age ≥ 60 years, or age 50–59 years plus two of the following: cerebrovascular accident as the cause of death, preexisting hypertension, or terminal serum creatinine greater than 1.5 mg/dl. In the aggregate, recipients of ECD kidneys have improved survival compared to end‐stage renal disease (ESRD) patients on the kidney transplant waiting list. Patient survival is 5% lower at 1 year and 8–12% lower at 3–5 years for ECD kidney recipients. Adjusted graft survival in ECD kidneys is 8% lower at 1 year and 15–20% lower at 3–5 years after transplantation compared to standard criteria donor kidneys. However, patients less than 40 years of age, African Americans, Asians for whom the median waiting time is less than 1350 days receive no survival benefit from ECD kidney transplantation. Informed choice by the potential recipient is a prominent feature of the allocation policy regarding ECD kidneys. Since there are recipient characteristics associated with no survival benefit following ECD transplantation, nephrologists who refer patients for kidney transplantation should be familiar with the combination of donor and recipient factors that are likely to yield detrimental results.
Immunosuppression and Immune Monitoring After Renal Transplantation
Authors: Zand Martin S.
Published: September 2010

Monitoring of immunosuppression therapy in renal transplant recipients is essential for good patient and graft survival. Monitoring includes frequent laboratory assays of serum immunosuppression levels, patient visits to assess and treat side effects, and vigilance for medication interactions. We review the various immunosuppression medications commonly used in renal transplantation, including usual dosing and side effects. Monitoring assays are discussed, as well as the frequency of monitoring and patient visits. Finally, we discuss several common clinical scenarios that often require adjustment of immunosuppression medications or regimens.
A Patient‐Focused Approach to Thrombolytic Use in the Management of Catheter Malfunction
Authors: Lok Charmaine E. , Thomas Alison , Vercaigne Lavern ,   on behalf of the Canadian Hemodialysis Catheter Working Group
Published: September 2010

Thrombus‐related catheter malfunction is a significant problem for catheter‐dependent dialysis patients. The primary medical intervention is the local luminal installation of thrombolytic agents (TLAs). There are three major TLA installation methodologies: locking, push, and infusion protocols. A systematic literature review of existing TLA protocols for treating dialysis catheter malfunction was performed using the PubMed and EMBASE (Drugs and Pharmacology) databases from the time of each database's inception to August 2005. Thrombolytic administration was then categorized according to the patient's clinical need: (1) an acute/immediate requirement, such as when malfunction prohibits dialysis initiation, and (2) rescue therapy, such as when the thrombus threatens to significantly impair current or subsequent dialysis clearance. Published TLA protocols are discussed in the context of their clinical requirement (acute or rescue therapy). A unifying clinically relevant management algorithm that considers the etiology of catheter malfunction as being thrombus related or not, and an approach to TLA use based on clinical presentation is described. This algorithm was developed after a systematic review of the literature. The application of this treatment algorithm requires prospective validation and study.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Erythropoietin Resistance in the Treatment of the Anemia of Chronic Renal Failure
Authors: Priyadarshi Anumeet , Shapiro Joseph I.
Published: September 2010

Resistance to erythropoietin therapy is a common complication of the modern management of anemia in chronic kidney disease. Iron deficiency, deficiency of other nutrients, toxins, infections, and inadequate dialysis account for the vast majority of episodes of such resistance.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: The Safety of Heparins in End‐Stage Renal Disease
Authors: Sonawane Samsher , Kasbekar Nishaminy , Berns Jeffrey S.
Published: September 2010

In patients on chronic dialysis, unfractionated heparin (UFH) is the most commonly used agent for anticoagulation of the hemodialysis extracorporeal circuit, for hemodialysis catheter “locking” between dialysis treatments, and for nondialysis indications such as venous thromboembolic disease, peripheral vascular disease, and acute coronary artery disease. Potentially serious complications of UFH, such as hemorrhage, osteoporosis, and thrombocytopenia, have led to consideration of other options for anticoagulation, including low molecular weight heparin (LMWH) and direct thrombin inhibitors (DTIs). LMWH can be used for anticoagulation of the hemodialysis circuit, but whether this has significant benefit compared to UFH remains to be proven. Because of the somewhat unpredictable risk of severe bleeding complications when LMWH is used for other indications in dialysis patients, UFH rather than LMWH is preferred for treatment of thromboembolic disease in these patients. DTIs have been used for anticoagulation in dialysis patients with heparin‐induced thrombocytopenia (HIT), with argatroban being the preferred agent if heparin‐free hemodialysis cannot be performed. UFH still remains the preferred anticoagulant in the vast majority of dialysis patients requiring systemic anticoagulation and for anticoagulation of the extracorporeal hemodialysis circuit.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Anticoagulation and Continuous Renal Replacement Therapy
Authors: Amanzadeh Jamshid , Reilly Robert F.
Published: September 2010

