bluuebunny/crossref_metadata_2025_split huggingface dataset:
Haemodynamic effects of patent foramen ovale and atrial septal defect closure: a comparison during percutaneous shunt closure
Authors: Luermans Justin G. L .M. , Bos Willem J. W. , Post Martijn C. , Ten Berg Jurriën M. , Thijs Plokker H. W. , Suttorp Maarten J. 
Published: October 2009

SummaryObjectives:  We investigated the haemodynamic effect of percutaneous closure of an intra‐atrial shunt, using non‐invasive finger pressure measurements.Background:  Percutaneous closure of both patent foramen ovale (PFO) and atrial septal defect (ASD) is widely practised. Currently no data are available on short‐term haemodynamic changes induced by closure.Methods:  Twenty‐five consecutive patients (mean age 49 ± 17 years, 10 men) who underwent a percutaneous closure of a PFO (n = 15) or ASD (n = 10) were included in this study. During the procedure blood pressure and heart rate (HR) were monitored continuously with a Finometer®. Changes in systolic, mean, and diastolic pressure, stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were computed from the pressure registrations using Modelflow® methodology.Results:  Baseline characteristics were similar for the PFO and ASD patients. After PFO closure none of the haemodynamic parameters changed significantly. After ASD closure the systolic, mean, and diastolic pressures increased 7·1 ± 5·4 (P = 0·003), 3·8 ± 3·5 (P = 0·007) and 2·0 ± 3·0 mmHg (P = ns) respectively. HR decreased 5·1 ± 5·3 beats per minute (P = 0·01). SV, CO and TPR increased 8·5 ± 6·4 ml (13·5%; P = 0·002), 0·21 ± 0·45 l min−1 (5·6%; P = ns) and 0·02 ± 0·14 dynes (4·1%; P = ns) respectively. The changes in SV differ between the PFO and ASD patients (P = 0·009).Conclusions:  Using non‐invasive finger pressure measurements, we found that SV, mean and systolic blood pressure increased immediately after percutaneous closure of an ASD in adults, whereas the percutaneous PFO closure had no effect on haemodynamic characteristics.
Endonasal Endoscopic Management of Contact Point Headache and Diagnostic Criteria
Authors: Mohebbi Alireza , Memari Framarz , Mohebbi Saleh 
Published: October 2009

(Headache 2010;50:242‐248)Background.— Some types of headaches with sinonasal origin may be present in the absence of inflammation and infection. The contact points between the lateral nasal wall and the septum could be the cause of triggering and sustained pain via trigeminovascular system.Objective.— The aim of this study was to evaluate the feasibility and effectiveness of endoscopic surgery in the sinonasal region for treatment of headache with special attention paid to specific diagnostic methods and patient selection.Methods.— This was a prospective, non‐randomized and semi‐quasi experimental research study. Thirty‐six patients with chronic headaches who had not previously responded to conventional treatments were evaluated by rhinoscopy and/or endoscopy, local anesthetic tests and computed tomography scans as diagnostic criteria. These patients were divided into 4 groups based on the diagnostic methods utilized. The intensity of headaches pre‐ and post‐operatively were recorded by utilizing the visual analog scale scale and performing analysis with analysis of variance test comparison and Statistical Package for Social Sciences. Average follow‐up was 30 months.Results.— Our overall success rate approximated 83% while the complete cure rate was 11%. Patients in group 4 achieved the best results. In this group all diagnostic criteria were positive. In addition, patient responses were statistically significant in groups with more than one positive criteria compared with group 1 who only had positive examination. The positive response of 14 migrainous patients diagnosed with migraine prior to treatment was 64%.Conclusion.— Surgery in specific cases of headaches with more positive evidence of contact point could be successful, particularly if medical therapy has failed.
Topiramate for Migraine Prevention in a Naturalistic Setting: Results From an Open Label, Flexible Dose Study
Authors: Nelles Gereon , Delbrück Anette , Schulze Lutz , Kademann Barbara , Bornhoevd Karin , Schäfer Susanne , Schäuble Barbara 
Published: October 2009

