bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of Postoperative End-tidal Pco2Measurements with Mainstream and Sidestream Capnography in Non-obese Patients and in Obese Patients with and without Obstructive Sleep Apnea
Authors: Kasuya Yusuke , Akça Ozan , Sessler Daniel I. , Ozaki Makoto , Komatsu Ryu 
Published: August 2009

Background
Obtaining accurate end-tidal carbon dioxide pressure measurements via nasal cannula poses difficulties in postanesthesia patients who are mouth breathers, including those who are obese and those with obstructive sleep apnea (OSA); a nasal cannula with an oral guide may improve measurement accuracy in these patients. The authors evaluated the accuracy of a mainstream capnometer with an oral guide nasal cannula and a sidestream capnometer with a nasal cannula that did or did not incorporate an oral guide in spontaneously breathing non-obese patients and obese patients with and without OSA during recovery from general anesthesia.

Methods
The study enrolled 20 non-obese patients (body mass index less than 30 kg/m) without OSA, 20 obese patients (body mass index greater than 35 kg/m) without OSA, and 20 obese patients with OSA. End-tidal carbon dioxide pressure was measured by using three capnometer/cannula combinations (oxygen at 4 l/min): (1) a mainstream capnometer with oral guide nasal cannula, (2) a sidestream capnometer with a nasal cannula that included an oral guide, and (3) a sidestream capnometer with a standard nasal cannula. Arterial carbon dioxide partial pressure was determined simultaneously. The major outcome was the arterial-to-end-tidal partial pressure difference with each combination.

Results
In non-obese patients, arterial-to-end-tidal pressure difference was 3.0 +/- 2.6 (mean +/- SD) mmHg with the mainstream capnometer, 4.9 +/- 2.3 mmHg with the sidestream capnometer and oral guide cannula, and 7.1 +/- 3.5 mmHg with the sidestream capnometer and a standard cannula (P < 0.05). In obese non-OSA patients, it was 3.9 +/- 2.6 mmHg, 6.4 +/- 3.1 mmHg, and 8.1 +/- 5.0 mmHg, respectively (P < 0.05). In obese OSA patients, it was 4.0 +/- 3.1 mmHg, 6.3 +/- 3.2 mmHg, and 8.3 +/- 4.6 mmHg, respectively (P < 0.05).

Conclusions
Mainstream capnometry performed best, and an oral guide improved the performance of sidestream capnometry. Accuracy in non-obese and obese patients, with and without OSA, was similar.
Desflurane, Isoflurane, and Sevoflurane Provide Limited Neuroprotection against Neonatal Hypoxia-Ischemia in a Delayed Preconditioning Paradigm
Authors: McAuliffe John J. , Loepke Andreas W. , Miles Lili , Joseph Bernadin , Hughes Elizabeth , Vorhees Charles V. 
Published: August 2009

Background
The volatile anesthetics desflurane, isoflurane, and sevoflurane have been found to produce neuroprotection in various paradigms. The authors used these agents in a delayed preconditioning model to test the hypothesis that they could provide neuroprotection against neonatal hypoxia-ischemia as assessed by a battery of behavioral tests.

Methods
Institutional Animal Care and Use Committee approval was obtained. A total of 140, C57-129T2 F1 hybrid 9-day-old mice were randomized to 3 h of preconditioning with room air (Group Sham and Group HI), 8.4% desflurane in 40% oxygen (Group D), 1.8% isoflurane (Group I), or 3.1% sevoflurane (Group S). Twenty-four hours later, the Group HI, D, I, and S mice had 60 min of hypoxia-ischemia, and Group Sham had 60 min of sham HI. Surviving animals had behavioral testing, including open field activity, acoustic startle, prepulse inhibition, rotorod, novel object recognition, water mazes, and apomorphine challenge. Histologic analysis was also performed.

Results
Mice in Groups D, I, and S performed better than Group HI and similarly to Group Sham on novel object recognition and apomorphine challenge and better than Group HI but not as well as Group Sham on cued maze testing. All mice exposed to hypoxia-ischemia performed worse than Group Sham on the spatially oriented water mazes with no difference among groups. Histologic sections did not show any significant effect of preconditioning on injury scores.