More than half of patients with acute renal failure in the intensive care unit require dialysis, and the majority of them have significant hemodynamic instability. Continuous renal replacement therapy (CRRT) is often the preferred dialysis modality in these patients. One requirement for CRRT is anticoagulation, which can expose patients to the risk of bleeding. However, absence of effective anticoagulation may result in clotting of the CRRT circuit and subsequently less effective treatment. While heparins are widely used for anticoagulation, because of potential side effects such as bleeding and heparin‐induced thrombocytopenia, alternative anticoagulation protocols should be considered. Citrate anticoagulation, regional heparin/protamine, predilution, r‐hirudin, prostacyclin, and nafamostat are among these methods.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Dialysis‐Related Carnitine Disorder
Authors: Hedayati S. Susan
Published: September 2010

L‐carnitine plays an essential role in the β‐oxidation of fatty acids by catalyzing their transport into the mitochondrial matrix. The kidney maintains plasma free L‐carnitine levels in the homeostatic range by selective saturable tubular reabsorption. The preferential retention of free L‐carnitine over acyl‐L‐carnitines by the kidney is lost in patients with end‐stage renal disease (ESRD). Loss of renal parenchyma as a site of carnitine synthesis, as well as nonselective clearance of L‐carnitine by the dialysis procedure lead to dialysis‐related carnitine deficiency. Numerous studies investigating whether L‐carnitine supplementation will alleviate several dialysis‐related symptoms, such as intradialytic hypotension, heart failure, muscle weakness, low exercise capacity, and anemia, have reported conflicting results. Many of these studies suffer from a lack of randomization and control groups, heterogeneity in the administration of L‐carnitine, and nonstandardized measures of symptom improvement. More data exist to support the use of L‐carnitine in selected anemic dialysis patients with very large erythropoietin requirements in whom extensive examination for reversible causes of anemia was unrevealing.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Multiple Myeloma in End‐Stage Renal Disease
Authors: Penfield Jeffrey G.
Published: September 2010

Multiple myeloma is a common cause of chronic kidney disease (CKD). Patients with myeloma‐related kidney disease but low levels of serum monoclonal proteins can be diagnosed with symptomatic myeloma in a simplified diagnostic classification. The presence and type of renal disease in myeloma is dependent on the light chain secreted. Treatment has recently changed and now includes the use of thalidomide and bisphosphonates. Thalidomide can cause hyperkalemia and bisphosphonates can cause renal failure in patients with CKD. Their use is not contraindicated, but they should be used with caution. High‐dose melphalan with an autologous stem cell transplant is now the standard of care and should not be withheld from patients with CKD, even those on dialysis. This treatment can improve the renal disease, and this is more likely if treatment is started early. In patients with persistent dialysis dependence, renal transplantation can be performed if the patient has a complete remission.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Vascular Access Thrombosis Prophylaxis
Authors: Choudhury Devasmita
Published: September 2010

Vascular access thrombosis in the hemodialysis patient leads to significant cost and morbidity. Fistula patency supersedes graft patency, therefore obtaining a mature functioning fistula in patients approaching end‐stage renal disease (ESRD) by early patient education and referral needs to be practiced. Current methods to maintain vascular access patency rely on early detection and radiologic or surgical prevention of thrombosis. Study of thrombosis biology has elucidated other potential targets for the prophylaxis of vascular access thrombosis. The goal of this review is to examine the current available methods for vascular access thrombosis prophylaxis.
A Smile Enhances 3‐Month‐Olds’ Recognition of an Individual Face
Authors: Turati Chiara , Montirosso Rosario , Brenna Viola , Ferrara Veronica , Borgatti Renato
Published: September 2010

