bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful surgical repair of acute type A aortic dissection without the use of blood products
Authors: Papalexopoulou N , Attia RQ , Bapat VN 
Published: October 2013

We report successful surgical treatment of type A aortic dissection in a Jehovah’s Witness without the use of any blood products. An interposition graft replacement of the ascending aorta was carried out. This was under right axillo-atrial cardiopulmonary bypass with antegrade cerebral perfusion via right a subclavian and left carotid cannula for 24 minutes at 28ºC. Body temperature was kept at 32ºC throughout. Autologous transfusion was deployed using cell salvage and a preoperative haemodilution technique. The patient was given tranexamic acid, desmopressin, recombinant factor VIIa, folic acid and epoetin alfa. Patients who object to transfusion represent a significant challenge, especially those who are at a high risk of coagulopathy associated with inherent aortic dissection leading to perturbed haemodynamics, cardiopulmonary bypass and hypothermic circulatory arrest. Type A aortic dissection repair is possible in patients refusing the use of blood products with blood salvage techniques and synthetic products that can limit the risk of bleeding. Minimal hypothermia is vital to preserve platelet function and avoid coagulopathy. Thus, a combination of normothermic/minimal hypothermia and antegrade cerebral protection with a blood conservation strategy can be deployed for a successful surgical outcome in aortic dissection without transfusion.
Variations in selective nerve root block technique
Authors: Eastley NC , Spiteri V , Newey ML 
Published: October 2013

Introduction Much literature reports on selective nerve root blocks (SNRBs) in cases of lumbosacral radiculopathy. Unfortunately, authors only inconsistently reveal the exact needle tip position relative to the causative pathology at the time of injection. Different injection sites may provide different symptomatic benefits. We investigated the variation in injection techniques of practitioners working in the UK. Methods A clinical scenario was devised depicting a patient with radiculopathy secondary to an L4/5 vertebral disc prolapse. Participants were questioned on their chosen management of this patient, focusing particularly on SNRB technique. Questionnaires were sent to spinal surgeons, pain management specialists and musculoskeletal radiologists. Results A total of 100 responses were detailed enough for inclusion. The majority (83%) of respondents reported they would inject local anaesthetic and steroids, 4% would inject local anaesthetic alone and 13% would inject a different substance. Over half (53%) would target the L5 nerve root, 26% the L4 nerve root, 12% the prolapsed disc itself and 9% two separate vertebral levels. Variation was also noted in needle tip location relative to the neural sheath. Conclusions When treating lumbar radiculopathy, there are apparent variations in the use and positioning of SNRBs for a given level of disc pathology. Needle tip position may have a direct influence on clinical outcome following SNRBs. Caution is therefore required when considering the validity of previously published studies investigating SNRBs and different injectates.
Natural history of acalculous biliary symptoms
Authors: Warwick AM , Bintcliffe F , Wu E , Stell D 
Published: October 2013

Introduction The radiological criteria for the diagnosis of gallbladder disease rely largely on the detection of calculi using ultrasonography. Patients may, however, suffer symptoms typical of biliary pain without detectable gallstones. The aim of this study was to identify a cohort of patients presenting with recurrent episodes of biliary symptoms in the absence of identifiable pathology on ultrasonography and to record the outcome of subsequent imaging investigations. Methods Records of patients having abdominal ultrasonography during a four-month period in 2006 were accessed retrospectively and those with symptoms suggesting biliary disease were identified. Radiology records were reviewed over a five-year follow-up period to identify patients undergoing further imaging for recurrent biliary symptoms and outcomes were recorded. Results A total of 512 patients had ultrasonography for investigation of symptoms consistent with biliary disease. Almost half (41.2%) of these were found to have gallbladder pathology on ultrasonography and 4.7% of patients went on to have further investigations for similar symptoms without achieving a diagnosis. The median age of this group was 47 years and 75% of these patients were female. During the follow-up period, 2.6% of patients with biliary symptoms and initially normal ultrasonography developed gallstones and in 1.3% pancreatitis was demonstrated on imaging. Conclusions A small minority of patients who present with biliary symptoms and have no abnormality on ultrasonography present with recurrent symptoms or develop significant biliary pathology. These patients should be identified by interview at routine follow-up visits and further investigations should be considered.
The role of magnetic resonance cholangiopancreatography in the management of acute gallstone pancreatitis
Authors: Barlow AD , Haqq J , McCormack D , Metcalfe MS , Dennison AR , Garcea G 
Published: October 2013

