bluuebunny/crossref_metadata_2025_split huggingface dataset:
An in vitro study of the effects of isoflurane on oxygen transfer
Authors: Muhle Michelle L , Stammers Alfred H , Tremain Kimberly D , Niimi Kevin S , Glogowski Kimberly R , Trowbridge Cody C , Yang Tianyu 
Published: January 2013

A common anesthetic technique utilized during cardiopulmonary bypass (CPB) includes the use of various inhalation agents, such as isoflurane. The purpose of this study was to evaluate the effects of this agent on oxygen transfer during CPB. An in vitro model was designed using bovine blood. Blood flow was held constant at 2 l/min, while gas flow was manipulated at 1 and 3 l/min. The percentage of inspired oxygen (FiO2) was set at 50 and 100%, and isoflurane was manipulated to 1.0, 3.0 and 5.0%. Blood gas analysis, oxygen transfer, and inlet and outlet isoflurane concentrations were measured at each of the given conditions. A total of 12 trials with four oxygenators were conducted. In the four oxygenators used in our study, no significant differences in oxygenator performance were found. At conditions of 1 l/min gas flow, 50% FiO2 and 1% isoflurane, there were no significant changes in O2 transfer between baseline and measurements taken during isoflurane administration (100.18 ± 12.49 vs 102.35 ± 10.99 ml O2/min, p=0.8031). At 3 l/min gas flow, 100% FiO2 and 5% isoflurane, no significant differences were found (142.35 ± 10.76 vs 154.04 ± 8.95 ml O2/min, p=0.1459). The only significant differences found for oxygen transfer were between 50 and 100% FiO2, all other conditions being set equal (102.35 ± 10.99 vs 137.68 ± 8.62 ml O2/min, p=0.0023). In conclusion, increasing concentrations of isoflurane up to 5% does not affect the efficiency of oxygen transfer in an in vitro circuit. Further studies are necessary to evaluate the effects in an in vivo setting.
Neurone-specific enolase and Sangtec 100 assays during cardiac surgery: part II - must samples be spun within 30 min?
Authors: Sapsed-Byrne S , Gao F , Harris D N F 
Published: January 2013

Sangtec 100 (S-100) (Sangtec Medical, Sweden) and neurone-specific enolase (NSE) assays are showing promise in the assessment of cerebral damage following cardiopulmonary bypass (CBP). The manufacturer’s instructions state, however, that samples must be spun and frozen within 30 min, which is inconvenient for serial studies. We, therefore, investigated whether storing blood samples at room temperature (RT) or 4°C for up to 48 h affected the measured levels. Blood samples were taken before and after CBP in six patients and stored for 15 min, 4, 8, 24 or 48 h at RT or 4°C. S-100 and NSE levels did not alter in either ‘before surgery’ or CPB samples when stored for up to 48 h at 4°C. There was a small, nonsignificant rise when stored at RT. Samples may, therefore, be collected throughout long operations or stored overnight without affecting NSE or S-100 plasma levels.
Neurone-specific enolase and Sangtec 100 assays during cardiac surgery: part III - does haemolysis affect their accuracy?
Authors: Gao F , Harris D N F , Sapsed-Byrne S , Sharp S 
Published: January 2013

Neurone-specific enolase (NSE) and Sangtec 100 (S-100) are useful for detecting cerebral damage during cardiopulmonary bypass (CPB). However, red cells contain NSE, and the haemolysis frequently caused by CPB could produce a false rise in NSE; S-100 is not found in red cells and should not be affected. We, therefore, compared the effects of haemolysis on NSE and S-100 to see if correction was necessary and possible. From seven patients, serial dilutions of haemolysed red cells were added to plasma (1/64-1/2048), measured for absorption at 540 nm and assayed for NSE and S-100. S-100 concentrations showed no change with haemolysis. Measured NSE increased significantly with haemolysis >1/512 (an increase of 6.6 μg/ml): a correction formula is presented. In 39/48 patients after CPB, mean haemolysis was <1/256 and would not need any correction. NSE and S-100 assay can, therefore, be used throughout CPB, which allows both glial and neuronal damage to be studied.
Modified ultrafiltration in paediatric cardiopulmonary bypass
Authors: Wang Wei , Huang Hui Ming , De Ming Zhu  , Chen Hong , Su Zhao Kang , Ding Wei Xiang 
Published: January 2013