Recent studies demonstrated that in adults and children recognition of face identity and facial expression mutually interact (Bate, Haslam, & Hodgson, 2009; Spangler, Schwarzer, Korell, & Maier‐Karius, 2010). Here, using a familiarization paradigm, we explored the relation between these processes in early infancy, investigating whether 3‐month‐old infants’ ability to recognize an individual face is affected by the positive (happiness) or neutral emotional expression displayed. Results indicated that infants’ face recognition appears enhanced when faces display a happy emotional expression, suggesting the presence of a mutual interaction between face identity and emotion recognition as early as 3 months of age.
Effects of Intramuscular Administration of Acepromazine on Palmar Digital Blood Flow, Palmar Digital Arterial Pressure, Transverse Facial Arterial Pressure, and Packed Cell Volume in Clinically Healthy, Conscious Horses
Authors: LEISE BRITTA S. , FUGLER LEE ANN , STOKES ASHLEY M. , EADES SUSAN C. , MOORE RUSTIN M.
Published: September 2010

Objective—To determine the magnitude and duration of effects of acepromazine administered intramuscularly (IM) on digital and systemic hemodynamic variables in clinically healthy horses.

Study Design—Experimental study.

Animals—Healthy adult horses (n=12).

Methods—An ultrasonic Doppler flow probe was surgically implanted around the medial palmar digital artery before the study. Catheters were inserted in the transverse facial artery, lateral palmar digital artery, and jugular vein. A treatment group (n=6) was administered 0.04 mg/kg body weight of acepromazine IM; control horses (n=6) were administered an equivalent volume of saline IM. Palmar digital blood flow, and digital and facial arterial pressures were measured at baseline and for 6 hours after administration. Venous blood was collected for measurement of packed cell volume (PCV).

Results—Horses administered acepromazine had significantly lower facial arterial pressure compared with control horses administered saline. Palmar digital arterial blood flow in acepromazine‐treated horses was not significantly different from that in control horses but increased significantly post‐administration, compared with the respective baseline values for acepromazine‐treated horses. PCV significantly decreased in horses administered acepromazine compared with their respective baseline value.

Conclusion—IM acepromazine causes hypotension and increases palmar digital blood flow over time but the magnitude of the effect on digital blood flow was not sufficient to yield differences compared with saline‐treated horses.

Clinical Relevance—IM acepromazine has a modest effect on palmar digital blood flow, facial arterial pressures and PCV in healthy horses with minimal sedation.
A Modified Ventral Approach to the Atlantoaxial Junction in the Dog
Authors: SHORES ANDY , TEPPER LAURA C.
Published: September 2010

Objective— To describe and evaluate a surgical technique using a modified ventral approach for stabilization of the atlantoaxial (AA) junction in dogs with AA subluxation.

Study Design— Retrospective study.

Animals— Dogs (n=5) with AA subluxation.

Methods— Medical records (2000–2006) of 5 dogs with AA treated by stabilization via a right parasagittal approach were reviewed and outcome assessed by clinical examination and phone interviews with owners.

Results— The AA joint was clearly visualized and fixation devices were placed in all dogs. A right parasagittal approach provided excellent access to the AA junction and avoided dissection around the thyroid gland, trachea, and recurrent laryngeal nerve. Recovery was considered good to excellent by owners, and dogs returned to good function.

Conclusions— A right parasagittal approach to the AA junction provides improved exposure and allows for surgical stabilization with minimal complications.

Clinical Relevance— In dogs that require surgical stabilization of the AA joint, a right parasagittal approach should be considered. This approach offers advantages over the standard ventral median approach by improved surgical exposure, less dissection, and provides protection of vital structures during insertion of fixation devices used for ventral AA stabilization.
In Vitro Biomechanical Comparison of Equine Proximal Interphalangeal Joint Arthrodesis Techniques: Prototype Equine Spoon Plate Versus Axially Positioned Dynamic Compression Plate and Two Abaxial Transarticular Cortical Screws Inserted in Lag Fashion
Authors: SOD GARY A. , MITCHELL COLIN F. , HUBERT JEREMY D. , MARTIN GEORGE S. , GILL MARJORIE S.
Published: September 2010

Objectives—To compare in vitro monotonic biomechanical properties of an equine spoon plate (ESP) with an axial 3‐hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws (DCP‐TLS) inserted in lag fashion for equine proximal interphalangeal (PIP) joint arthrodesis.

Study Design—Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints.

Animal Population—Cadaveric adult equine forelimbs (n=18 pairs).