Introduction The aim of this study was to identify whether magnetic resonance cholangiopancreatography (MRCP) can be used selectively in patients with acute gallstone pancreatitis to detect choledocholithiasis, based on liver function tests (LFTs) and ultrasonography appearance. Methods All patients admitted between January 2008 and January 2011 with gallstone pancreatitis (amylase >300u/l) who underwent MRCP were included in the study. LFTs and radiology reports were obtained from the respective computer systems. RESULTS Overall, 173 patients with acute gallstone pancreatitis underwent MRCP and 30% (52/173) showed choledocholithiasis. The mean bilirubin level was significantly higher in those with choledocholithiasis (46 ±5µmol/l vs 36 ±3µmol/l, p=0.0388) although there was no significant difference in alkaline phosphatase (276 ±25iu/l vs 229 ±16iu/l, p=0.1154). However, sensitivity of abnormal bilirubin (>21µmol/l) for choledocholithiasis was only 62% and specificity was 41%. Sensitivity of abnormal alkaline phosphatase (>140iu/l) for choledocholithiasis was only 75% and specificity was 37%. There was a significant association between biliary dilatation on ultrasonography and choledocholithiasis on MRCP (p=0.0099) although the sensitivity of biliary dilatation for choledocholithiasis was only 44% and the specificity was 79%. Furthermore, there was no difference in the incidence of choledocholithiasis on MRCP for those patients with persistently deranged LFTs versus those whose LFTs returned to normal (relative risk: 1.07, 95% confidence interval: 0.61–1.89, p=1.00). Overall, 10% of patients with choledocholithiasis on MRCP had entirely normal LFTs on admission and no biliary dilatation or choledocholithiasis on ultrasonography. Conclusions All patients with acute gallstone pancreatitis should undergo specific imaging, preferably MRCP, to exclude choledocholithiasis as LFTs and ultrasonography are inaccurate in predicting common bile duct stones.
Fine-Needle Aspiration Cytology for the Diagnosis of Metastatic Melanoma
Authors: Hall Brian J. , Schmidt Robert L. , Sharma Rohit R. , Layfield Lester J. 
Published: October 2013

Abstract

Objectives:
To perform a thorough review and meta-analysis of studies that have shown non–image-guided fine-needle aspiration cytology (FNAC) to be highly sensitive and specific for assessing questionable metastatic melanoma to lymph nodes.

Methods:
MEDLINE and Scopus were searched for potentially relevant articles with a search string including the words “melanoma” and “fine needle.” All relevant articles were screened by two authors (B.J.H. and R.L.S.). Full articles were screened for extractable data, and the data was pooled for analysis.

Results:
Of 978 unique studies found, 10 (5,518 cases) met our inclusion criteria. In a pooled analysis of palpation and ultrasound-guided fine-needle aspirations, the area under the receiver operating characteristic curve was 0.99 (95% confidence interval [CI], 0.99–1.00). The summary estimates for the sensitivity and specificity were 0.97 (95% CI, 0.95–0.98) and 0.98 (95% CI, 0.98–1.00), respectively.

Conclusions:
With a sensitivity and specificity of 0.97 and 0.99, the overall diagnostic accuracy of FNAC for metastatic melanoma is quite high, and with a positive and negative likelihood ratio of 58 and 0.03, FNAC for metastatic melanoma should be the first-line option in a patient with a clinically suspected mass and a history of melanoma.
Pear Drying: Thermodynamics Studies and Coefficients of Convective Heat and Mass Transfer
Authors: da Silva Alexandre Navarro , dos Reis Coimbra Jane Sélia , Botelho Fernando Mendes , de Moraes Moysés Naves , de Faria Janaína Teles , Bezerra Maria da Conceição Trindade , Martins Márcio Arêdes , Marcos de Oliveira Siqueira Antônio 
Published: October 2013