Cardiopulmonary bypass (CPB), a nonphysiological procedure, is associated with haemodilution and the inflammatory response, causing the accumulation of body water and organ dysfunction. The purpose of this study was to evaluate the efficacy of modified ultrafiltration. Forty paediatric patients undergoing cardiac operations were randomized into a control group and a modified ultrafiltration group. Blood cells, protein and cytokine concentrations were recorded for 24 h postoperatively. As the fluid was removed at 50 ml/min, both blood cells and protein were concentrated by modified ultrafiltration ( p < 0.001). The tumour necrosis factor (TNF)-α concentration was increased and interleukin-8 (IL-8) and endothelin (ET) concentrations were unaltered after ultrafiltration. After correction for albumin, TNF-α concentration changed little, and IL-8 and ET concentrations (36.75 ± 12.35, 42.89 ± 15.54) were decreased significantly (21.47 ± 13.87, 26.06 ± 12.54) after ultrafiltration. Modified ultrafiltration is an effective method for removing excess tissue fluid and concentrating blood after CPB. This technique can also filter out some cytokines.
Effects of the combinations propofol/alfentanil and midazolam/fentanyl on blood pressure and contact phase system during coronary surgery
Authors: Schulze Hans-Joachim , Wendel Hans Peter , Kleinhans Martin , Oehmichen Siegfried , Guggenberger Herbert , Heller Wolfgang , Hoffmeister Hans-Eberhard 
Published: January 2013

Perioperative haemodynamic changes leading to severe circulatory problems during open-heart surgery still represent dreaded complications. The aim of this study was to examine the relationship between the use of applied anaesthetic agents and alterations of the contact phase of the intrinsic blood-clotting system, as changes within the kallikrein-kinin system can lead to a fall in blood pressure. In a randomized study, parameters of the kallikrein-kinin system, coagulation and fibrinolysis were determined for 36 patients with aortocoronary bypass operations. The patients had been given either midazolam/fentanyl or propofol/alfentanil to maintain anaesthesia. Perioperative blood pressure values were registered at seven fixed points. The measured values of the factor XIIa-like activity and the kallikrein-like activity suggested a higher activation of the contact phase, when propofol/alfentanil was given. From the start of the extracorporeal circulation (ECC) to the end of the operation, the kallikrein-like activities in the propofol/alfentanil group were significantly higher than those of the midazolam/fentanyl group. Also, the results of the kallikrein inhibition capacity and the indicators of fibrinolysis (t-PA and D-dimers) indicate a stronger activation of the contact phase - at least at the beginning of recirculation - and as a result of it, a stronger fibrinolysis within the propofol/alfentanil group. In addition, the hypotensive side-effects differed significantly between the two groups. Patients receiving propofol/alfentanil needed the triple amount of anti-hypotonicum to maintain the mean arterial blood pressure above 75 mmHg. With the results of this study, a correlation between the application of propofol/alfentanil, contact phase activation, with activation of the kallikrein-kinin-bradykinin system and the observed hypotension, can be presumed.
A new bladder allows kinetic venous augmentation with a roller pump
Authors: Tamari Yehuda , Lee-Sensiba Kerri , Ganju Rik , Chan Richard , Hall Michael H 
Published: January 2013