Methods—For each forelimb pair, 1 PIP joint was stabilized with an ESP (8 hole, 4.5 mm) and 1 with an axial 3‐hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion. Six matching pairs of constructs were tested in single cycle to failure under axial compression with load applied under displacement control at a constant rate of 5 cm/s. Six construct pairs were tested for cyclic fatigue under axial compression with cyclic load (0–7.5 kN) applied at 6 Hz; cycles to failure were recorded. Six construct pairs were tested in single cycle to failure under torsional loading applied at a constant displacement rate (0.17 radians/s) until rotation of 0.87 radians occurred. Mean values for each fixation method were compared using a paired t‐test within each group with statistical significance set atP<.05.

Results—Mean yield load, yield stiffness, and failure load for ESP fixation were significantly greater (for axial compression and torsion) than for DCP‐TLS fixation. Mean (± SD) values for the ESP and DCP‐TLS fixation techniques, respectively, in single cycle to failure under axial compression were: yield load 123.9 ± 8.96 and 28.5 ± 3.32 kN; stiffness, 13.11 ± 0.242 and 2.60 ± 0.17 kN/cm; and failure load, 144.4 ± 13.6 and 31.4 ± 3.8 kN. In single cycle to failure under torsion, mean (± SD) values for ESP and DCP‐TLS, respectively, were: stiffness 2,022 ± 26.2 and 107.9 ± 11.1 N m/rad; and failure load: 256.4 ± 39.2 and 87.1 ± 11.5 N m. Mean cycles to failure in axial compression of ESP fixation (622,529 ± 65,468) was significantly greater than DCP‐TLS (95,418 ± 11,037).

Conclusion—ESP was superior to an axial 3‐hole narrow DCP with 2 abaxial transarticular screws inserted in lag fashion in resisting static overload forces and cyclic fatigue.

Clinical Relevance—In vitro results support further evaluation of ESP for PIP joint arthrodesis in horses. Its specific design may provide increased stability without need for external coaptation support.
Endoscope‐Guided, Transoral Axial Division of an Entrapping Epiglottic Fold in Fifteen Standing Horses
Authors: PERKINS JUSTIN D. , HUGHES THOMAS K. , BRAIN BEN
Published: September 2010

Objectives—To describe and evaluate the use of a transoral, endoscope‐guided technique for transection of an entrapping epiglottic fold in sedated standing horses.

Study Design—Retrospective study.

Animals—Horses (n=16) with epiglottic fold entrapment (EFE).

Methods—Medical records (2005–2006) of 16 horses with EFE were reviewed to determine history, physical and endoscopic examination findings, postoperative complications, and outcome after axial division of EFE using a hooked bistoury, under an endoscopic‐guided, transoral approach.

Results—EFE was confirmed by endoscopy. Axial division was successfully performed in 15 sedated, standing horses. One horse had to be anesthetized to complete the procedure. None of the horses made abnormal respiratory noise after surgery and all returned to their intended use. After surgery, 1 horse had a short, deformed epiglottis.

Conclusions—EFE can be axially divided safely and effectively using an endoscope‐guided, transoral approach, with the horse sedated and standing.

Clinical Relevance—Endoscopic‐guided, transoral axial division of EFE in sedated standing horses is an alternative choice to performing this procedure under general anesthesia.
Comparison of Radiographic and Anatomic Femoral Varus Angle Measurements in Normal Dogs
Authors: SWIDERSKI JENNIFER K. , RADECKI STEVEN V. , PARK RICHARD D. , PALMER ROSS H.
Published: September 2010

Objective— To determine if the clinically practiced method of radiographic femoral varus angle (R‐FVA) measurement is repeatable, reproducible, and accurate.

Study Design— Radiographic and anatomic study.

Animals/Sample Population— Normal Walker hound cadavers (n=5) and femora (n=10).

Methods— Cadavers were held in dorsally‐recumbent and torso‐elevated positions as 3 craniocaudal radiographs were made of each femur, by each of 2 different technicians. Femora were then harvested for direct measurement of anatomic femoral varus angle (A‐FVA). R‐FVA was measured on each radiograph by each of 3 examiners on 3 separate occasions. Intra‐observer (repeatability) and inter‐observer (reproducibility) variance in R‐FVA measurement and the strength of relationship between R‐FVA and A‐FVA (accuracy) were determined.