Background.— Headaches are one of the most common neurological symptoms and migraines are the most common primary headache disorder. The global prevalence of migraines is around 10% and the condition is associated with a high burden of disease. Despite an abundance of good quality evidence, only 1 in 5 of patients who fulfill the criteria for preventive migraine therapy are appropriately treated. Data on patient outcomes with preventive medication derive mostly from specialized academic centers, which contrasts with normal clinical practice where the majority of patients are treated outside tertiary care centers.Objective.— To explore tolerability, safety and efficacy outcomes of patients receiving topiramate for migraine prevention in a naturalistic setting.Methods.— After a 4‐week prospective baseline, patients with a diagnosis of migraine according to International Headache Society criteria and eligible for migraine prevention were treated with flexible dosing of topiramate for 24 weeks (core phase), and optionally for a total of 48 weeks. The primary safety analysis included adverse events (AEs) during the core phase. For the main efficacy measures, the absolute changes from baseline to end of core phase as well as last follow‐up visit were calculated for migraine days per 4 weeks, migraine attacks per 4 weeks, mean maximum visual analogue scale of migraine headache per 4 weeks and mean maximum pain intensity of migraine headache (4‐point scale) per 4 weeks. In addition, changes in individual quality of life aspects were captured.Results.— The intention‐to‐treat population (ITT) consisted of 161 patients (90.7% female, mean age 45.7 ± 11.1 years). Topiramate median dose was 45.7 mg/day at endpoint. Some 74.1% of patients reported treatment emergent AEs, most frequently paresthesias (18.4%) and nausea (12.4%). Some 20.0% of patients withdrew from the study due to AEs. The mean number of migraine days per 4 week decreased from 6.2 ± 3.9 days at baseline to 3.9 ± 3.5 days at last core visit (P < .001). Mean maximum pain intensity per 4 week changed from 7.0 ± 2.3 at baseline to 4.7 ± 3.2 at last visit core phase (P < .001). Consumption of triptans and analgesics reduced during the course of the core phase (P < .005). Fifty‐one percent of all patients experienced at least a 50% reduction in migraine days during the core phase.Conclusion.— Topiramate used for migraine prevention in non‐academic institutions is generally safe, well tolerated and results in good control of migraine headaches and improvement in several aspects of quality of life.
Prevalence and Incidence of Headache in Adolescent Finnish Twins
Authors: Virtanen Ruut , Aromaa Minna , Koskenvuo Markku , Sillanpää Matti , Rose Richard J. , Metsähonkala Liisa , Helenius Hans , Anttila Pirjo , Kaprio Jaakko 
Published: October 2009

Objectives.— The study aim was to determinate changes in prevalence and incidence rates of headache among adolescent Finnish twins.Methods.— Questionnaire data were collected during 1994‐1998 from a nationwide sample of Finnish families of 11‐year‐old twins who were born between 1983 and 1987 (n = 6262) and again at ages of 14 and 17.Results.— During follow‐up, the prevalence of regular headache (ie, at least once a month = RHA) increased from 59% at age 11 to 65% at age 14 and decreased to 63% at age 17. Among boys the prevalence of RHA increased significantly from 59% at age 11 to 62% at age 14 decreasing to 52% at age 17. Among girls the prevalence rates increased significantly between ages of 11 and 14 from 60% to 68% up to 74% at age 17. The prevalence of weekly headache increased in girls between ages of 11 and 14 from 16% to 25%. Incidence of RHA (at least once a month) decreased from 47% at age 14 to 44% at age 17 in girls and from 44% at age 14 to 30% at age 17 in boys.Conclusions.— RHA is more common in girls than boys during puberty, while the incidence of RHA declined especially in boys during same age period.
Headache Disability Among Adolescents: A Student Population‐Based Study
Authors: Fuh Jong‐Ling , Wang Shuu‐Jiun , Lu Shiang‐Ru , Liao Yi‐Chu , Chen Shih‐Pin , Yang Chin‐Yi 
Published: October 2009