Abstract
The objective of this work was to study the convective drying process used for cylindrical samples of two different pear varieties, one originating from Europe (Pyrus communis) and the other from Asia (Pyrus pyrifolia), submitted to two blanching treatments, as well as determine some coefficients referring to heat and mass transfer and thermodynamic parameters of the process, being: enthalpy (ΔH*), entropy (ΔS*) and Gibbs energy of activation (ΔG*). All samples were dried in a forced air oven at temperatures of (62, 76, 84 and 92)°C until reaching a constant mass. The heat and mass transfer coefficients referring to the constant and falling-rate drying periods were obtained by adjusting the experimental data to wet bulb temperature and liquid diffusion models, respectively. The heat and mass transfer coefficients varied linearly with temperature. Blanching altered the drying behavior of the two varieties in relation to the non-blanched samples, mainly at the elevated drying temperatures of 84°C and 92°C. ΔH* and ΔS* decreased while ΔG* increased with the elevation of drying temperature; therefore, it was possible to verify that variation in the diffusion process in pears during drying is dependent on energetic contributions of the environment.
SNPs within the GH-signaling pathway are associated with the early IGF1 response to GH replacement therapy in GHD adults
Authors: Glad Camilla A M , Barbosa Edna J L , Filipsson Nyström Helena , Carlsson Lena M S , Nilsson Staffan , Nilsson Anna G , Svensson Per-Arne , Johannsson Gudmundur 
Published: October 2013

ObjectiveGH-deficient (GHD) adults have reduced serum concentrations of IGF1. GH replacement therapy increases serum IGF1 concentrations, but the interindividual variation in treatment response is large and likely influenced by genetic factors. This study was designed to test the hypothesis that single-nucleotide polymorphisms (SNPs) in genes within the GH signaling pathway influence the serum IGF1 response to GH replacement.Design and methodsA total of 313 consecutive GHD adults (58.1% men; mean age 49.7 years) were studied before and after 1 week, 6 months, and 1 year of GH treatment. GH dose was individually titrated to normalize serum IGF1 levels. Six SNPs in the GH receptor (GHR) and the GH signaling pathway (JAK2,STAT5B,SOCS2, andPIK3CB) genes were selected for genotyping. TheGHRexon 3-deleted/full-length (d3/fl) polymorphism was analyzed using tagSNP rs6873545.ResultsAfter 1 week of GH replacement, homozygotes of the fl-GHR showed a better IGF1 response to GH than carriers of the d3-GHR (P=0.016). Conversely, homozygotes of the minor allele ofPIK3CBSNP rs361072 responded better than carriers of the major allele (P=0.025). Compared with baseline, both SNPs were associated with the IGF1 response at 6 months (P=0.041 andP=0.047 respectively), and SNP rs6873545 was further associated with the IGF1 response at 1 year (P=0.041).ConclusionsOur results indicate that common genetic variants in the GH signaling pathway may be of functional relevance to the response to GH replacement in GHD adults.
Estradiol regulates GH-releasing peptide's interactions with GH-releasing hormone and somatostatin in postmenopausal women
Authors: Norman Catalina , Rollene Nanette L , Erickson Dana , Miles John M , Bowers Cyril Y , Veldhuis Johannes D 
Published: October 2013

ObjectiveEstrogen stimulates pulsatile secretion of GH, via mechanisms that are largely unknown. An untested hypothesis is that estradiol (E2) drives GH secretion by amplifying interactions among GH-releasing hormone (GHRH), somatostatin (SS), and GH-releasing peptide (GHRP).DesignThe design comprised double-blind randomized prospective administration of transdermal E2vs placebo to healthy postmenopausal women (n=24) followed by pulsatile GHRH or SS infusions for 13 h overnight with or without continuous GHRP2 stimulation.MethodsEnd points were mean concentrations, deconvolved secretion, and approximate entropy (ApEn; a regularity measure) of GH.ResultsBy generalized ANOVA models, it was observed that E2vs placebo supplementation: i) augmented mean (13-h) GH concentrations (P=0.023), GHRH-induced pulsatile GH secretion over the first 3 h (P=0.0085) and pulsatile GH secretion over the next 10 h (P=0.054); ii) increased GHRP-modulated (P=0.022) and SS-modulated (P<0.001) GH ApEn; and iii) did not amplify GHRH/GHRP synergy during pulsatile GH secretion. By linear regression, E2concentrations were found to be positively correlated with GH secretion during GHRP2 infusion (P=0.022), whereas BMI was found to be negatively correlated with GH secretion during GHRH (P=0.006) and combined GHRH/GHRP (P=0.015) stimulation. E2and BMI jointly determined triple (combinedl-arginine, GHRH, and GHRP2) stimulation of GH secretion after saline (R2=0.44 andP=0.003) and pulsatile GHRH (R2=0.39 andP=0.013) infusions.ConclusionIn summary, in postmenopausal women, E2supplementation augments the amount (mass) and alters the pattern (regularity) of GH secretion via interactions among GHRH, SS, GHRP, and BMI. These outcomes introduce a more complex model of E2supplementation in coordinating GH secretion in aging women.
Synthesis, characterisation, and antioxidant study of Cr(III)-rutin complex
Authors: Panhwar Qadeer , Memon Shahabuddin 
Published: October 2013