Results— Mean (±SD) A‐FVA was 5.2±2.1° (range, 2.4–8.2°). Mean (±SD) R‐FVA was 5.8±1.0° (range, 2.7–9.6°). Intra‐observer variance (range: 11–16%) and inter‐observer variance (16%) were acceptable. The strength of relationship between measured R‐FVA and A‐FVA (maximum adjusted R2<0) was unacceptably low regardless of observer, patient position, or radiographic technician.

Conclusion— R‐FVA measurement was repeatable and reproducible, but not statistically accurate in predicting A‐FVA in these 5 normal Walker hounds. The detected inaccuracy may be real or the result of a selection bias for normal dogs obscuring the true relationship.

Clinical Relevance— R‐FVA may not be an accurate method of femoral varus measurement in dogs with A‐FVA<10°. Using Slocum's criteria for distal femoral osteotomy (R‐FVA>10°), the procedure would not have been erroneously performed in any of the normal dogs of this study.
Pull‐Through Technique for Palmar Digital Neurectomy: Forty‐One Horses (1998–2004)
Authors: MAHER OMAR , DAVIS DAVID MICHAEL , DRAKE CHRISTIANA , MYHRE GRANT D. , LABBE KAREN M. , HAN JANET H. , LEJEUNE SARAH S.
Published: September 2010

Objectives—To report outcome of horses treated for navicular syndrome using a pull‐through (PT) technique for palmar digital neurectomy (PDN).

Design—Retrospective study.

Animals—Horses (n=41) with navicular syndrome (NS).

Methods—Medical records (1998–2002) for horses that had NS and failed to respond to conservative management that had unilateral or bilateral forelimb, biaxial PDN were reviewed. Outcome for up to 6 years was obtained by telephone questionnaire or lameness examination. Survival analysis was used to assess time to recurrence of lameness.

Results—One year after PDN, 36 horses (88%) were free of lameness. Mean survival with no lameness after surgery was estimated at 4.14±0.33 years (median, 5 years).

Conclusions—PT–PDN technique resulted in soundness for 88% of horses for at least 1 year. PT–PDN was easily and quickly performed without specialized equipment, and had a low incidence of complications.

Clinical Relevance—The PT technique is an effective and viable alternative surgical method for PDN.
Storing apheresis platelets without agitation with simulated shipping conditions during two separate periods: immediately after collection and subsequently between Day 2 and Day 3
Authors: Moroff Gary , Kurtz James , Seetharaman Shalini , Wagner Stephen J.
Published: September 2010

BACKGROUND: Apheresis platelet (PLT) units are not routinely agitated during transit. Our study compared the in vitro properties of apheresis PLT units that were stored with continuous agitation (CA) and without continuous agitation (WCA) during two separate periods, immediately after collection and between Day 2 and Day 3 of storage.

STUDY DESIGN AND METHODS: Two identical apheresis PLTs units were prepared from collections with Amicus (n = 11, Fenwal, Inc.) and Trima (n = 10, CaridianBCT) cell separators. One apheresis PLT unit was continuously agitated, starting routinely within 30 minutes of collection, and an identical apheresis PLT unit was held without agitation initially for 7 to 8 hours and subsequently for 24 hours between Day 2 and Day 3 of storage. The apheresis PLT units were maintained WCA at 20 to 24°C in a shipping box. In vitro PLT properties were evaluated on Day 1 (day after collection), after 5 and 7 days of storage.

RESULTS: With both Amicus and Trima apheresis PLT units, the mean PLT content and concentration of CA and WCA were comparable and essentially constant throughout storage. Mean pH levels (±1 SD) after 5 days for Amicus apheresis PLT units were 6.97 ± 0.20 (WCA) and 7.13 ± 0.16 (p < 0.001, CA) and for Trima apheresis PLT units 6.97 ± 0.21 (WCA) and 7.22 ± 0.17 (p < 0.001, CA). In vitro variables, including percentage of disc PLTs, extent of shape change, and hypotonic stress levels, after 5 days of storage, showed mean differences between WCA and CA that were less than 15%.

