bluuebunny/crossref_metadata_2025_split huggingface dataset:
High intestinal IgA associates with reduced risk of IgE‐associated allergic diseases
Authors: Kukkonen Kaarina , Kuitunen Mikael , Haahtela Tari , Korpela Riitta , Poussa Tuija , Savilahti Erkki 
Published: June 2009

Kukkonen K, Kuitunen M, Haahtela T, Korpela R, Poussa T, Savilahti E. High intestinal IgA associates with reduced risk of IgE‐associated allergic diseases. Pediatr Allergy Immunol 2010: 21: 67–73. © 2009 John Wiley & Sons A/SDevelopment of oral tolerance and its stimulation by probiotics are still incomprehensible. Microbial stimulation of the gut may induce a subtle inflammation and induce secretion of mucosal IgA, which participates in antigen elimination. In a cohort of allergy‐prone infants receiving probiotics and prebiotics or placebo we studied intestinal IgA and inflammation in the development of eczema, food allergy, asthma, and rhinitis (allergic diseases). We performed a nested unmatched case–control study of 237 infants participating in a randomized double‐blind placebo‐controlled allergy‐prevention trial using a combination of four probiotic strains pre‐natally and during 6 months form birth. We measured faecal IgA, α1‐antitrypsin (α1‐AT), tumour necrosis factor‐alpha (TNF‐α), and calprotectin at the age of 3 and 6 months. By age 2 yr, 124 infants had developed allergic disease or IgE‐sensitization (cases) and 113 had not (controls). In infants with high faecal IgA concentration at the age of 6 months, the risk of having any allergic disease before the age of 2 yr tended to reduce [odds ratio (OR: 0.52)] and the risk for any IgE‐associated (atopic) disease reduced significantly (OR: 0.49). High faecal calprotectin at the age of 6 months associated also with lower risk for IgE‐associated diseases up to age 2 yr (OR: 0.49). All faecal inflammation markers (α1‐AT, TNF‐α, and calprotectin) correlated positively with faecal IgA (p < 0.001). Probiotics tended to augment faecal IgA (p = 0.085) and significantly increased faecal α1‐AT (p = 0.001). High intestinal IgA in early life associates with minimal intestinal inflammation and indicates reduced risk for IgE‐associated allergic diseases.
Preemptive therapy is not adequate for prevention of cytomegalovirus disease in pancreas–kidney transplant recipients
Authors: López‐Medrano F. , Rueda B. , Lizasoain M. , Juan R. San , Folgueira D. , Andrés A. , Morales J. M. , Jiménez C. , Meneu J. C. , Aguado J. M. 
Published: June 2009

Background. Cytomegalovirus (CMV) remains the most common viral infection after pancreas–kidney transplantation (PKT). Comparative studies about CMV prophylaxis in PKT have not been developed.Methods. We analyzed CMV disease in a cohort of 84 PKT recipients. All received intravenous ganciclovir during treatment with anti‐thymocyte globulin and later one of the following options for pre‐transplant CMV‐seropositive recipients: (a) no prophylaxis (n=10 patients), (b) preemptive therapy (PT) (n=13), or (c) continuous prophylaxis (CP) for 12 weeks (n=29). Pre‐transplant CMV‐seronegative recipients received CP (n=21).Results. Eleven patients were excluded because of organ explantation in the first 15 days. Incidence of CMV disease in seropositive recipients was 30% under no prophylaxis, 23% under PT, and 6.9% under CP. Incidence of CMV disease under CP was 33.3% in seronegative recipients. Six of 9 episodes of CMV disease under CP occurred after finishing prophylaxis. Under CP, the incidence of CMV disease was significantly higher in seronegative than in seropositive recipients (P<0.05).Conclusion. According to the results of our study, for CMV‐seropositive PKT recipients, CP is a better strategy than PT. For CMV‐seronegative recipients, 3 months of CP is an inadequate strategy.
Phosphodiesterase inhibition by naloxone augments the inotropic actions of β‐adrenergic stimulation
Authors: PARK W. K. , CHANG C. H. , CHAE J. E. , KIM M. H. , CHO Y. L. , AHN D. S. 
Published: June 2009