Augmented venous drainage improves venous return during minimally invasive cardiac surgery. Two systems to augment drainage are common: in one, a centrifugal pump draws blood from the venous site and pumps it into a venous reservoir. In the other, suction is applied directly to a hard-shell venous reservoir. Both systems overcome the high resistance of the venous cannula when gravity alone is insufficient to provide adequate drainage. Both systems also have shortcomings: in the first approach, the centrifugal pump head can entrap large bubbles, reducing flow and requiring pump stoppage to remove them. Air from the venous line also can be broken up by the centrifugal pump into small bubbles that can pass through the pump head. The direct suction system in the second approach cannot use a closed-bag reservoir, and has the potential to introduce air into the arterial line. We have developed a new venous augmentation system for a closed venous reservoir that provides excellent suction control without the potential to introduce air into the arterial line. Our system replaces the centrifugal pump of the first approach with a roller pump controlled by the Better-Bladder™, a new device with FDA 510(k) clearance for long-term pumping. The Better-Bladder is a length of medical tubing, processed to form a thin-walled, enlarged bladder that is sealed within a clear rigid housing. It acts as an in-line reservoir that provides compliance in the venous line and a noninvasive means to measure blood pressure at the pump inlet. The bladder housing can maintain a negative pressure set by the user that controls the degree of gravity drainage. Tests have shown that the Better-Bladder allows for safe, smooth pump control using a roller pump in the venous line.
Ex vivo testing of the Quart® arterial line filter
Authors: Mueller Xavier M , Tevaearai Hendrick T , Jegger David , Augstburger Monique , Burki Marco , von Segesser Ludwig K 
Published: January 2013

Arterial line filters are now routinely used in cardiac surgery in order to decrease the microemboli load to the patient. The Quart® filter (Jostra, Hirrlingen, Germany) with a new planar construction design, an easy de-airing system and an integrated bypass, was tested for air filtration capacity and resistance to blood path in a standardized setting with surviving animals. Three calves (mean body weight: 71 ± 3.4 kg) were connected to a standard cardiopulmonary bypass (CPB) circuit by jugular venous and carotid arterial cannulation with a mean flow rate of 3.5 l/min. The arterial line filter was challenged with upstream injections of boluses of air of 5, 10 and 15 ml, respectively. A Doppler ultrasound was positioned downstream on the arterial line to measure bubble count and size. The pressure drop through the filter was monitored at flow rates of between 1 and 6 l/min. At the end of the procedure the animals were weaned from the CPB and, thereafter, from the ventilator. After 7 days, the animals were sacrificed electively. This study shows that important quantities of air can be injected into the arterial line upstream of the filter with small volumes of small sized bubbles recorded downstream. With the 5 ml air bolus injection, mean values of 0.3 ± 0.6 bubbles of 30 and 40 μm were detected, whereas with the 20 ml bolus, 32.6 ± 8.7 bubbles of 10 μm, 3.7 ± 1.1 bubbles of 30 μm, 3.3 ± 0.6 bubbles of 40 μm and 0.7 ± 1.1 bubbles of 50 μm were recorded. The blood path resistance at different blood flow rates was well within the acceptable range with a pressure drop of 20 ± 0 and 26.6 ± 5.7 mmHg at flow rates of 4 and 5 l/min, respectively. With its planar concept, the Quart filter offers good air filtering capacity both in terms of bubble count and size after injection of large boluses of air, without any increase of resistance to the blood path. Moreover, it offers a venting function and an integrated bypass system.
Differences in Knee Joint Stabilization Between Children and Adults and Between the Sexes
Authors: Tagesson Sofi , Witvrouw Erik , Kvist Joanna 
Published: January 2013

Background: Differences in knee joint stabilization between children and adults and between the sexes are not fully understood. Purpose: To compare the knee laxity and the dynamic tibial translation between (1) children and adults, (2) girls and boys, and (3) women and men. Study Design: Controlled laboratory study. Methods: Sixty-seven children (aged 8-13 years) and 63 adults (aged 18-30 years) without previous knee injuries participated. Sagittal tibial translation was measured during the instrumented Lachman test at 90 N and 134 N (knee laxity) and during gait (dynamic translation). Tibial translation was recorded with an electrogoniometer. Results: Knee laxity was greater in children than in adults (Lachman test at 90 N: 9.1 ± 2.9 vs 7.3 ± 2.7, respectively; P < .001). In contrast, dynamic tibial translation during gait did not differ between children and adults. Girls and boys did not differ in knee laxity or maximum anterior tibial translation during gait, and men and women did not differ in knee laxity. Women had greater dynamic tibial translation during gait than men (7.8 ± 2.7 vs 5.7 ± 3.0, respectively; P = .004). Conclusion: Children had greater knee laxity than adults, whereas the dynamic tibial translation did not differ. In adults, knee laxity did not differ between the sexes, but dynamic tibial translation was greater in women. Clinical Relevance: Children and men had less dynamic tibial translation during gait in proportion to their maximum knee laxity. The observed less dynamic tibial translation in children and adult men might be related to their reduced risk of sustaining an anterior cruciate ligament injury.
Resource utilization and direct medical costs in adult systemic lupus erythematosus patients from a commercially insured population
Authors: Furst DE , Clarke A , Fernandes AW , Bancroft T , Gajria K , Greth W , Iorga SR 
Published: January 2013