CONCLUSION: The in vitro results show that apheresis PLT units can be stored without agitation for 7 to 8 hours immediately after collection and also subsequently during storage for 24 hours with minimal influence on in vitro PLT properties compared to continuously agitated PLTs.
Is there a clinical need for a diagnostic test allowing detection of chain type–specific anti‐A and anti‐B? (CME)
Authors: Lindberg Linda , Johansson Sandra M. , Liu Jining , Grufman Per , Holgersson Jan
Published: September 2010

BACKGROUND: Hemagglutination for detection and semiquantification of ABO antibodies is associated with large center‐to‐center variations and poor reproducibility. Because acceptance for transplantation and diagnosis of rejection in ABO‐incompatible transplantation rely on the levels and specificity of ABO antibodies, reproducible tests that allow their detection and specificity determination are required.

STUDY DESIGN AND METHODS: The level of chain type–specific anti‐A and anti‐B were analyzed in the sera of 44 healthy individuals of known ABO blood group using an enzyme‐linked immunosorbent assay (ELISA) with polyacrylamide (PAA) conjugates of blood group A and B trisaccharides or Type 2 chain A and B tetrasaccharides. Selected sera were further analyzed by hemagglutination and in an ELISA with Types 1 to 4 chain A or B neoglycolipids (NGL) as antigens.

RESULTS: Immunoglobulin (Ig)G anti‐A and anti‐B levels were higher (p ≤ 0.05) in blood group O than in B and A individuals. More IgM anti‐A and anti‐B cross‐reactivity was detected in AB serum on PAA‐conjugated A and B trisaccharides than on the tetrasaccharides. One of 11 blood group B and two of 12 A individuals had IgG antibodies binding the tetrasaccharide despite lack of, or very low reactivity with, the trisaccharides. IgG antibodies preferring the A and B Type 2 tetrasaccharides were of the IgG2 subclass. The NGL ELISA further supported the presence of chain type–specific anti‐A and ‐B antibodies among nonsensitized, healthy individuals.

CONCLUSION: An ELISA with structurally defined ABH antigens will allow the antibody class and fine specificity of ABO antibodies to be determined, which may improve risk assessment in ABO‐incompatible transplantation.
Survival of Plasmodium falciparum in human blood during refrigeration
Authors: Chattopadhyay Rana , Majam Victoria F. , Kumar Sanjai
Published: September 2010

BACKGROUND: Transfusion‐transmitted malaria remains a serious concern for blood safety. Viable Plasmodium parasites must be present in human blood to transmit malaria, but their survival in blood over time stored under refrigeration has never been carefully investigated.

STUDY DESIGN AND METHODS: We spiked leukoreduced normal human blood with Plasmodium falciparum (3D7 strain) asexual ring‐stage parasites and stored it at 4°C for 28 days, taking samples at different days intervals. We evaluated the samples for parasitemia by blood film microscopy and by culturing red blood cells (RBCs) to allow further development of parasites.

RESULTS: We observed a significant reduction in parasitemia (0.5% vs. 0.12%) after only 1 day in storage at 4°C. Thereafter, reduction in parasitemia was relatively gradual. Microscopically detectable parasites were present even after 28 days of storage. However, after storing for more than 14 days at 4°C, parasites no longer replicated when cultured in vitro.

CONCLUSION: Although the storage of asexual blood‐stage P. falciparum parasites at 4°C is detrimental to their survival (a 7.1‐fold reduction in parasitemia after 14 days in storage), parasites remained microscopically detectable for 28 days, the end time point of our study. Further in vitro and in vivo studies will be needed to confirm loss of viability of P. falciparum after 14 days in storage, but our initial efforts repeatedly failed to show maturation and development of the parasites in cultured RBCs after that time.
Use of additive solutions and pathogen inactivation treatment of platelet components in a regional blood center: impact on patient outcomes and component utilization during a 3‐year period
Authors: Cazenave Jean‐Pierre , Isola Hervé , Waller Chantal , Mendel Isabelle , Kientz Daniel , Laforêt Michel , Raidot Jean‐Pierre , Kandel Gérard , Wiesel Marie‐Louise , Corash Laurence
Published: September 2010

BACKGROUND: The Etablissement Français du Sang Alsace (EFS Alsace) successively implemented universal use of platelet additive solutions (PASs) and pathogen inactivation (PI) for platelet components (PCs). To assess the impact of these changes, EFS Alsace evaluated PC use, red blood cell (RBC) component use, and transfusion‐related adverse events after implementation of these new technologies.