Conclusions
Volatile agent preconditioning partially protects perirhinal cortex and striatal dependent functions against moderate to severe neonatal hypoxia-ischemia.
Placental Transfer and Fetal Metabolic Effects of Phenylephrine and Ephedrine during Spinal Anesthesia for Cesarean Delivery
Authors: Ngan Kee Warwick D. , Khaw Kim S. , Tan Perpetua E. , Ng Floria F. , Karmakar Manoj K. 
Published: August 2009

Background
Use of ephedrine in obstetric patients is associated with depression of fetal acid-base status. The authors hypothesized that the mechanism underlying this is transfer of ephedrine across the placenta and stimulation of metabolism in the fetus.

Methods
A total of 104 women having elective Cesarean delivery under spinal anesthesia randomly received infusion of phenylephrine (100 microg/ml) or ephedrine (8 mg/ml) titrated to maintain systolic blood pressure near baseline. At delivery, maternal arterial, umbilical arterial, and umbilical venous blood samples were taken for measurement of blood gases and plasma concentrations of phenylephrine, ephedrine, lactate, glucose, epinephrine, and norepinephrine.

Results
In the ephedrine group, umbilical arterial and umbilical venous pH and base excess were lower, whereas umbilical arterial and umbilical venous plasma concentrations of lactate, glucose, epinephrine, and norepinephrine were greater. Umbilical arterial Pco2 and umbilical venous Po2 were greater in the ephedrine group. Placental transfer was greater for ephedrine (median umbilical venous/maternal arterial plasma concentration ratio 1.13 vs. 0.17). The umbilical arterial/umbilical venous plasma concentration ratio was greater for ephedrine (median 0.83 vs. 0.71).

Conclusions
Ephedrine crosses the placenta to a greater extent and undergoes less early metabolism and/or redistribution in the fetus compared with phenylephrine. The associated increased fetal concentrations of lactate, glucose, and catecholamines support the hypothesis that depression of fetal pH and base excess with ephedrine is related to metabolic effects secondary to stimulation of fetal beta-adrenergic receptors. Despite historical evidence suggesting uteroplacental blood flow may be better maintained with ephedrine, the overall effect of the vasopressors on fetal oxygen supply and demand balance may favor phenylephrine.
Monitoring Electrical Skin Conductance
Authors: Hullett Bruce , Chambers Neil , Preuss James , Zamudio Italo , Lange Jonas , Pascoe Elaine , Ledowski Thomas 
Published: August 2009

Background
Monitoring changes in electrical skin conductance has been described as a potentially useful tool for the detection of acute pain in adults. The aim of this study was to test the method in pediatric patients.

Methods
A total of 180 postoperative pediatric patients aged 1-16 yr were included in this prospective, blinded observational study. After arrival in the recovery unit, pain was assessed by standard clinical pain assessment tools (1-3 yr: Face Legs Activity Cry Consolability Scale, 4-7 yr: Revised Faces Scale, 8-16 yr: Visual Analogue Scale) at various time points during their stay in the recovery room. The number of fluctuations in skin conductance per second (NFSC) was recorded simultaneously.

Results
Data from 165 children were used for statistical analysis, and 15 patients were excluded. The area under the Receiver Operating Characteristic curve for predicting moderate to severe pain from NFSC was 0.82 (95% confidence interval 0.79-0.85). Over all age groups, an NFSC cutoff value of 0.13 was found to distinguish between no or mild versus moderate or severe pain with a sensitivity of 90% and a specificity of 64% (positive predictive value 35%, negative predictive value 97%).

Conclusions
NFSC accurately predicted the absence of moderate to severe pain in postoperative pediatric patients. The measurement of NFSC may therefore provide an additional tool for pain assessment in this group of patients. However, more research is needed to prospectively investigate the observations made in this study and to determine the clinical applicability of the method.
Adjunct Nitrous Oxide Normalizes Vascular Reactivity Changes after Hemorrhagic Shock in Mice under Isoflurane Anesthesia
Authors: Samarska Iryna V. , van Meurs Matijs , Buikema Hendrik , Houwertjes Martin C. , Wulfert Francis M. , Molema Grietje , Epema Anne H. , Henning Robert H. 
Published: August 2009

Background
Hemorrhagic shock is associated with changes in vascular responsiveness that may lead to organ dysfunction and, ultimately, multiple organ dysfunction syndrome. Volatile anesthetics interfere with vasoresponsiveness, which may contribute to organ hypoperfusion. In this study, the authors examined the influence of adjunct nitrous oxide on the vascular responsiveness after short-term hemorrhagic shock under isoflurane anesthesia.