Background: In a shock state, naloxone generates the cardiovascular pressor effect by displacing the endogenous opiate‐like peptide β‐endorphin, resulting in restoration of the normal response to catecholamines. In addition to this opioid antagonistic effect, the non‐opiate receptor‐mediated effect has also been proposed. The aim of this study was to define the mechanism of non‐opiate receptor‐mediated action of naloxone.Methods: In guinea‐pig ventricular tissues, cumulative concentration–response curves for isoproterenol as well as for forskolin and 3‐isobutylmethylxanthine (IBMX) were obtained by increasing the concentration stepwise. To assess the effect on the phosphodiesterase (PDE), the effects of naloxone on contractile forces induced by isoproterenol (0.05 μM) in the presence of IBMX, cilostamide (a PDE III inhibitor), or rolipram (a PDE IV inhibitor) were observed. Naloxone‐induced changes in cAMP production by isoproterenol both in the absence and in the presence of IBMX were measured. Naloxone‐induced changes in cAMP production by forskolin in the presence of IBMX were also measured.Results: Naloxone (30 μM) produced a leftward shift of the isoproterenol concentration–response curve (0.01–2 μM) without changing the maximal response. Forskolin (0.5–10 μM) produced a concentration‐dependent increase in contractile forces. Naloxone increased the maximal inotropic response of forskolin. Naloxone showed no effect on the IBMX concentration–response curve. In the presence of IBMX (200 μM), naloxone did not alter the contractions evoked by isoproterenol or forskolin. Whereas naloxone increased contractile forces significantly (approximately 25%) more than that of isoproterenol in the presence of rolipram, no alteration of contractile forces in the cilostamide‐incubated muscles was observed. Naloxone caused a concentration‐related increase of cAMP in the absence of IBMX, but caused no change in its presence.Conclusions: The enhancement of myocardial contractility by naloxone in the presence of stimulation of adenylyl cyclase activity appears to be mediated by inhibition of PDE, specifically PDE III.
The occurrence of intra‐operative hypotension varies between hospitals: observational analysis of more than 147,000 anaesthesia
Authors: TAFFÉ P. , SICARD N. , PITTET V. , PICHARD S. , BURNAND B. ,   for the ADS study group
Published: June 2009

Background: Hypotension, a common intra‐operative incident, bears an important potential for morbidity. It is most often manageable and sometimes preventable, which renders its study important. Therefore, we aimed at examining hospital variations in the occurrence of intra‐operative hypotension and its predictors. As secondary endpoints, we determined to what extent hypotension relates to the risk of post‐operative incidents and death.Methods: We used the Anaesthesia Databank Switzerland, built on routinely and prospectively collected data on all anaesthesias in 21 hospitals. The three outcomes were assessed using multi‐level logistic regression models.Results: Among 147,573 anaesthesias, hypotension ranged from 0.6% to 5.2% in participating hospitals, and from 0.3% up to 12% in different surgical specialties. Most (73.4%) were minor single events. Age, ASA status, combined general and regional anaesthesia techniques, duration of surgery and hospitalization were significantly associated with hypotension. Although significantly associated, the emergency status of the surgery had a weaker effect. Hospitals' odds ratios for hypotension varied between 0.12 and 2.50 (P≤0.001), even after adjusting for patient and anaesthesia factors, and for type of surgery. At least one post‐operative incident occurred in 9.7% of the procedures, including 0.03% deaths. Intra‐operative hypotension was associated with a higher risk of post‐operative incidents and death.Conclusion: Wide variations remain in the occurrence of hypotension among hospitals after adjustment for risk factors. Although differential reporting from hospitals may exist, variations in anaesthesia techniques and blood pressure maintenance may also have contributed. Intra‐operative hypotension is associated with morbidities and sometimes death, and constant vigilance must thus be advocated.
Does 1 or 2 g paracetamol added to ketoprofen enhance analgesia in adult tonsillectomy patients?
Authors: SALONEN A. , SILVOLA J. , KOKKI H. 
Published: June 2009