(Headache 2010;50:210‐218)Objective.— To examine the extent and to identify the relevant predictors of headache disabilities in adolescents.Background.— Headaches are common in adolescents but their impact and related factors have not been extensively studied in adolescent communities.Method.— We recruited and surveyed 3963 students aged 13‐15 from 3 middle schools using self‐administered questionnaires. The questionnaires were used to make 3 assessments: (1) headaches were diagnosed using a validated headache questionnaire; (2) headache disabilities were valuated using the 6‐question Pediatric Migraine Disability Assessment; (3) depression was measured using the Adolescent Depression Inventory.Results.— The student response rate was 93%. In total, 484 students (12.2%) had migraines with or without auras, 444 (11.2%) had probable migraines, and 1092 (27.6%) had tension‐type headaches. The students with migraine had the highest Pediatric Migraine Disability Assessment scores (10.7 ± 20.0); whereas, the students with tension‐type headaches had the lowest scores (2.0 ± 4.4). Logistic regression analyses indicated that there were a number of independent predictors for moderate to severe headache‐related disability (Pediatric Migraine Disability Assessment score ≥31), including a migraine or probable migraine diagnosis, a higher depression score, severe headache intensity, and frequent headaches.Conclusions.— The Pediatric Migraine Disability Assessment provides a simple tool to measure the impact of headaches in adolescents. Adolescents with migraine headaches suffered the greatest level of disability. Higher depression scores were associated with more severe headache‐related disabilities in adolescents, independent of headache frequency and severity.
Cluster Headache As the Result of Secondhand Cigarette Smoke Exposure During Childhood
Authors: Rozen Todd D. 
Published: October 2009

(Headache 2010;50:130‐132)Unique to cluster headache (CH) compared with all other primary headache conditions is its association with a personal history of cigarette smoking. Studies have indicated that greater than 80% of CH patients have a prolonged history of tobacco usage prior to CH onset. How tobacco exposure can lead to CH has not yet been elucidated. As secondhand smoke exposure during childhood has been linked to multiple medical illnesses could CH also be the result of childhood exposure to tobacco smoke? The United States Cluster Headache survey is the largest survey ever done of CH sufferers living in the United States. The survey addressed various clinical, epidemiologic, and economic issues related to CH. Several survey questions dealt with the issue of personal and parental smoking history. Results from the survey suggest that CH can result from secondhand cigarette smoke exposure during childhood as greater than 60% of non‐smoking CH patients had parents who smoked. Strengthening the probable association between secondhand smoke exposure and the development of CH is the fact that double the number of survey responders developed CH at or before 20 years of age if during their childhood they lived with a parent who smoked cigarettes.
Intraoperatively salvaged red blood cells contain nearly no functionally active platelets, but exhibit formation of microparticles: results of a pilot study in orthopedic patients
Authors: Oswald Elgar , Streif Werner , Hermann Martin , Hengster Paul , Mittermayr Markus , Innerhofer Petra 
Published: October 2009

BACKGROUND: Previous data show improved clot formation after retransfusion of salvaged red blood cells (RBCs). This study was conducted to explore whether such RBCs contain clinically relevant numbers of active residual platelets (PLTs) or exhibit formation of microparticles (MPs).STUDY DESIGN AND METHODS: Thirteen patients undergoing major orthopedic surgery were included in the study, and arterial blood samples from patients and samples from the retransfusion bag were analyzed with various PLT function tests and flow cytometry.RESULTS: With commercial blood cell counters, the numbers of PLTs in the RBC unit were reduced to approximately 25% compared to patients' blood. In contrast, results from flow cytometry showed an 11‐ to 945‐fold reduction in median counts referring to total PLTs and free PLTs. Interestingly, smaller quantities of PLT‐derived MPs were found in samples from the retransfusion bag than in patients' arterial blood. Conversely, RBC‐ and white blood cell–derived MP counts were increased in the retransfusion bag compared to the patient. Rotational thrombelastometry and the Impact‐R system (DiaMed) showed a pronounced impairment of PLT ability with regard to adhesion, aggregation, and clot formation. With the use of confocal microscopy, only a few free thrombocytes were detectable among the huge numbers of RBCs.CONCLUSION: Only few free and thus active PLTs are detectable in processed RBCs. It seems very unlikely that these few PLTs can improve clot strength. Nevertheless, the impact of the detected MPs on thrombin generation needs to be clarified in further studies.
BLOOD DONORS AND BLOOD COLLECTION: Delayed adverse reactions to blood donation
Authors: Kamel Hany , Tomasulo Peter , Bravo Marjorie , Wiltbank Thomas , Cusick Robin , James Robert C. , Custer Brian 
Published: October 2009