Methods
Spontaneously breathing mice (n = 31, 27.6 +/- 0.31 g) were anesthetized with isoflurane (1.4%) or with isoflurane (1.4%) and adjunct nitrous oxide (66%). Both groups were divided into Sham, Shock, and Resuscitated groups. Vascular reactivity to phenylephrine and acetylcholine and expression of cyclooxygenases were studied in the aorta.

Results
In the isoflurane-anesthetized groups, the contractile response to phenylephrine was increased in the Shock as compared with the Sham and Resuscitated groups (Emax = 3.2 +/- 0.4, 1.2 +/- 0.4, and 2.5 +/- 0.5 mN, respectively). Adjunct nitrous oxide increased phenylephrine contraction to a similar level in all three groups. In the Sham isoflurane group, acetylcholine caused a biphasic response: An initial relaxation followed by a contractile response sensitive to cyclooxygenases inhibition by indomethacine. The contractile response was abrogated in the isoflurane-anesthetized groups that underwent shock. In all groups, adjunct nitrous oxide preserved the contractile phase. Shock induced a down-regulation of cyclooxygenases-1, which was normalized by adjunct nitrous oxide.

Conclusion
Adjunct nitrous oxide attenuates shock-induced changes in vascular reactivity and cyclooxygenases expression of mice under isoflurane anesthesia. This implies that vascular reactive properties during anesthesia in hemorrhagic shock conditions may be influenced by the choice of anesthetics.
Phospholipase Dα1 and Phosphatidic Acid Regulate NADPH Oxidase Activity and Production of Reactive Oxygen Species in ABA-Mediated Stomatal Closure inArabidopsis
Authors: Zhang Yanyan , Zhu Huiying , Zhang Qun , Li Maoyin , Yan Min , Wang Rong , Wang Liling , Welti Ruth , Zhang Wenhua , Wang Xuemin 
Published: August 2009

AbstractWe determined the role of Phospholipase Dα1 (PLDα1) and its lipid product phosphatidic acid (PA) in abscisic acid (ABA)-induced production of reactive oxygen species (ROS) in Arabidopsis thaliana guard cells. The pldα1 mutant failed to produce ROS in guard cells in response to ABA. ABA stimulated NADPH oxidase activity in wild-type guard cells but not in pldα1 cells, whereas PA stimulated NADPH oxidase activity in both genotypes. PA bound to recombinant Arabidopsis NADPH oxidase RbohD (respiratory burst oxidase homolog D) and RbohF. The PA binding motifs were identified, and mutation of the Arg residues 149, 150, 156, and 157 in RbohD resulted in the loss of PA binding and the loss of PA activation of RbohD. The rbohD mutant expressing non-PA-binding RbohD was compromised in ABA-mediated ROS production and stomatal closure. Furthermore, ABA-induced production of nitric oxide (NO) was impaired in pldα1 guard cells. Disruption of PA binding to ABI1 protein phosphatase 2C did not affect ABA-induced production of ROS or NO, but the PA–ABI1 interaction was required for stomatal closure induced by ABA, H2O2, or NO. Thus, PA is as a central lipid signaling molecule that links different components in the ABA signaling network in guard cells.
Refractoriness to random donor platelet transfusions in patients with aplastic anaemia: a multivariate analysis of data from 264 cases
Authors: Klingemann Hans‐G. , Self Steven , Banaji Meera , Deeg H. Joachim , Doney Kristine , Slichter Sherrill J. , Thomas E. Donnall , Storb Rainer 
Published: August 2009

Summary.Frequent platelet support is an essential part of the management of patients with severe aplastic anaemia and platelet transfusions from random donors are usually given as initial therapy. To evaluate those parameters that might correlate with the development of refractoriness to platelets from random donors, we performed a retrospective multivariate analysis in 264 patients with severe aplastic anaemia who presented for allogeneic bone marrow transplantation. Two hundred and ten (79.5%) of these patients had received multiple platelet and red cell transfusions, and 71 (34%) were refractory to random donor platelets. The strongest factor correlating with refractoriness was the presence of lymphocytotoxic antibodies, followed by the number of platelet units previously transfused. However, the latter variable attained significance only when the number of platelet units transfused exceeded 40. When given HLA‐compatible platelet transfusions, only five (7%) of the refractory patients did not show a reasonable post‐transfusion platelet increment. Measures which would delay or prevent platelet alloimmunization might include a policy of therapeutic rather than prophylactic platelet transfusions, and referring patients early in the course of their disease for marrow grafting if a suitable donor is available.
Prospective evaluation of haemoglobin oxygen saturation at rest and after exercise in paediatric sickle cell disease patients
Authors: Campbell Andrew , Minniti Caterina P. , Nouraie Mehdi , Arteta Manuel , Rana Sohail , Onyekwere Onyinye , Sable Craig , Ensing Gregory , Dham Niti , Luchtman‐Jones Lori , Kato Gregory J. , Gladwin Mark T. , Castro Oswaldo L. , Gordeuk Victor R. 
Published: August 2009