Background: We have evaluated whether co‐administration of intravenous (i.v.) paracetamol could enhance the analgesic efficacy of ketoprofen (a non‐steroidal anti‐inflammatory drug or NSAID) in patients undergoing a tonsillectomy.Methods: This prospective, randomized, double‐blinded and placebo‐controlled add‐on study with three parallel groups included 114 patients, aged 16–50 years, and scheduled for elective tonsillectomy. All patients were given ketoprofen 1 mg/kg i.v. after surgery, followed 5 min later by paracetamol 1 or 2 g i.v., or normal saline as a placebo. The primary outcome measure was the proportion of patients requiring oxycodone for rescue analgesia over the first 6 h (pain score >30/100 mm at rest or >50/100 mm during swallowing) after surgery.Results: No difference was detected in the proportion of patients receiving oxycodone (31/37 in the paracetamol 1 g group, 29/39 in the paracetamol 2 g group and 30/38 in the ketoprofen‐alone group) between the three groups. However, significantly less doses of rescue analgesia were provided in the paracetamol groups than in the ketoprofen‐alone group (P=0.005); among those who required rescue analgesia, 27% less oxycodone was required in the paracetamol 1 g group (80 doses, P=0.023) and 38% less in the paracetamol 2 g group (64 doses, P=0.002) than in the ketoprofen‐alone group (106 doses).Conclusion: Combining paracetamol i.v. with ketoprofen at the end of tonsillectomy did not reduce the proportion of the patients requiring rescue analgesia, but the number of opioid doses was less in the add‐on groups.
Different apoptosis ratios and gene expressions in two human cell lines after sevoflurane anaesthesia
Authors: KVOLIK S. , DOBROSEVIC B. , MARCZI S. , PRLIC L. , GLAVAS‐OBROVAC L. 
Published: June 2009

Background: The aim of this study was to determine the effect of a single exposure of carcinoma cells (Caco‐2 and HEp‐2) to an anaesthetic gas mixture containing sevoflurane 3%, applied for a period of either 1 or 2 h, on the induction of apoptosis, propapototic gene expression and sphingomyelinase activity.Methods: Apoptosis was determined by flow cytometry. p53, caspase 3 and CYP2E1 gene expression was determined using reverse transcriptase polymerase chain reaction. Activities of acid (aSMase) and neutral sphingomyelinases (nSMase) were measured using methyl‐14C sphingomyeline, and for de novo ceramide and lipid synthesis [3H] palmitic acid was used. All results were compared with controls and analysed by Mann–Whitney and Kruskal–Wallis tests.Results: In the treated Caco‐2 cells, the apoptotic ratio increased 24 h after anaesthesia (16.9%; P=0.04). The expression of both p53 and caspase‐3 genes increased in Caco‐2 and decreased in HEp‐2 cells. The CYP2E1 gene expression was observed only in the Caco‐2 cells. In control cells, the catalytic activity of aSMase was 2.3 times higher than that of nSMase activity. Decreased aSMase and nSMase activities were observed in Caco‐2 cells 24 h after exposition. aSMase activity was halved (54.2%; P=0.06) in HEp‐2 cells 24 h after anaesthesia. De novo ceramide synthesis correlated with SMase activity in Caco‐2 cells.Conclusion: Sevoflurane anaesthesia induces late apoptosis in the colonic and laryngeal cancer cells investigated. Although the results obtained may indicate that an anaesthetic gas mixture containing sevoflurane induces p53‐dependent apoptosis in the Caco‐2 cells, the mechanism of apoptosis induction is unclear and remains to be elucidated.
Adding Gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty
Authors: CLARKE H. , PEREIRA S. , KENNEDY D. , ANDRION J. , MITSAKAKIS N. , GOLLISH J. , KATZ J. , KAY J. 
Published: June 2009

Background: Gabapentin (GPN) is effective in reducing post‐operative pain and opioid consumption, but its effects with regional anesthesia for total hip arthroplasty (THA) are not known. We designed this study to determine whether (1) gabapentin administration reduces pain and opioid use after THA using a multimodal analgesic regimen including spinal anesthesia; (2) pre‐operative administration of gabapentin is more effective than post‐operative administration.Methods: After REB approval and informed consent, 126 patients were enrolled in a double‐blinded, randomized‐controlled study. Patients received acetaminophen 1 g per os (p.o.), celecoxib 400 mg p.o. and dexamethasone 8 mg intravenously, 1–2 h pre‐operatively. Patients were randomly assigned to one of three treatment groups (G1: Placebo/Placebo; G2: GPN/Placebo; G3: Placebo/GPN). Patients received gabapentin 600 mg (G2) or placebo (G1 and G3) 2 h before surgery. All patients had spinal anesthesia [15 mg (3cc) of 0.5% hypobaric bupivacaine with 10 μg of fentanyl]. In the post‐anesthetic care unit, patients received gabapentin 600 mg (G3) or placebo (G1 and G2). On the ward, patients received acetaminophen 1000 mg p.o. q6h, celecoxib 200 mg p.o. q12h and a morphine PCA device. Patients were interviewed 6 months post‐surgery to determine the incidence and severity of chronic post‐surgical pain.Results: Mean±SD cumulative morphine (mg) consumption (G1=49.4±24.8, G2=47.2±30.1 and G3=56.1±38.2) at 48 h and pain scores at 12, 24, 36 and 48 h post‐surgery were not significantly different among the groups [G1 (n=38), G2 (n=38) and G3 (n=38)]. Side effect profiles were similar across groups. Six months after surgery, the number of patients who reported chronic post‐surgical pain (G1=10, G2=12 and G3=9) and the severity of the pain (G1=4.2±2.9, G2=4.1±2.2 and G3=4.9±2.2) did not differ significantly among the groups (P>0.05).Conclusions: A single 600 mg dose of gabapentin given pre‐operatively or post‐operatively does not reduce morphine consumption or pain scores in hospital or at 6 months after hip arthroplasty within the context of spinal anesthesia and a robust multimodal analgesia regimen.
Low‐flow anaesthesia at a fixed flow rate
Authors: CHERIAN A. , BADHE A. 
Published: June 2009

