bluuebunny/crossref_metadata_2025_split huggingface dataset:
ED50and ED95of Intrathecal Bupivacaine in Morbidly Obese Patients Undergoing Cesarean Delivery
Authors: Carvalho Brendan , Collins Jeremy , Drover David R. , Atkinson Ralls Lindsey , Riley Edward T. 
Published: February 2011

Background
It has been suggested that morbidly obese parturients may require less local anesthetic for spinal anesthesia. The aim of this study was to determine the effective dose (ED(50)/ED(95)) of intrathecal bupivacaine for cesarean delivery in morbidly obese patients.

Methods
Morbidly obese parturients (body mass index equal to or more than 40) undergoing elective cesarean delivery were enrolled in this double-blinded study. Forty-two patients were randomly assigned to receive intrathecal hyperbaric bupivacaine in doses of 5, 6, 7, 8, 9, 10, or 11 mg (n = 6 per group) coadministered with 200 μg morphine and 10 μg fentanyl. Success (induction) was defined as block height to pinprick equal to or more than T6 and success (operation) as success (induction) plus no requirement for epidural supplementation throughout surgery. The ED(50)/ED(95) values were determined using a logistic regression model.

Results
ED(50) and ED(95) (with 95% confidence intervals) for success (operation) were 9.8 (8.6-11.0) and 15.0 (10.0-20.0), respectively, and were similar to corresponding values of a nonobese population determined previously using similar methodology. We were unable to measure ED(50)/ED(95) values for success (induction) because so few blocks failed initially, even at the low-dose range. There were no differences with regard to secondary outcomes (i.e., hypotension, vasopressor use, nausea, and vomiting).

Conclusions
Obese and nonobese patients undergoing cesarean delivery do not appear to respond differently to modest doses of intrathecal bupivacaine. This dose-response study suggests that doses of intrathecal bupivacaine less than 10 mg may not adequately ensure successful intraoperative anesthesia. Even when the initial block obtained with a low dose is satisfactory, it will not guarantee adequate anesthesia throughout surgery.
Pulmonary Vasoconstrictive and Bronchoconstrictive Responses to Anaphylaxis Are Weakened via β2-adrenoceptor Activation by Endogenous Epinephrine in Anesthetized Rats
Authors: Zhang Wei , Shibamoto Toshishige , Kuda Yuhichi , Ohmukai Chieko , Kurata Yasutaka 
Published: February 2011

Background
Patients treated with propranolol, a nonselective β-adrenoceptor antagonist, have increased incidence and severity of anaphylaxis. We determined whether β1- or β2-adrenoceptor antagonist modulated pulmonary vasoconstriction and bronchoconstriction in rat anaphylactic hypotension.

Methods
Anesthetized ovalbumin-sensitized male Sprague-Dawley rats were randomly allocated to the following pretreatment groups (n = 7/group): (1) sensitized control (nonpretreatment), (2) propranolol, (3) the selective β2-adrenoceptor antagonist ICI 118,551, (4) the selective β1-adrenoceptor antagonist atenolol, and (5) adrenalectomy. Shock was induced by an intravenous injection of the antigen. Mean arterial pressure, pulmonary arterial pressure, left atrial pressure, central venous pressure, portal venous pressure, airway pressure, and aortic blood flow were continuously measured.

Results
In either sensitized control or atenolol-pretreated rats, mean arterial pressure and aortic blood flow decreased substantially, whereas pulmonary arterial pressure and airway pressure did not increase soon after antigen injection. In contrast, in rats pretreated with either propranolol, ICI 118,551, or adrenalectomy, airway pressure significantly increased by 14 cm H2O, and pulmonary arterial pressure by 7.5 mmHg after antigen injection. At 2.5 min after antigen injection, the plasma concentration of epinephrine increased 14-fold in the sensitized rats except for the adrenalectomy group. Portal venous pressure after antigen injection increased by 16 mmHg similarly in all sensitized rats. All of the sensitized control group and two of the atenolol group were alive for 60 min after antigen injection, whereas all rats of the propranolol, ICI 118,551, and adrenalectomy groups died within 50 min after antigen injection.