STUDY DESIGN AND METHODS: EFS Alsace prospectively collects data on production, distribution, and response to transfusion of all blood components with greater than 99.5% data acquisition. Adverse events attributed to platelet (PLT) transfusions were collected through a mandatory, active hemovigilance program. A retrospective review of prospectively collected data was conducted covering three periods: 1) apheresis and whole blood–derived PCs in plasma, 2) apheresis and whole blood–derived PCs with PAS, and 3) PCs prepared with PI and PAS. Data on component utilization were analyzed for all patients receiving PCs in each period and for the subset of hematology‐oncology patients to evaluate PC use in an intensely transfused population. Values for all continuous variables were summarized as mean and standard deviation, median, and range.

RESULTS: Approximately 2000 patients received PCs in each period. PLT and RBC use per patient was not increased after PI (analysis of variance, F = 1.9 and 2.9, respectively) and the incidence of acute transfusion reactions was significantly reduced (p < 0.001).

CONCLUSIONS: Universal use of PI was implemented without impacting component use, as indicated by total dose of PLTs per patient, and outcomes to transfusion were improved.
Cord blood banking and transplantation at the Mexican Institute of Social Security: the first 5 years
Authors: Guerra‐Marquez Angel , Novelo‐Garza Barbara , Malagón‐Martínez Araceli , Limon‐Flores Alejandro , Luna‐Bautista Fernando , Juan‐Shum Luis , Montero‐Ponce Ines , Sanchez‐Valle Elizabeth , Peñaflor Karina , Vélez‐Ruelas Maria Antonieta , Romero‐Juárez Yanin , Mayani Hector
Published: September 2010

BACKGROUND: In January 2005, the Cord Blood Bank (CBB) at the Mexican Institute of Social Security initiated activities. Herein, we describe the experience generated during this period (January 1, 2005‐December 31, 2009).

STUDY DESIGN AND METHODS: Good manufacturing practices and standard operating procedures were used to address donor selection, as well as umbilical cord blood (UCB) collection, processing, and cryopreservation. Based mainly on HLA and nucleated cell content, specific UCB units were thawed, processed, and released for transplantation.

RESULTS: A total of 589 UCB units were stored, representing 54% of the total number of units collected. Forty‐eight units (8.14% of the stored units) were released for transplantation of 36 patients. Twenty‐six patients (72% of cases) corresponded to patients with acute leukemia, five (14%) to patients with marrow failure, and the rest (five; 14%) to patients with hemoglobinopathies and other syndromes. The median number of nucleated cells infused per patient was 6.71 × 107/kg and the median number of CD34+ cells was 4.8 × 105/kg. Current engraftment data indicate that engraftment occurred in 56%, and no engraftment in 44%, of cases. Engraftment was more frequent (59%) in patients that received more than 3 × 107 total nucleated cells (TNCs)/kg body weight, than in those receiving fewer than 3 × 107 TNCs/kg (40%). Myeloid engraftment was observed 7 to 54 days posttransplant (median, 23 days), whereas platelet engraftment was detected on Days 12 to 87 posttransplant (median, 38 days). To date, the disease‐free survival rate was 41% and the overall survival was 47%, with survival periods of 126 to 1654 days.

CONCLUSION: Although the experience presented herein is still limited and the period of analysis is still short, the results obtained during these 5 years are encouraging.
Analysis of Chinese donors' return behavior
Authors: Guo Nan , Wang Jingxing , Ness Paul , Yao Fuzhu , Dong Xiangdong , Bi Xinhong , Mei Heili , Li Julin , He Weilan , Lu Yunlai , Ma Hongli , Wen Xiuqiong , Huang Mei , Wright David J. , King Melissa , High Patrick , Nelson Kenrad , Shan Hua ,   for the NHLBI Retrovirus Epidemiology Donor Study‐II (REDS‐II), International Component
Published: September 2010

BACKGROUND: It is important to understand donor return behavior. Converting first‐time donors to become repeat donors is essential for maintaining an adequate blood supply.

STUDY DESIGN AND METHODS: Characteristics of 241,552 whole blood (WB) donations from first‐time and repeat donors who donated in 2008 at the five blood centers in China were compared. A subset of 54,394 WB donors who donated between January 1 and March 31, 2008, were analyzed for their return behavior in 2008 after the index donation using logistic regression.