Aims and Objectives: This study attempts to assess the safety of low‐flow anaesthesia (LFA) at fixed flow rates with particular reference to the incidence of a decline in FiO2 below safe levels of 0.3 and to determine whether LFA can be used safely in the absence of an FiO2 monitor.Methods: A total of 100 patients undergoing procedures under general anaesthesia at fresh gas flows of 300 ml/min of O2 and 300 ml/min of N2O were monitored while maintaining the dial setting of isoflurane at 1.5% for 2 h. The changes in gas composition were analysed and even a single recording of FiO2 of <0.3 was considered sufficient to render the technique unsafe in the absence of gas monitors.Results: The lowest recorded value of FiO2 was 31% (v/v%). There was no incidence of adverse events necessitating the conversion from low flows to conventional flows.Conclusions: We conclude that low flows of 300 ml/min of N2O and 300 ml/min of oxygen can be used safely for a period of 2 h without the use of monitors for gas analysis of oxygen and agent in adult patients weighing between 40 and 75 kgs.
The investigation of bronchospasm during induction of anaesthesia
Authors: FISHER M. M. , RAMAKRISHNAN N. , DOIG G. , ROSE M. , BALDO B. 
Published: June 2009

Background: The aim of this study was to ascertain whether anaesthetic induction‐related anaphylactic bronchospasm could be distinguished from other types of bronchospasm by clinical features and response to treatment. Such features could then be used to identify a group of patients in whom skin testing is indicated.Methods: We retrospectively studied data from 183 patients referred to an anaesthetic allergy clinic because of bronchospasm during induction. For the analysis, the patients were divided into two groups depending on whether there was evidence suggesting immunological anaphylaxis.Results: When the patients in whom intradermal tests were positive were compared with those in whom intradermal tests were negative, the skin test‐positive patients had significantly more severe reactions, and they were more commonly associated with other clinical signs. Mast cell tryptase (MCT) was an excellent discriminator between reactions likely to be allergic and those unlikely to be allergic.Conclusions: Anaphylactic bronchospasm related to induction of anaesthesia is more likely to be severe than bronchospasm due to non‐immune causes. An allergic cause is more likely if there are associated features of anaphylaxis (skin changes, hypotension, angioedema) or elevated MCT. Patients with any of these features should undergo immuno‐allergolical investigation.
The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia
Authors: CHO J. E. , KIM J. Y. , HONG J. Y. , KIL H. K. 
Published: June 2009

Background: Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5 mg/ml ropivacaine for post‐operative epidural analgesia in children.Methods: One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ml ropivacaine (R1.25 group), 1.25 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.5F group) for post‐operative epidural analgesia. The epidural catheter was threaded caudally through the L4‐5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score >4, an epidural bolus of 0.5 ml/kg of ropivacaine 1.5 mg/ml was given as the rescue analgesia. The incidence of side effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was recorded.Results: The need for rescue analgesia was higher in the R1.25 group compared with that in the other three groups (all P<0.05). The incidence of side effects was higher in the R1.5F group compared with that in the R1.25 and R1.5 groups (both P=0.010).Conclusion: The addition of 0.2 mcg/kg/h fentanyl to 1.5 mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl.
The use of cord blood for transfusion purposes: current status
Authors: Khodabux C. M. , Brand A. 
Published: June 2009