BACKGROUND: Blood donation is safe, but a small proportion of donors have delayed and/or off‐site reactions that have the potential to lead to serious injury. This retrospective study sought to identify risk factors for delayed reactions (DRs).STUDY DESIGN AND METHODS: The records of 793,293 allogeneic whole blood and apheresis donations in 2007 were assessed for vasovagal reactions. Donor demographic, biometric, and clinical measurements were captured. Incidents related to needle insertion and mild reactions were excluded. Based on the reaction onset time relative to the procedure end time, reactions were classified as delayed (>15 min) or immediate (≤15 min). Reactions were analyzed by multivariable logistic regression comparing donors with immediate reactions (IRs) or DRs to donors without reactions and comparing donors with DRs to IRs. The clinical consequences of off‐site and on‐site reactions are reported.RESULTS: The prevalence of reactions classified as moderate or severe was 41 in 10,000 donations; 24% of these reactions were delayed and 12% occurred off‐site. DRs were associated with female sex (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.21‐3.96) and with low estimated blood volume (EBV; OR, 3.91; 96% CI, 2.84‐5.51). Off‐site reactions, particularly in female donors, were more likely to be associated with a fall, with head trauma, with other injury, and with the use of outside medical care.CONCLUSION: Low EBV, youth, and first‐time donor status are major risk factors for IRs and DRs. Women are more likely than men to report DRs. Delayed and off‐site reactions lead to potentially preventable morbidity. Understanding the physiologic basis of DRs may lead to the development of appropriate interventions to reduce their likelihood.
Many genetically defined ABO subgroups exhibit characteristic flow cytometric patterns
Authors: Hult Annika K. , Olsson Martin L. 
Published: October 2009

BACKGROUND:A flow cytometric method for detection of low levels of A/B antigen had been developed previously in our laboratory. The aim of this study was to investigate if this approach could be utilized to characterize different ABO subgroups and constitute a useful tool in a reference laboratory.STUDY DESIGN AND METHODS:Blood samples causing ABO discrepancies (n = 94) by routine serology were further analyzed byABOgenotyping and flow cytometry. To verify the specificity of the monoclonal anti‐A and ‐B reagents and to establish normal flow cytometric patterns, samples from 80 blood donors with common phenotypes were also assessed.RESULTS:Distinguishable flow cytometric patterns were detected for several subgroups but were more apparent for Aweak(n = 80) samples than Bweak(n = 14). Two subgroups, Afinn(n = 11) and A3(n = 10) displayed diagnostic features and were used to establish reproduciblity over time and between donors. In general, the consistency within subgroups was remarkable. The allelic enhancement phenomenon was clearly visualized among Axsamples (n = 10) where different alleles intransresulted in high, low, or no A antigen expression. Nonsubgroup samples including O/A and O/B chimeras or Ahand Bhpara‐Bombay phenotypes displayed clearly distinguishable histograms. Samples from pregnant women (n = 10) displayed acquired A antigen loss, apparently accentuated during the third trimester.CONCLUSIONS:Genetically defined ABO subgroups and other anomalous phenotypes displayed flow cytometric profiles that may contribute valuable information to the investigation of ABO discrepancies. We conclude that the presented assay may complement traditional serology and genetic analysis in the reference laboratory setting.
Improved plasma removal efficiency for therapeutic plasma exchange using a new apheresis platform
Authors: Tormey Christopher A. , Peddinghaus Marie E. , Erickson Michelle , King Karen E. , Cushing Melissa M. , Bill Jerry , Goodrich Tay , Snyder Edward L. 
Published: October 2009