SummaryLow steady state haemoglobin oxygen saturation in patients with sickle cell anaemia has been associated with the degree of anaemia and haemolysis. How much pulmonary dysfunction contributes to low saturation is not clear. In a prospective study of children and adolescents with sickle cell disease aged 3–20 years at steady state and matched controls, 52% of 391 patients versus 24% of 63 controls had steady state oxygen saturation <99% (P < 0·0001), 9% of patients versus no controls had saturation <95% (P = 0·008) and 8% of patients versus no controls had exercise‐induced reduction in saturation ≥3%. Decreasing haemoglobin concentration (P ≤ 0·001) and increasing haemolysis (P ≤ 0·003) but not pulmonary function tests were independent predictors of both lower steady‐state saturation and exercise‐induced reduction in saturation. Neither history of stroke nor history of acute chest syndrome was significantly associated with lower steady‐state oxygen saturation or exercise‐induced reduction in saturation. Tricuspid regurgitation velocity was higher in patients with lower steady state haemoglobin oxygen saturation (P = 0·003) and with greater decline in oxygen saturation during the six‐minute walk (P = 0·022). In conclusion, lower haemoglobin oxygen saturation is independently associated with increasing degrees of anaemia and haemolysis but not pulmonary function abnormalities among children and adolescents with sickle cell disease.
Usual sleep duration and cognitive function in older adults in Spain
Authors: FAUBEL RAQUEL , LÓPEZ‐GARCÍA ESTHER , GUALLAR‐CASTILLÓN PILAR , GRACIANI AUXILIADORA , BANEGAS JOSÉ R. , RODRÍGUEZ‐ARTALEJO FERNANDO 
Published: August 2009

SummaryThe few studies that have examined the association between usual sleep duration and cognitive function have shown conflicting results. This cross‐sectional study examined the association between sleep duration and cognitive function among 3212 people, representative of the non‐institutionalized population aged 60 years and over in Spain. Sleep duration was self‐reported, and cognitive function was measured with the Mini‐Examen Cognoscitivo (MEC), a version of the Mini‐Mental State Examination that has been validated in Spain. Linear regression, with adjustment for the main confounders, was used to obtain mean differences in the MEC between the categories of sleep duration (≤5, 6, 7, 8, 9, 10, ≥11 h day−1). The MEC score decreased progressively (became worse) across sleep categories from 7 to ≥11 h (P for linear trend <0.001). People who slept for ≥11 h had a significantly lower MEC score than those who slept for 7 h (mean difference −1.48; 95% confidence interval −2.12 to −0.85). This difference in the MEC was similar to that observed for a 10‐year increase in age. The results did not vary significantly by sex (P for interaction >0.05). No association was observed between short sleep duration (<7 h) and cognitive function. We conclude that long sleep duration is associated with poorer cognitive function in older adults from the general population.
Effects of thermal acclimation on water loss rate and tolerance in the collembolanPogonognathellus flavescens
Authors: LEINAAS HANS PETTER , SLABBER SARETTE , CHOWN STEVEN L. 
Published: August 2009

Abstract.A few days of thermal acclimation (to 5 °C versus 15 °C) may strongly affect tolerance to drought stress in Collembola. To better understand this phenomenon, the effect of acclimation on water loss rate and its consequence for survival in the speciesPogonognathellus flavescensTullberg (Tomoceridae) is investigated. Acclimation does not affect the water content of hydrated animals but animals exposed to 15 °C and 76% relative humidity lose water much faster after having been acclimated to 5 °C rather than 15 °C. Tolerance to water loss is not affected; in both treatment groups, animals survive up to 40% loss of the water content recorded when fully hydrated. The percentage water content of hydrated animals decreases with size, which may explain why the proportion of initial water lost appears to be a better predictor for survival than the amount of remaining water. The proportion of initial water lost per unit time is little influenced by size in animals acclimated to 15 °C but increases with decreasing size in the group at 5 °C, indicating that acclimation affects a physiological protection against water loss.
Are hospitals prepared to support newborn survival? – an evaluation of eight first‐referral level hospitals in Kenya*
Authors: Opondo Charles , Ntoburi Stephen , Wagai John , Wafula Jackline , Wasunna Aggrey , Were Fred , Wamae Annah , Migiro Santau , Irimu Grace , English Mike 
Published: August 2009