AbstractThe article describes the synthesis and characterisation of the Cr(III)-rutin complex along with an estimate of its antioxidant activity. The complex was characterised using elemental analysis, UV-VIS, IR, conductance data, thermal, and gravimetric analyses. In the UV-VIS study, a bathochromic shift of approximately 98 nm indicates the formation of a rutin complex by more than one chelating site. The FT-IR spectra clearly show the formation of the Cr—O bond between rutin and Cr(III) at 494 cm−1, while the thermal study shows the presence of eight coordinated water molecules in the complex. The gravimetric analysis quantitatively proves the presence of four chloride ions. From these data, the formula of the Cr(III)-rutin complex was deduced as [Cr2(C27H28O16)(H2O)8]Cl4. Moreover, the antioxidant study of the complex was evaluated by using 2,2′-diphenyl-1-picrylhydrazyl (DPPH) free-radical, ferric-reducing, and phosphomolybdenum assays, which show that the complex has a higher antioxidant activity than rutin.
Reduction of nitroblue tetrazolium to formazan by folic acid
Authors: Achilli Cesare , Grandi Stefania , Ciana Annarita , Balduini Cesare , Minetti Giampaolo 
Published: October 2013

AbstractThe reduction of nitroblue tetrazolium (NBT) to formazan by folic acid, N-(4-aminobenzoyl) glutamic acid, and other amino acids was studied in this paper. The reduction involves only one of the two tetrazolium rings of NBT. The reaction is considerably more rapid with folic acid and N-(4-aminobenzoyl) glutamic acid than with the other amino acids under study. The electron donor moiety appears to be the carboxylic acid in the alpha position. N-ethyl-N′(3-dimethylaminopropyl) carbodiimide notably increases the rate of the reaction and promotes the reduction of both tetrazolium rings.
Recruitment of Discrete Regions of the Psoas Major and Quadratus Lumborum Muscles Is Changed in Specific Sitting Postures in Individuals With Recurrent Low Back Pain
Authors: Park Rachel J. , Tsao Henry , Claus Andrew , Cresswell Andrew G. , Hodges Paul W. 
Published: October 2013

Study Design Cross-sectional controlled laboratory study. Objectives To investigate potential changes in the function of discrete regions of the psoas major (PM) and quadratus lumborum (QL) with changes in spinal curvatures and hip positions in sitting, in people with recurrent low back pain (LBP). Background Although the PM and QL contribute to control of spinal curvature in sitting, whether activity of these muscles is changed in individuals with LBP is unknown. Methods Ten volunteers with recurrent LBP (pain free at the time of testing) and 9 pain-free individuals in a comparison group participated. Participants with LBP were grouped into those with high and low erector spinae (ES) electromyographic (EMG) signal amplitude, recorded when sitting with a lumbar lordosis. Data were recorded as participants assumed 3 sitting postures. Fine-wire electrodes were inserted with ultrasound guidance into fascicles of the PM arising from the transverse process and vertebral body, and the anterior and posterior layers of the QL. Results When data from those with recurrent LBP were analyzed as 1 group, PM and QL EMG signal amplitudes did not differ between groups in any of the sitting postures. However, when subgrouped, those with low ES EMG had greater EMG signal amplitude of the PM vertebral body and QL posterior layer in flat posture and greater EMG signal amplitude of the QL posterior layer in short lordotic posture, compared to those in the pain-free group. For the group with high ES EMG, the PM transverse process and PM vertebral body EMG was less than that of the other LBP group in short lordotic posture. Conclusion The findings suggest a redistribution of activity between muscles that have a potential extensor moment in individuals with LBP. The modification of EMG of discrete fascicles of the PM and QL was related to changes in ES EMG signal amplitude recorded in sitting. J Orthop Sports Phys Ther 2013;43(11):833–840. Epub 10 October 2013. doi:10.2519/jospt.2013.4840
Risk factors for bad obstetric history in Kirkuk women, Iraq
Authors: Aljumaily ZKM , Alsamarai AM 
Published: October 2013

