bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes After Intravenous Opioids in Emergency Patients: A Prospective Cohort Analysis
Authors: O’Connor Alec B. , Zwemer Frank L. , Hays Daniel P. , Feng Changyong 
Published: May 2009

AbstractObjectives:  Pain management continues to be suboptimal in emergency departments (EDs). Several studies have documented failures in the processes of care, such as whether opioid analgesics were given. The objectives of this study were to measure the outcomes following administration of intravenous (IV) opioids and to identify clinical factors that may predict poor analgesic outcomes in these patients.Methods:  In this prospective cohort study, emergency patients were enrolled if they were prescribed IV morphine or hydromorphone (the most commonly used IV opioids in the study hospital) as their initial analgesic. Patients were surveyed at the time of opioid administration and 1 to 2 hours after the initial opioid dosage. They scored their pain using a verbal 0–10 pain scale. The following binary analgesic variables were primarily used to identify patients with poor analgesic outcomes: 1) a pain score reduction of less than 50%, 2) a postanalgesic pain score of 7 or greater (using the 0–10 numeric rating scale), and 3) the development of opioid‐related side effects. Logistic regression analyses were used to study the effects of demographic, clinical, and treatment covariates on the outcome variables.Results:  A total of 2,414 were approached for enrollment, of whom 1,312 were ineligible (658 were identified more than 2 hours after IV opioid was administered and 341 received another analgesic before or with the IV opioid) and 369 declined to consent. A total of 691 patients with a median baseline pain score of 9 were included in the final analyses. Following treatment, 57% of the cohort failed to achieve a 50% pain score reduction, 36% had a pain score of 7 or greater, 48% wanted additional analgesics, and 23% developed opioid‐related side effects. In the logistic regression analyses, the factors associated with poor analgesia (both <50% pain score reduction and postanalgesic pain score of ≥7) were the use of long‐acting opioids at home, administration of additional analgesics, provider concern for drug‐seeking behavior, and older age. An initial pain score of 10 was also strongly associated with a postanalgesic pain score of ≥7. African American patients who were not taking opioids at home were less likely to achieve a 50% pain score reduction than other patients, despite receiving similar initial and total equianalgesic dosages. None of the variables we assessed were significantly associated with the development of opioid‐related side effects.Conclusions:  Poor analgesic outcomes were common in this cohort of ED patients prescribed IV opioids. Patients taking long‐acting opioids, those thought to be drug‐seeking, older patients, those with an initial pain score of 10, and possibly African American patients are at especially high risk of poor analgesia following IV opioid administration.
Frequency of Acute Coronary Syndrome in Patients with Normal Electrocardiogram Performed during Presence or Absence of Chest Pain
Authors: Turnipseed Samuel D. , Trythall William S. , Diercks Deborah B. , Laurin Erik G. , Kirk J. Douglas , Smith David S. , Main David N. , Amsterdam Ezra A. 
Published: May 2009

AbstractObjectives:  The authors hypothesized that patients with active chest pain at the time of a normal electrocardiogram (ECG) have a lower frequency of acute coronary syndrome (ACS) than patients being evaluated for chest pain but with no active chest pain at the time of a normal ECG. The study objective was to describe the association between chest pain in patients with a normal ECG and the diagnosis of ACS.Methods:  This was a prospective observational study of emergency department (ED) patients with a chief complaint of chest pain and an initial normal ECG admitted to the hospital for chest pain evaluation over a 1‐year period. Two groups were identified: patients with chest pain during the ECG and patients without chest pain during the ECG. Normal ECG criteria were as follow: 1) normal sinus rhythm with heart rate of 55–105 beats/min, 2) normal QRS interval and ST segment, and 3) normal T‐wave morphology or T‐wave flattening. “Normal” excludes pathologic Q waves, left ventricular hypertrophy, nonspecific ST‐T wave abnormalities, any ST depression, and discrepancies in the axis between the T wave and the QRS. Patients’ initial ED ECGs were interpreted as normal or abnormal by two emergency physicians (EPs); differences in interpretation were resolved by a cardiologist. ACS was defined as follows: 1) elevation and characteristic evolution of troponin I level, 2) coronary angiography demonstrating >70% stenosis in a major coronary artery, or 3) positive noninvasive cardiac stress test. Chi‐square analysis was performed and odds ratios (ORs) are presented.Results:  A total of 1,741 patients were admitted with cardiopulmonary symptoms; 387 met study criteria. The study group comprised 199 males (51%) and 188 females (49%), mean age was 56 years (range, 25–90 years), and 106 (27%) had known coronary artery disease (CAD). A total of 261 (67%) patients experienced chest pain during ECG; 126 (33%) patients experienced no chest pain during ECG. There was no difference between the two groups in age, sex, cardiac risk factors, or known CAD. The frequency of ACS for the total study group was 17% (67/387). There was no difference in prevalence of ACS based on the presence or absence of chest pain (16% or 42/261 vs. 20% or 25/126; OR = 0.77, 95% confidence interval = 0.45 to 1.33, p = 0.4).Conclusions:  Contrary to our hypothesis concerning patients who presented to the ED with a chief complaint of chest pain, our study demonstrated no difference in the frequency of acute coronary syndrome between patients with chest pain at the time of acquisition of a normal electrocardiogram and those without chest pain during acquisition of a normal electrocardiogram.
Cyclin D1 expression in typical chronic lymphocytic leukaemia
Authors: Abboudi Zaid , Patel Ketan , Naresh Kikkeri N. 
Published: May 2009