Objective Our aim was to estimate annual health care resource use and medical costs associated with systemic lupus erythematosus (SLE) in a large US managed care health plan. Methods Subjects at least 18 years of age and with claims-based evidence of SLE (ICD-9-CM 710.0x) were identified from a health plan database. Subjects were matched on the basis of demographic and clinical characteristics to unaffected controls. Resource use and costs were determined during a fixed 12-month period. A generalized linear model (GLM) was used to adjust costs for demographic and clinical characteristics. Results In total, 1278 newly diagnosed SLE subjects were matched to 3834 controls, and 10,152 subjects with existing SLE were matched to 30,456 controls. Health care resource use was significantly higher among SLE subjects than matched controls, including average annual numbers of ambulatory visits, specialist visits, and inpatient hospital stays (all p < 0.001). SLE subjects had significantly higher overall mean annual medical costs than matched controls (newly diagnosed: $19,178 vs. $4909; existing: $15,487 vs. $5156; both p < 0.001). Evidence of specific organ involvement including renal failure and central nervous system complications, were each associated with increased costs (both p < 0.001). Conclusions Subjects with SLE have high resource use and medical costs relative to controls.
Spatial Modelling of Urban Growth and Urban Influence
Authors: Ali Md. Julfikar , Varshney Deepika 
Published: January 2013

Urbanization and regional development are closely associated. Allocation of higher and lower order facilities and specialization of business influence urban growth, which diffuses its benefits to the surrounding countryside. Subsequently, socio-economic development of the region comes into being. The continuous increase of urban size cannot be sustained; rather declining growth will certainly set in the long run. Optimum level of its growth depends on the capacity of an urban centre to provide required facilities to the people in fair manner. Hierarchical growth of urban centres in association with location of civic amenities induces regional development in hierarchical dimension, which is the common problem in developing economy. Subsequently, few of the urban centres are having large number of facilities while others are lacking corresponding to their population size. Formulation of pragmatic planning model is the rescue of wiping out such problems. It is an attempt to analyze the hierarchical growth of urban centres associated with their functional potentiality and diffusion of urban developmental impulses to the surrounding rural part. Further, it proposes a model for developing economy like India to solve the problem of regional variations of development. Besides, it examines the adequacy and inadequacy of facilities in the urban centres and puts forward planning recommendations, so that a balanced regional development would be achieved by not leaving any rural part out of the zone of functional influence of urban centre.
Land Use Dynamics and Peri-urban Growth Characteristics
Authors: Dutta Venkatesh 
Published: January 2013

The importance of urban transition is recognized in the literature, but largely underexplored in developing world cities. There are no actual relationships between projections and discussions of spatial growth with urban and regional reality. This paper attempts to fill this gap by assessing the spatio-temporal patterns of land use dynamics in urban and peri-urban areas of Lucknow, which is the capital city of India’s largest State, Uttar Pradesh. It also evaluates to what extent the Master Plan 2021 deviates from the actual reality. The finding shows that patterns of urban growth do not follow Master Plan and even Master Plan deviates profoundly from the preferred land suitability. The multi-temporal land use change statistics reveal two major land transformation trends between 1997 and 2010: ( i) Intensification of urbanization in the central core areas where a few remaining open areas and water bodies were occupied and landfilled to accommodate residential developments. ( ii) Urban expansion in peri-urban/suburban areas through edge expansion and envelopment, where the extension of urban core increased at the cost of permanent crops and pastures. The results indicate that substantial Class I agricultural land was lost due to urban growth during 1997—2010, with an average annual rate of 13 per cent. Around 77 per cent of the available land in the peri-urban areas has weak or very weak suitability for future urban development primarily because of the high conservation and agriculture suitability and incompatibility of physical land use to enable infrastructure. The case is similar to any other developing city and transition country of the global south and may provide useful policy lessons.
Pragmatic Municipal Finance Reform in India
Authors: Sahasranaman Anand 
Published: January 2013