Conclusions
The pulmonary vasoconstrictive and bronchoconstrictive responses to systemic anaphylaxis were weakened via β2-adrenoceptor activation by epinephrine endogenously released from the adrenal gland in the anesthetized Sprague-Dawley rats.
Hypotension during Fluid-restricted Abdominal Surgery
Authors: Hiltebrand Luzius B. , Koepfli Eliana , Kimberger Oliver , Sigurdsson Gisli H. , Brandt Sebastian 
Published: February 2011

Background
Vasopressors, such as norepinephrine, are frequently used to treat perioperative hypotension. Increasing perfusion pressure with norepinephrine may increase blood flow in regions at risk. However, the resulting vasoconstriction could deteriorate microcirculatory blood flow in the intestinal tract and kidneys. This animal study was designed to investigate the effects of treating perioperative hypotension with norepinephrine during laparotomy with low fluid volume replacement.

Methods
Twenty anesthetized and ventilated pigs were randomly assigned to a control or treatment (norepinephrine) group. Both groups received 3 ml · kg⁻¹ · h⁻¹ Ringer's lactate solution. In addition, the norepinephrine group received norepinephrine to stepwise increase blood pressure to 65 and 75 mmHg. Regional blood flow was measured in the splanchnic arteries. In the small bowel and colon, microcirculatory blood flow was measured using laser Doppler flowmetry. Intestinal tissue oxygen tension was measured with intramural Clark-type electrodes.

Results
Hepatosplanchnic and kidney blood flow remained unchanged after reversal of arterial hypotension to a mean arterial pressure of 75 mmHg with norepinephrine. For the norepinephrine group versus the control group, the mean ± SD microcirculatory blood flow in the jejunum (96 ± 41% vs. 93 ± 18%) and colon (98 ± 19% vs. 97 ± 28%) and intestinal tissue oxygen tension (jejunum, 45 ± 13 vs. 43 ± 5 mmHg; colon, 50 ± 10 vs. 45 ± 8 mmHg) were comparable.

Conclusions
In this model of abdominal surgery in which clinical conditions were imitated as close as possible, treatment of perioperative hypotension with norepinephrine had no adverse effects on microcirculatory blood flow or tissue oxygen tension in the intestinal tract.
Peristaltic Pneumatic Compression of the Legs Reduces Fluid Demand and Improves Hemodynamic Stability during Surgery
Authors: Kiefer Nicholas , Theis Judith , Putensen-Himmer Gabriele , Hoeft Andreas , Zenker Sven 
Published: February 2011

Background
Perioperative fluid restriction might be beneficial in specific clinical settings. In this prospective, randomized and blinded study, we assessed whether peristaltic pneumatic compression of the legs can support restrictive fluid management strategies by reducing intraoperative fluid demand and improving hemodynamic stability.

Methods
Seventy patients scheduled for minor surgery were randomly assigned to receive either intraoperative peristaltic pneumatic compression or placebo compression. Both groups received fluid therapy according to a goal-directed protocol with a crystalloid base rate of 2 ml · kg⁻¹ · h⁻¹ and bolus infusions of 250 ml crystalloids triggered by hypotension, tachycardia, or high Pleth Variability Index.

Results
Patients treated with peristaltic pneumatic compression received less intravenous fluid: median (interquartile range) 286 (499) versus 921 (900) ml (P < 0.001), resulting in a median difference of 693 ml (95% CI, 495-922 ml) and a median difference of 8.4 ml/kg (95% CI, 5.3-11.5 ml; P < 0.001). After the anesthesia induction phase, median overall infusion rates were 12.2 (14.1) ml · kg⁻¹ · h⁻¹ in the control group and 1.9 (0.4) ml · kg⁻¹ · h⁻¹ in the pneumatic peristaltic compression group (P < 0.001). Among patients treated with pneumatic peristaltic compression, the median cumulative time of hypotension was shorter (0 [12.5] vs. 22.6 [22.8] min; P = 0.002), fewer hypotensive events were recorded (39 vs. 137; P = 0.001), and median lowest individual systolic pressure was higher (92 [8] vs. 85 [16] mmHg; P = 0.002).

Conclusions
This study demonstrates that peristaltic pneumatic compression of the legs significantly improves hemodynamic stability and reduces fluid demand during minor surgery.
Empirically derived subtypes of opioid use and related behaviors
Authors: Chan Grace , Gelernter Joel , Oslin David , Farrer Lindsay , Kranzler Henry R. 
Published: February 2011