AbstractDemonstration of cyclin D1 expression by immunohistochemistry in a CD5‐positive small B‐cell proliferation is extremely helpful in the diagnosis of mantle cell lymphoma in tissue samples, including bone marrow trephine biopsies (BMTB) and in differentiating them from chronic lymphocytic leukaemia (CLL). Following the identification of cyclin D1 expression in one case of CLL on BMTB, 64 additional cases, which included 25 lymph nodes, one tonsillar lesion, one skin lesion and 37 BMTBs were systematically reviewed for presence of cyclin D1 overexpression. Overall, in seven of 65 samples (∼10%) of CLL, a minority of the leukaemic cells in the proliferation centres expressed cyclin D1. Cytogenetic analysis had been performed in three of seven cases and there was no evidence of translocation involving CCND1 locus. Our findings suggest that a small subset of CLL overexpresses cyclin D1 in amounts that can be demonstrated by immunohistochemistry. Our observation has impact on the diagnosis of small B‐cell lymphomas in BMTB and other tissue samples.
All‐trans retinoic acid can intensify the growth inhibition and differentiation induction effect of rosiglitazone on multiple myeloma cells
Authors: Huang Haiwen , Wu Depei , Fu Jinxiang , Chen Guanghua , Chang Weirong , Chow Howard C. H. , Leung Anskar Y. H. , Liang Raymond 
Published: May 2009

AbstractObjective:  Activation of PPARγ by its ligands has shown potential anti‐neoplastic effects in solid tumors. In this study, we investigate the effects of rosiglitazone (RGZ) alone as well as in combination with all trans‐retinoic acid (ATRA) on human myeloma cell lines and try to address its potential mechanism.Methods:  U266, RPMI‐8226 and primary myeloma cells from patients were treated with different concentrations of RGZ in the presence or absence of ATRA and various biological responses were studied by the methods of [3H] thymidine incorporation, MTT, cell cycle analysis, Annexin V‐PI staining, Wright‐Giemsa staining, CD49e expression assay, light chain protein detection, RT‐PCR and caspase‐3 activity assay.Results:  We report that exposure to RGZ induced proliferation inhibition and viability reduction in a dose‐dependent manner in both U266 and RPMI‐8226 cells. A similar exposure to RGZ also induced cell cycle arrest and cell apoptosis of myeloma cells. A combination of RGZ with ATRA enhanced the effects of RGZ and induced cell cycle arrest and apoptosis more profoundly in both cell lines. RGZ treated cells displayed morphological characteristics of cell differentiation, and more evident signs of differentiation were observed when combined with ATRA. These changes were confirmed by the detection of CD49e expression and light chain protein secretion. Similar cell apoptosis and differentiation were observed when primary CD138+ myeloma cells were treated with RGZ and ATRA. The mRNA expressions of FLIP, XIAP and survivin were detected in both cell lines and the levels decreased significantly after culture with RGZ. The addition of ATRA in culture medium made these changes more apparently. Caspase‐3 activity was increased upon exposure to RGZ in both U266 and RPMI‐8226 cells while combination of RGZ and ATRA brought out more effective activation of caspase‐3. Similar apoptosis and cell differentiation induced by RGZ and ATRA can also be observed in primary CD138+ cells from myeloma patients.Conclusion:  Concomitant RXRα activation by ATRA enhanced the inhibitory effects of RGZ on myeloma cell proliferation, cell cycle, apoptosis and differentiation. Combination of RGZ and ATRA may be a useful therapy for human multiple myeloma.
Chronic fatigue in adolescence—autonomic dysregulation and mental health: an exploratory study
Authors: Gjone Helene , Wyller Vegard Bruun 
Published: May 2009

AbstractAim:  The present study investigates associations between autonomic cardiovascular dysregulation, psychosocial load and mental health in adolescents presenting with chronic fatigue.Method:  Twenty‐two adolescents, mean age 15.7 years (12.7–19.1), underwent a clinical mental health examination as part of a broad medical investigation which included autonomic tests. Adolescents and their parents were also interviewed with regard to psychosocial stress factors, family health and previous illnesses. A count of psychosocial load was made for each adolescent based on the interview.Results:  Of 22 fatigued adolescents in the present sample, 14 had psychiatric diagnoses. There was no significant difference in psychosocial load for the fatigued adolescents classified with normal autonomic regulation compared to those with deviant or borderline autonomic regulation. The present psychiatric diagnosis did not differ between the two groups. In a subsample, there was a significant negative association between depressive symptoms and abnormal blood pressure responses during orthostatic challenge.Conclusion:  No significant psychiatric or psychosocial differences between fatigued adolescents with or without autonomic dysregulation were found in this study. The trends towards higher psychosocial load and greater burden of depressive symptoms in fatigued adolescents with normal autonomic regulation warrant further studies.
The acoustic hood: a patient‐independent device improving acoustic noise protection during neonatal magnetic resonance imaging
Authors: Nordell Anders , Lundh Marcus , Horsch Sandra , Hallberg Boubou , Åden Ulrika , Nordell Bo , Blennow Mats 
Published: May 2009