Although the use of umbilical cord blood (UCB) for transfusion purposes has been proposed decades ago, the employ is still limited. In this article we review studies evaluating UCB collection efficiency and sterility, examine processing and storage of UCB‐derived red blood cells (RBC) and discuss clinical studies in which UCB was used for transfusion purposes.Efforts to provide preterm newborns with autologous RBC derived from UCB have not been very successful. UCB collected after full‐term deliveries can however easily be processed into RBC products and could be used autologous in case surgery of the neonate is indicated early after birth, or for allogeneic small volume paediatric transfusions. To harvest enough UCB volume, immediate clamping of the umbilical cord is commonly used as standard practice. Although delayed cord clamping has shown to improve the iron status in full‐term infants; for small‐for‐gestational‐age infants this has not been demonstrated. In addition, an increased need for phototherapy after delayed clamping exists. Altogether, we could find no disencouraging evidence to collect UCB, which could be processed into an easily available RBC product for paediatric transfusion in resource‐restricted countries.
Simultaneous genotyping of human platelet antigen‐1 to 17w by polymerase chain reaction sequence‐based typing
Authors: Xu X. , Zhu F. , Ying Y. , Tao S. , Liu Y. , Hong X. , Yan L. 
Published: June 2009

Background and Objectives  Genotyping for human platelet antigen (HPA) systems is required in the investigation of patients with suspected HPA antibodies and for the provision of compatible blood products from HPA‐typed donors. Here, we set up a polymerase chain reaction sequence‐based typing method for simultaneous genotyping of HPA‐1 to 17w (PCR‐SBT).Materials and methods  The specific primers for HPA‐1 to 17w were designed by primer premier 5·0 software. The PCR amplification conditions were optimized. Amplification products were purified by enzyme digestion and sequenced by a BigDye Terminator Cycle Sequencing kit.Results  We used two standard DNA samples and 16 reference samples, including six with HPA gene mutations, for the HPA‐1 to 17w analysis by the PCR‐SBT and obtained 100% correct genotypes in these samples. The genotype and allele frequencies of HPA‐1 to 17w were analysed from 112 Han Chinese persons. Thirteen new single nucleotide polymorphisms and one microsatellite were found in the sequenced regions, in which two nucleotide polymorphisms of ITGB3 gene could cause amino acid alteration of Val419Met and Glu628Lys on the mature glycoprotein, respectively.Conclusions  The PCR‐SBT method is reliable and accurate for HPA genotyping, suitable for routine HPA analysis, and can screen large numbers of donors. We identified 14 new polymorphisms, two of which led to amino acid changes.
A pair of naturally occurring antibodies may dampen complement‐dependent phagocytosis of red cells with a positive antiglobulin test in healthy blood donors
Authors: Alaia V. , Frey B. M. , Siderow A. , Stammler P. , Kradolfer M. , Lutz H. U. 
Published: June 2009

Background and Objective  It is known that red blood cells (RBC) from healthy blood donors with a positive direct antiglobulin test (DAT) for IgG continue to circulate despite carrying elevated numbers of IgG molecules. To unravel the properties of these RBC‐bound IgG, we studied them not only on whole RBC populations, but also on density‐fractionated RBCs.Materials and Methods  The properties of acid‐eluted RBC‐bound IgG and plasma IgG were studied by ELISA for binding to RBC proteins and opsonins, and by blotting. In vitro phagocytosis was studied on density‐separated RBCs.Results  IgG‐DAT‐positive blood donors carried most IgG molecules on dense RBCs and had more RBCs of high density than DAT‐negative controls. Their densest RBCs were older than the oldest RBCs of DAT‐negative controls, based on the band 4·1a/b ratio. In vitro phagocytosis of senescent RBCs from IgG‐DAT‐positive donors was 1·5 to 2 fold higher than that of senescent control cells, but the same or less in the presence of physiological IgG concentrations, implying that RBC‐bound IgGs impaired complement‐dependent uptake. The IgG molecules on these DAT‐positive RBCs comprised anti‐band 3 naturally occurring antibodies (NAbs) and were two‐ to fivefold enriched in anti‐C3 and framework‐specific anti‐idiotypic NAbs as compared to controls. Correspondingly, anti‐C3 and framework‐specific anti‐idiotypic NAbs were proportionally elevated in the plasma of two‐thirds of DAT+ donors.Conclusions  Extra‐binding of anti‐C3 together with anti‐idiotypic NAbs to senescent RBC‐associated C3 fragments may suppress complement‐dependent RBC phagocytosis and may prolong the in vivo life span of RBCs.