BACKGROUND: The Spectra Optia (SPO; CaridianBCT) is a new apheresis device based on the COBE Spectra (CSP; CaridianBCT) platform. This study was designed to evaluate the safety and efficiency of the SPO in comparison to the predicate CSP device.STUDY DESIGN AND METHODS: Twenty patients were recruited for a randomized, nonblinded, paired (crossover) clinical trial comparing the SPO to the CSP (pivotal trial). The primary outcome measure was plasma removal efficiency (PRE); secondary outcomes included platelet (PLT) content and hemolysis in the waste plasma, changes in patient cellular counts, patient coagulation and complement cascade activation, accuracy of machine fluid balance measurement, and review of significant adverse events (SAEs).RESULTS: Overall SPO demonstrated 87% PRE with 1.0% PLT loss; these variables were statistically different from CSP (79 and 3.0%, respectively). The accuracy of anticoagulant usage, plasma removal, and fluid replacement as measured by the SPO fluid pumps was 97% or more; fluid balance was within 2% of the measured value. After apheresis there were no statistical changes in patient cellular counts with respect to the initial values. Patient d‐dimer and prothrombin fragment 1.2 assays showed no activation of the coagulation system with either device. Measurement of patient C3a, C5a, and plasma free hemoglobin showed no significant differences between the SPO and the CSP. No SAEs were reported.CONCLUSION: The SPO has improved performance characteristics over the CSP. Based on our results, the SPO is acceptable for use in therapeutic plasma exchange programs.
Prospective monitoring of plasma and platelet transfusions in a large teaching hospital results in significant cost reduction
Authors: Sarode Ravindra , Refaai Majed A. , Matevosyan Karen , Burner James D. , Hampton Scott , Rutherford Cynthia 
Published: October 2009

BACKGROUND: Plasma and platelets (PLTs) are often transfused to correct mild to moderately abnormal laboratory values. Our objective was to reduce unnecessary plasma and PLT transfusions to nonbleeding patients by prospective triage and education of end users in evidence‐based hemostasis and transfusion medicine practices.STUDY DESIGN AND METHODS: Using the Parkland Memorial Hospital's transfusion service and admission database as the data source, this study comprises the comparison of transfusion data on plasma and PLT use between pre‐ (2000‐2002) and posttriage (2003‐2006) periods. Yearly transfusion and wastage data on red blood cells (RBCs), plasma, and PLTs and yearly hospital admissions, trauma visits, and surgical procedures were extracted retrospectively for the study.RESULTS: The study revealed that implementation of triage resulted in a significant reduction of plasma (60%) and PLT (25%) transfusions, saving more than $3,000,000 over 4 years.CONCLUSIONS: Prospective triage and evidence‐based transfusion practice education reduced unnecessary plasma and PLT transfusions and health care costs.
Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients
Authors: Shaz Beth H. , Dente Christopher J. , Nicholas Jeffrey , MacLeod Jana B. , Young Andrew N. , Easley Kirk , Ling Qiang , Harris Robert S. , Hillyer Christopher D. 
Published: October 2009

BACKGROUND: Recent data from military and civilian centers suggest that mortality is decreased in massive transfusion patients by increasing the transfusion ratio of plasma and platelet (PLT) products, and fibrinogen in relationship to red blood cell (RBC) products during damage control resuscitation and surgery. This study investigates the relationship of plasma:RBC, PLT:RBC, and cryoprecipitate:RBC transfusion ratios to mortality in massively transfused patients at a civilian Level 1 trauma center.STUDY DESIGN AND METHODS: Demographic, laboratory, transfusion, and outcome data were collected prospectively from February 1, 2007, to January 31, 2009, and retrospectively from February 1, 2005, to January 31, 2007, on all injured patients who underwent massive transfusion (defined as ≥10 RBC products within 24 hr). Mortality was analyzed in relation to the plasma:RBC, PLT:RBC, and cryoprecipitate:RBC transfusion ratios using both univariate and multivariate analyses.RESULTS: A total of 214 patients received massive transfusion secondary to traumatic injury. High versus low transfusion ratios were associated with improved 30‐day survival: plasma:RBC 59% versus 44%, p = 0.03; PLT:RBC 63% versus 33%, p < 0.01; and cryoprecipitate:RBC 66% versus 41%, p < 0.01. By multivariable stepwise logistic regression analysis, increased plasma:RBC (p = 0.02) and PLT:RBC (p = 0.02), and decreased age (p = 0.02), ISS (p < 0.01) and total RBCs (p = 0.03) were statistically associated with improved 30‐day survival.CONCLUSIONS: In the civilian setting, plasma, PLT, and cryoprecipitate products significantly increased 30‐day survival in trauma patients. Future prospective randomized clinical trials are required to determine the optimal transfusion ratios.