ABSTRACTAims  To identify and validate homogeneous subtypes of opioid use and related behaviors.Design  Family‐based and case–control genetic studies of opioid and/or cocaine dependence.Settings  Clinical and general community samples from Connecticut, Massachusetts, Pennsylvania and South Carolina.Participants  A total of 4061 individuals (2003 individuals from 835 families and 2058 unrelated individuals) recruited to participate in genetic studies.Measurements  The computer‐assisted Semi‐Structured Assessment for Drug Dependence and Alcoholism (SSADDA) was used to assess participants' demographics, medical history, substance use behaviors and disorders and other psychiatric disorders.Findings  Five homogeneous subtypes were identified, which differed on opioid‐related measures, demographics and prevalence rates of substance use and psychiatric disorders. Heritability estimates for the two most severely affected subtypes exceeded 0.60.Conclusions  An empirical approach based on opioid use and related behaviors can yield homogeneous subtypes that could be of value in gene finding for opioid dependence.
Empathic accuracy of nurses’ immediate responses to fibromyalgia patients’ expressions of negative emotions: an evaluation using interaction analysis
Authors: Eide Hilde , Sibbern Tonje , Johannessen Tone 
Published: February 2011

eide h., sibbern t. & johannessen t. (2011) Empathic accuracy of nurses’ immediate responses to fibromyalgia patients’ expressions of negative emotions: an evaluation using interaction analysis. Journal of Advanced Nursing67(6), 1242–1253.AbstractAim.  This paper is a report of an observation study designed to describe and evaluate nurses’ immediate responses to fibromyalgia patients’ expressions of negative emotions in first consultations at a pain clinic.Background.  Providing comfort to patients in emotional distress is an important task for nurses. Empathic accurate perception of patients’ emotions is a precondition for empathic accurate responses.Methods.  We analysed 58 videotaped assessment consultations with patients with fibromyalgia performed from April 2005 to June 2007. Implicit and explicit negative emotional expressions were identified with the Verona Coding Definitions of Emotional Sequences. Nurses’ responses were coded with the Hierarchical Coding System for Sensitivity of Comforting Strategies, with three levels of response to the person’s perspective: (i) denial, (ii) implicit recognition or approval and (iii) explicit recognition of the expressed emotion.Results.  We identified 801 expressions of negative emotions, 591 implicit and 210 explicit, on average 14 per consultation. Nurses responded with implicit recognition, mostly using minimal encouragement, to 75% of emotional expressions, with explicit recognition to 13% of expressions while 12% of responses were not within the perspective of the patient. Nurses responded with a higher degree of explicit recognition (Level 3 responses) to patients’ explicit negative emotional expressions.Conclusion.  The effects of empathic accurate response to implicit and explicit expressions of negative emotions should be explored further. The combination of coding systems used appears to be valid and reliable for assessing verbal empathic accuracy by observers in nursing settings.
Requirement for acetyl‐CoA carboxylase in Trypanosoma brucei is dependent upon the growth environment
Authors: Vigueira Patrick A. , Paul Kimberly S. 
Published: February 2011

Summary Trypanosoma brucei, the causative agent of human African trypanosomiasis, possesses two fatty acid synthesis pathways: a major de novo synthesis pathway in the ER and a mitochondrial pathway. The 2‐carbon donor for both pathways is malonyl‐CoA, which is synthesized from acetyl‐CoA by Acetyl‐CoA carboxylase (ACC). Here, we show that T. brucei ACC shares the same enzyme architecture and moderate ∼30% identity with yeast and human ACCs. ACC is cytoplasmic and appears to be distributed throughout the cell in numerous puncta distinct from glycosomes and other organelles. ACC is active in both bloodstream and procyclic forms. Reduction of ACC activity by RNA interference (RNAi) resulted in a stage‐specific phenotype. In procyclic forms, ACC RNAi resulted in 50–75% reduction in fatty acid elongation and a 64% reduction in growth in low‐lipid media. In bloodstream forms, ACC RNAi resulted in a minor 15% decrease in fatty acid elongation and no growth defect in culture, even in low‐lipid media. However, ACC RNAi did attenuate virulence in a mouse model of infection. Thus the requirement for ACC in T. brucei is dependent upon the growth environment in two different life cycle stages.
FMP30 is required for the maintenance of a normal cardiolipin level and mitochondrial morphology in the absence of mitochondrial phosphatidylethanolamine synthesis
Authors: Kuroda Takuya , Tani Motohiro , Moriguchi Akira , Tokunaga Sho , Higuchi Takahito , Kitada Sakae , Kuge Osamu 
Published: February 2011