The 74th Constitutional Amendment Act (CAA) enacted in 1993 gave urban local governments constitutional status and aimed to strengthen municipal governance. Municipalities were to be given greater responsibilities in the provision of basic infrastructure and social services and financial power was also to be devolved. Now, seventeen years since the passage of this constitutional amendment, the promise held out by decentralization has remained largely unrealized. In this context, the intention of this paper is to recommend specific policy initiatives for municipal governance reform in India. In drawing up these recommendations, the paper analyses two broad sources, namely the policy environments for local government in post-Apartheid South Africa and post-democracy Brazil. South Africa and Brazil are instructive case studies because they too, like India, are trying to address the issues of widespread poverty and inequality in a democratic framework. Additionally, they are widely recognized as having innovated in many aspects of the policy framework for local government and service delivery. Based on our analysis, we recommend pragmatic changes in aspects of property tax, municipal finance, community involvement and models of service delivery as the levers to improve urban governance and service delivery.
Posterior Pilon Fractures
Authors: Klammer Georg , Kadakia Anish R. , Joos David A. , Seybold Jeffrey D. , Espinosa Norman 
Published: January 2013

Background: Posterior malleolus fractures occur in 7% to 44% of ankle fractures and are associated with worse clinical outcomes. Fractures that involve the posteromedial plafond extending to the medial malleolus have been described previously in small case series. Failure to identify this fracture pattern has led to poor clinical outcomes and persistent talar subluxation. The purpose of this study was to report our outcomes following fixation of this posterior pilon fracture and to describe a novel classification system to help guide operative planning and fixation. Methods: Eleven patients were identified following fixation of a posterior pilon fracture over a 4-year span; 7 returned at minimum 1-year follow-up to complete a physical examination, radiographs, and RAND-36 (health-related quality of life score developed at RAND [Research and Development Corporation] as part of the Medical Outcomes Study) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot questionnaires. Patient records were reviewed to evaluate for secondary complications or operative procedures. Results: Our mean postoperative AOFAS ankle/hindfoot score was 82. Anatomical reduction of the plafond was noted radiographically in 7 of 11 patients, with the remainder demonstrating less than 2 mm of articular incongruity. Five of 7 patients demonstrated ankle and hindfoot range of motion within 5 degrees of the uninvolved extremity. Four complications required operative intervention; 2 patients reported continued pain secondary to development of CRPS. Conclusion: The posterior pilon fracture is a challenging fracture pattern to treat, and it has unique characteristics that require careful attention to operative technique. Our results following fixation of this fracture pattern are comparable with results in the literature. In addition, a novel classification scheme is described to guide recognition and treatment of this fracture pattern. Level of Evidence: Level IV, retrospective case series.
Inflammation in dry eye associated with rheumatoid arthritis: Cytokine and in vivo confocal microscopy study
Authors: Villani Edoardo , Galimberti Daniela , Papa Nicoletta Del , Nucci Paolo , Ratiglia Roberto 
Published: January 2013

The purpose of this research was to study ocular surface inflammation in relation to systemic disease activity in rheumatoid arthritis (RA) patients with or without secondary Sjögren’s syndrome (SSII and non-SSII respectively). The study was conducted in two phases. In phase I, 12 patients with active RA SSII and 12 with active RA non-SSII were consecutively enrolled. Each completed an Ocular Surface Disease Index (OSDI) questionnaire and underwent a full eye exam and in vivo confocal microscopy examination of the cornea. Tear fluid samples were collected in sponges and analyzed for IL-1α, -6, and -8, and TNF-α. When RA activity was suppressed by systemic treatment the patients entered phase II of the study in which all of the phase I examinations were repeated. In RA SSII patients, OSDI, fluorescein staining dendritic cell density, and concentrations of IL-1α and IL-6 decreased significantly ( P < 0.01) between phases I and II. Tear breakup time scores increased significantly. For RA non-SSII patients, there were no significant differences between phases I and II. Differences in the clinical, cellular and cytokine responsiveness to systemic RA treatments show that the ocular surface pathology is dissimilar for RA SSII and RA non-SSII patients.