RESULTS: Of all donations, 64% were from first‐time donors. Donors with self‐reported previous donations tended to be male, older, and married; donated larger volume (≥300 mL); and were heavier in weight. Among donors who donated from January to March 2008, 14% returned for subsequent WB donations by the end of 2008. The number of previous donations and blood collection location were the two strongest predictors for making subsequent donations. Donors with one, two to three, and more than three previous donations were 3.7, 5.7, and 11.0 times more likely to return than first‐time donors. Those who donated in a blood collection vehicle were four times more likely to return than those who donated at a blood center. Being female, younger, and of a lower education level (middle school or less) were positively associated with subsequent return blood donation during the follow‐up period observed in this study.

CONCLUSION: Most of the Chinese blood supply is from first‐time donors. Strategies aimed at encouraging current donors to become repeat donors are needed.
Implications of demographics on future blood supply: a population‐based cross‐sectional study
Authors: Greinacher Andreas , Fendrich Konstanze , Brzenska Ralf , Kiefel Volker , Hoffmann Wolfgang
Published: September 2010

BACKGROUND: Data on blood recipients are sparse and unconnected to data on blood donors. The objective was to analyze the impact of the demographic change on future blood demand and supply in a German federal state.

STUDY DESIGN AND METHODS: A population‐based cross‐sectional study was conducted. For all in‐hospital transfused red blood cells (RBCs; n = 95,477), in the German federal state Mecklenburg‐Pomerania in 2005, characteristics of the patient and the blood donor (118,406 blood donations) were obtained. Population data were used to predict blood demand and supply until 2020.

RESULTS: By 2020 the population increase of those aged 65 years or more (+26.4%) in Mecklenburg‐Pomerania will be paralleled by a decrease of the potential donor population (18‐68 years; −16.1%). Assuming stable rates per age group until 2020, the demand for in‐hospital blood transfusions will increase by approximately 25% (24,000 RBC units) while blood donations will decrease by approximately 27% (32,000 RBC units). The resulting, predicted shortfall is 47% of demand for in‐hospital patients (56,000 RBC units). Validation using historical data (1997‐2007) showed that the model predicted the RBC demand with a deviation of only 1.2%. Demographic changes are particularly pronounced in former East Germany, but by 2030 most European countries will face a similar situation. The decrease of younger age groups requires an increase of blood donation rates and interdisciplinary approaches to reduce the need for transfusion to maintain sufficient blood supply.

CONCLUSIONS: Demography is a major determinant of future transfusion demand. All efforts should be made by Western societies to systematically obtain data on blood donors and recipients to develop strategies to meet future blood demand.
Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia
Authors: Behere R. V. , Arasappa R. , Jagannathan A. , Varambally S. , Venkatasubramanian G. , Thirthalli J. , Subbakrishna D. K. , Nagendra H. R. , Gangadhar B. N.
Published: September 2010

Behere RV, Arasappa R, Jagannathan A, Varambally S, Venkatasubramanian G, Thirthalli J, Subbakrishna DK, Nagendra HR, Gangadhar BN. Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.

Objective:  Facial emotion recognition deficits have been consistently demonstrated in schizophrenia and can impair socio‐occupational functioning in these patients. Treatments to improve these deficits in antipsychotic‐stabilized patients have not been well studied. Yoga therapy has been described to improve functioning in various domains in schizophrenia; however, its effect on FERD is not known.

Method:  Antipsychotic‐stabilized patients randomized to receive Yoga (n = 27), Exercise (n = 17) or Waitlist group (n = 22) were assessed at baseline, 2nd month, and 4th month of follow‐up by raters blind to group status. Assessments included Positive and Negative Syndrome Scale (PANSS), Socio‐Occupational Functioning Scale (SOFS), and Tool for Recognition of Emotions in Neuropsychiatric DisorderS (TRENDS).

Results:  There was a significant positive correlation between baseline FERD and socio‐occupational functioning (r = 0.3, P = 0.01). Paired samples t test showed significant improvement in positive and negative symptoms, socio‐occupational functioning and performance on TRENDS (P < 0.05) in the Yoga group, but not in the other two groups. Maximum improvement occurred at the end of 2 months, and improvement in positive and negative symptoms persisted at the end of 4 months.

Conclusion:  Yoga therapy can be a useful add‐on treatment to improve psychopathology, FERD, and socio‐occupational functioning in antipsychotic‐stabilized patients with schizophrenia.