SummaryMitochondria of the yeast Saccharomyces cerevisiae contain enzymes Crd1p and Psd1p, which synthesize cardiolipin (CL) and phosphatidylethanolamine respectively. A previous study indicated that crd1Δ is synthetically lethal with psd1Δ. In this study, to identify novel genes involved in CL metabolism, we searched for genes that genetically interact with Psd1p, and found that deletion of FMP30 encoding a mitochondrial inner membrane protein results in a synthetic growth defect with psd1Δ. Although fmp30Δ cells grew normally and exhibited a slightly decreased CL level, fmp30Δpsd1Δ cells exhibited a severe growth defect and an about 20‐fold reduction in the CL level, as compared with the wild‐type control. We found also that deletion of FMP30 caused a defect in mitochondrial morphology. Furthermore, FMP30 genetically interacted with seven mitochondrial morphology genes. These results indicated that Fmp30p is involved in the maintenance of mitochondrial morphology and required for the accumulation of a normal level of CL in the absence of mitochondrial phosphatidylethanolamine synthesis.
Secretion, but not overall synthesis, of catecholate siderophores contributes to virulence of extraintestinal pathogenic Escherichia coli
Authors: Caza Mélissa , Lépine François , Dozois Charles M. 
Published: February 2011

SummaryExtraintestinal pathogenic Escherichia coli (ExPEC) use siderophores to sequester iron during infection. Enterobactin and salmochelins are catecholate siderophores produced by some ExPEC strains and other pathogenic enterobacteria. Siderophore export and synthesis mutants of avian ExPEC strain χ7122 were tested in a chicken infection model. In single‐strain infections, siderophore‐negative (ΔentDΔiuc), ΔentS and ΔentSΔiroC export mutants were attenuated in tissues and blood, whereas the ΔiroC export mutant was only attenuated in blood. Interestingly, the ΔentD mutant, producing only aerobactin, retained full virulence, and loss of entD in the ΔentSΔiroC mutant restored virulence. LC‐MS/MS quantification of siderophores in export mutants demonstrated that loss of entS impaired enterobactin and mono‐glucosylated enterobactin secretion, whereas loss of iroC impaired di‐ and tri‐glucosylated enterobactin secretion. Loss of entS and/or iroC resulted in intracellular accumulation and increased secretion of siderophore monomers. Catecholate siderophore export mutants also demonstrated decreased fitness in a co‐challenge infection model. By contrast, catecholate siderophore synthesis mutants (ΔentD and ΔiroB) competed as well as the wild‐type strain. Results establish that EntS and IroC mediate specific export of catecholate siderophores and the role of these exporters for ExPEC virulence is contingent on enterobactin synthesis, which is not required when other siderophores like aerobactin are functional.
The Ime2 protein kinase family in fungi: more duties than just meiosis
Authors: Irniger Stefan 
Published: February 2011

SummaryIme2 of the budding yeast Saccharomyces cerevisiae belongs to a family of conserved protein kinases displaying sequence similarities to both cyclin‐dependent kinases and mitogen‐activated protein kinases. Ime2 has a pivotal role for meiosis and sporulation. The involvement of this protein kinase in the regulation of various key events in meiosis, such as the initiation of DNA replication, the expression of meiosis‐specific genes and the passage through the two consecutive rounds of nuclear divisions has been characterized in detail. More than 20 years after the identification of the IME2 gene, a recent report has provided the first evidence for a function of this gene outside of meiosis, which is the regulation of pseudohyphal growth. In the last few years, Ime2‐related protein kinases from various fungal species were studied. Remarkably, these homologues are not generally required for meiosis, but instead have other specific tasks. In filamentous ascomycete species, Ime2 homologues are involved in the inhibition of fruiting body formation in response to environmental signals. In the pathogenic basidiomycetes Ustilago maydis and Cryptococcus neoformans, members of this kinase family apparently have primary roles in regulating mating. Thus, Ime2‐related kinases exhibit an amazing variety in controlling sexual developmental programs in fungi.
Demographic characteristics and opportunistic diseases associated with attrition during preparation for antiretroviral therapy in primary health centres in Kibera, Kenya
Authors: Tayler‐Smith K. , Zachariah R. , Manzi M. , Kizito W. , Vandenbulcke A. , Dunkley S. , von Rege D. , Reid T. , Arnould L. , Suleh A. , Harries A. D. 
Published: February 2011