INTRODUCTION: Microbial agents such as Toxoplasma, rubella, CMV and HSV are important cause of infections during pregnancy, which mainly are asymptomatic. However, the infection during pregnancy may result in serious foetal side effects. Objective was to determine the risk factors that enhance the development of bad obstetric history (BOH) due to TORCH infections in Iraqi women. MATERIALS AND METHODS: A 538 women were included in the study, of them 293 (54.5%) were with BOH, and 245 (45.5%) were with normal pregnancy history. In the BOH group, 144 (49.1%) women were pregnant, while in the normal pregnancy group, 117 (47.7%) were pregnant. Logistic regression analysis was used to determine the risk factors that may play a role in development of BOH. RESULTS: Multifactorial analysis indicated that Toxoplasma gondi IgM, rubella IgM, rubella IgG, CMV IgM, HSV -2 IgG and animal exposure were risk factors that lead to BOH development. However, Toxoplasma IgG seropositivity had inverse correlation to BOH development. Mother education was a significant protective (OR=0.614, P=0.000) factor that reduce development of BOH. Residence, education, occupation and family size influenced the role of TORCH in induction of BOH. CONCLUSIONS: This study indicated that Toxoplasma gondi IgM, rubella IgM, rubella IgG, CMV IgM, HSV-2 IgG and animal exposure were risk factors that lead to BOH development. Mother education was a significant protective factor that reduce development of BOH. DOI: http://dx.doi.org/10.3126/ijim.v2i3.8121 Int J Infect Microbiol 2013;2(3):70-77
Development of the Mayo Investigational Neuromodulation Control System: toward a closed-loop electrochemical feedback system for deep brain stimulation
Authors: Chang Su-Youne , Kimble Christopher J. , Kim Inyong , Paek Seungleal B. , Kressin Kenneth R. , Boesche Joshua B. , Whitlock Sidney V. , Eaker Diane R. , Kasasbeh Aimen , Horne April E. , Blaha Charles D. , Bennet Kevin E. , Lee Kendall H. 
Published: October 2013

Object
Conventional deep brain stimulation (DBS) devices continue to rely on an open-loop system in which stimulation is independent of functional neural feedback. The authors previously proposed that as the foundation of a DBS “smart” device, a closed-loop system based on neurochemical feedback, may have the potential to improve therapeutic outcomes. Alterations in neurochemical release are thought to be linked to the clinical benefit of DBS, and fast-scan cyclic voltammetry (FSCV) has been shown to be effective for recording these evoked neurochemical changes. However, the combination of FSCV with conventional DBS devices interferes with the recording and identification of the evoked analytes. To integrate neurochemical recording with neurostimulation, the authors developed the Mayo Investigational Neuromodulation Control System (MINCS), a novel, wirelessly controlled stimulation device designed to interface with FSCV performed by their previously described Wireless Instantaneous Neurochemical Concentration Sensing System (WINCS).

Methods
To test the functionality of these integrated devices, various frequencies of electrical stimulation were applied by MINCS to the medial forebrain bundle of the anesthetized rat, and striatal dopamine release was recorded by WINCS. The parameters for FSCV in the present study consisted of a pyramidal voltage waveform applied to the carbon-fiber microelectrode every 100 msec, ramping between −0.4 V and +1.5 V with respect to an Ag/AgCl reference electrode at a scan rate of either 400 V/sec or 1000 V/sec. The carbon-fiber microelectrode was held at the baseline potential of −0.4 V between scans.

Results
By using MINCS in conjunction with WINCS coordinated through an optic fiber, the authors interleaved intervals of electrical stimulation with FSCV scans and thus obtained artifact-free wireless FSCV recordings. Electrical stimulation of the medial forebrain bundle in the anesthetized rat by MINCS elicited striatal dopamine release that was time-locked to stimulation and increased progressively with stimulation frequency.

Conclusions
Here, the authors report a series of proof-of-principle tests in the rat brain demonstrating MINCS to be a reliable and flexible stimulation device that, when used in conjunction with WINCS, performs wirelessly controlled stimulation concurrent with artifact-free neurochemical recording. These findings suggest that the integration of neurochemical recording with neurostimulation may be a useful first step toward the development of a closed-loop DBS system for human application.