SummaryObjective  To assess the availability of resources that support the provision of basic neonatal care in eight first‐referral level (district) hospitals in Kenya.Methods  We selected two hospitals each from four of Kenya’s eight provinces with the aim of representing the diversity of this part of the health system in Kenya. We created a checklist of 53 indicator items necessary for providing essential basic care to newborns and assessed their availability at each of the eight hospitals by direct observation, and then compared our observations with the opinions of health workers providing care to newborns on recent availability for some items, using a self‐administered structured questionnaire.Results  The hospitals surveyed were often unable to maintain a safe hygienic environment for patients and health care workers; staffing was insufficient and sometimes poorly organised to support the provision of care; some key equipment, laboratory tests, drugs and consumables were not available while patient management guidelines were missing in all sites.Conclusion  Hospitals appear relatively poorly prepared to fill their proposed role in ensuring newborn survival. More effective interventions are needed to improve them to meet the special needs of this at‐risk group.
Exploring kidney patients’ experiences of receiving individual peer support
Authors: Hughes Jane , Wood Eleri , Smith Gaynor 
Published: August 2009

AbstractBackground  Peer support schemes of various types are commonly offered to patients as an adjunct to health and social care services provided by professionals. For patients with chronic illness, peer support interventions have recently become associated with more directive attempts to increase self management and improve healthcare outcomes. There is little qualitative research on patients’ experiences of one‐to‐one peer support.Purpose  To explore kidney patients’ experiences of receiving individual peer support.Setting  Two large teaching hospital renal units in South London, with peer support services for patients on the pre‐dialysis care pathway.Methods  Qualitative telephone interviews with a purposive, maximum variation sample of 20 people who had received peer support.Results  The majority of respondents were overwhelmingly positive about their experience of peer support and its benefits. They valued peer support because it had given them access to practical information about kidney disease, based on lived experience, which helped them reach decisions about treatment. Peer supporters offered patients empathy and understanding; confirmation that they were not alone in suffering; positive role models of coping with treatment for kidney disease; and hope for the future. Peer support helped patients adapt to chronic illness by normalizing adherence to demanding treatment regimes and increasing patients’ sense of empowerment and agency.Conclusions  A brief meeting with a peer supporter delivered similar perceived benefits to those described by participants in support groups. Possible explanations for this include selection and training of peer supporters; careful matching of patients with peer supporters; and responsiveness to individual user‐defined needs for information and psychosocial support.
What is involvement in research and what does it achieve? Reflections on a pilot study of the personal costs of stroke
Authors: McKevitt Christopher , Fudge Nina , Wolfe Charles 
Published: August 2009

AbstractBackground  Health researchers are encouraged to involve service users as partners in their research. There is a need to increase the evidence base of involvement, including an accumulation of empirical accounts of involvement practices, demonstrating how involvement influences research and refinement of the concept itself.Aims  To report the development of a pilot study by academic researchers and stroke service users belonging to a user research group to investigate costs of stroke to individuals and families; to reflect on what this example of user involvement achieved and implications for what involvement means.Methods  We conducted a 2‐year ethnographic study that included participant observation, formal and informal interviews with professionals and user group members and documentary analysis. Data were systematically recorded to permit description of processes and reflexive analysis.Results and conclusions  We report on five stages of the research process from service user identification of a research question to interpretation of pilot study findings. Professional researchers led the research process and developed a novel method to involve stroke service users in the development of a questionnaire. Some academic colleagues questioned the value of the proposed investigation as it did not appear to conform to implicit criteria of quality research. We argue that the moral status that user involvement has acquired means that academics’ concerns about quality did not prevent the pilot study from being conducted. We suggest that much of what was undertaken might be considered standard good practice in developing new research studies but also identify additional benefits of user involvement. Implications for conceptual development and evaluation are discussed.