SummaryUsing routine data from HIV‐positive adult patients eligible for antiretroviral therapy (ART), we report on routinely collected demographic characteristics and opportunistic diseases associated with pre‐ART attrition (deaths and loss to follow‐up). Among 2471 ART eligible patients, enrolled between January 2005 and November 2008, 446(18%) were lost to attrition pre‐ART. Adjusted risk factors significantly associated with pre‐ART attrition included age <35 years (Odds Ratio, OR 1.4, 95% Confidence Interval, CI 1.1–1.8), severe malnutrition (OR 1.5, 95% CI 1.1–2.0), active pulmonary tuberculosis (OR 1.6, 95% CI 1.1–2.4), severe bacterial infections including severe bacterial pneumonia (OR 1.9, 95% CI 1.2–2.8) and prolonged unexplained fever (>1 month), (OR 2.6, 95% CI 1.3–5.2). This study highlights a number of clinical markers associated with pre‐ART attrition that could serve as ‘pointers’ or screening tools to identify patients who merit fast‐tracking onto ART and/or closer clinical attention and follow‐up.
Predictors of symptomatic lymphocele after radical prostatectomy and bilateral pelvic lymph node dissection
Authors: Gotto Geoffrey T , Yunis Luis Herran , Guillonneau Bertrand , Touijer Karim , Eastham James A , Scardino Peter T , Rabbani Farhang 
Published: February 2011

Objectives:  Lymphocele is the most common complication of pelvic lymphadenectomy (PLND). We sought to determine predictors of symptomatic lymphocele after radical prostatectomy (RP) and PLND, and in particular, to determine if the number of drains placed represents an independent predictor.Methods:  Between January 1999 and June 2007, 4173 consecutive patients underwent bilateral PLND at the time of either open or laparoscopic RP. Lymphoceles were identified in patients undergoing imaging as a result of symptoms suspicious for lymphocele, such as fever, abdominal pain or lower extremity swelling. Routine postoperative imaging was not carried out. Cox proportional hazards analysis was carried out using forced variable entry to obtain maximum likelihood estimates of the hazard ratios and 95% confidence intervals using the number of drains placed, number of nodes removed, RP approach and use of prophylactic low‐molecular‐weight heparin (LMWH) as predictors of symptomatic lymphocele.Results:  There were 164 patients (4%) with a symptomatic lymphocele on follow up, with a median time to presentation of 19 days. The primary presenting complaints were fever in 47%, abdominal pain in 40%, lower extremity swelling in 37%, genital swelling in 25%, groin pain in 22%, abdominal swelling in 9%, and back and flank pain in 6% and 5%, respectively. Median lymphocele diameter was 5 cm. Significant predictors of symptomatic lymphocele on multivariate analysis included number of nodes removed and use of LMWH, but not number of drains placed.Conclusions:  Use of prophylactic LMWH and a higher node count are predictive of a higher incidence of symptomatic lymphocele after RP and PLND.
Factors associated with acute kidney injury or failure in children undergoing cardiopulmonary bypass: a case‐controlled study
Authors: Chiravuri S. Devi , Riegger Lori Q. , Christensen Robert , Butler Russell R. , Malviya Shobha , Tait Alan R. , Voepel‐Lewis Terri 
Published: February 2011

SummaryAcute kidney injury (AKI) is a serious complication that occurs commonly following cardiopulmonary bypass (CPB) in infants and children. Underlying risk factors for AKI remain unclear, given changes in CPB practices during recent years. This retrospective, case–control study examined the relationships between patient, perioperative factors, AKI, and kidney failure in children who underwent CPB.Methods:  Cohorts of children with and without AKI were identified from the cardiac perfusion and nephrology consult databases. Demographic, perioperative, and postoperative outcome data were extracted from the databases and from medical records. Children were stratified into groups based on the Acute Dialysis Quality Initiative’s RIFLE definitions for acute kidney risk or injury (AKI‐RI) and kidney failure.Results:  The study groups included 308 controls (no AKI‐RI or failure), 161 with AKI‐RI, and 89 with failure. Young age, preoperative need for mechanical ventilation, milrinone, or gentamicin; intraoperative use of milrinone and furosemide; durations of CPB and anesthesia; multiple cross‐clamp and transfusion of blood products were significantly associated with AKI or failure. Young age, perioperative use of milrinone, multiple cross‐clamps, extracorporeal membrane oxygenation, cardiac failure, neurological complications, sepsis, and failure significantly increased the odds of mortality.Conclusion:  This study identified multiple perioperative risk factors for AKI‐RI, failure, and mortality in children undergoing CPB. In addition to commonly known risk factors, perioperative use of milrinone, particularly in young infants, and furosemide were independently predictive of poor renal outcomes in this sample. Findings suggest a need for the development of protocols aimed at renal protection in specific at risk patients.