AbstractBackground:  Magnetic resonance imaging (MRI) is today the imaging modality of choice to investigate the neonatal brain. However, the acoustic noise during scanning is very loud, often exceeding 100 dBA.Aim:  To reduce the acoustic noise during MRI for neonatal patients. If effective, this would create a safer environment and also result in fewer aborted examinations due to poor image quality from patient motion.Methods:  A passive acoustic noise protector, the acoustic hood, was built out of dampening material. Sound pressure measurements with and without the acoustic hood were performed using our clinical neonatal scan protocol, consisting of eight imaging sequences. The acoustic hood is placed over the newborn inside the MR scanner tunnel during the examination to absorb acoustic noise.Results:  The acoustic noise level was substantially reduced using the acoustic hood. Peak sound pressure was reduced 16.18–22.21 dBA depending on the pulse sequence. For the entire frequency spectra, reduction were between 4–13.59 dBA again varying with the pulse sequence.Conclusion:  Acoustic noise can be reduced further than before by using the patient‐independent acoustic hood in addition to other noise protection. We recommend the use of three passive hearing protections during neonatal MRI: (1) dental putty, (2) paediatric ear muffs, and (3) the acoustic hood.
Glycogen content regulates insulin‐ but not contraction‐mediated glycogen synthase activation in the rat slow‐twitch soleus muscles
Authors: Lai Y.‐C. , Lin F.‐C. , Jensen J. 
Published: May 2009

AbstractAim:  The aim of this study was to investigate the effect of glycogen content on glycogen synthase (GS) activation and phosphorylation in the slow‐twitch soleus muscles after contraction, during insulin stimulation and when these two stimuli were combined.Methods:  Glycogen content was manipulated in vivo with 24 h fasting and fasting followed by 24 h refeeding. Soleus strips were electrically stimulated for 30 min in vitro, and GS activation and phosphorylation were investigated after an additional 30 min incubation with or without insulin.Results:  Fasting reduced glycogen content in soleus muscle by 40% and refeeding enhanced by 40%, compared to rats with free access to chow. Insulin‐stimulated GS fractional activity was inversely correlated with glycogen content (R = −0.95, P < 0.001, n = 24) and rate of glycogen synthesis was also inversely correlated with glycogen content (R = −0.70, P < 0.001, n = 36). After contraction, GS fractional activity was increased to similar levels in muscles with low, normal and high glycogen content; rate of glycogen synthesis after contraction was also similar. After contraction, insulin additively increased GS activation at all glycogen contents. Group means of GS fractional activity was inversely correlated with GS Ser641 (R = −0.93, P < 0.001) and Ser645,649,653,657 (R = −0.85, P < 0.001) phosphorylation, but not with Ser7 phosphorylation.Conclusion:  Glycogen content regulates insulin‐ but not contraction‐stimulated GS activation and glycogen synthesis in soleus muscles. Furthermore, phosphorylation of GS Ser641 and Ser645,649,653,657 seems to regulate GS activity in soleus.
Stem Cell Platforms for Regenerative Medicine
Authors: Nelson Timothy J. , Behfar Atta , Yamada Satsuki , Martinez‐Fernandez Almudena , Terzic Andre 
Published: May 2009

AbstractThe pandemic of chronic degenerative diseases associated with aging demographics mandates development of effective approaches for tissue repair. As diverse stem cells directly contribute to innate healing, the capacity for de novo tissue reconstruction harbors a promising role for regenerative medicine. Indeed, a spectrum of natural stem cell sources ranging from embryonic to adult progenitors has been recently identified with unique characteristics for regeneration. The accessibility and applicability of the regenerative armamentarium has been further expanded with stem cells engineered by nuclear reprogramming. Through strategies of replacement to implant functional tissues, regeneration to transplant progenitor cells or rejuvenation to activate endogenous self‐repair mechanisms, the overarching goal of regenerative medicine is to translate stem cell platforms into practice and achieve cures for diseases limited to palliative interventions. Harnessing the full potential of each platform will optimize matching stem cell‐based biologics with the disease‐specific niche environment of individual patients to maximize the quality of long‐term management, while minimizing the needs for adjunctive therapy. Emerging discovery science with feedback from clinical translation is therefore poised to transform medicine offering safe and effective stem cell biotherapeutics to enable personalized solutions for incurable diseases.
CANNULATION PRACTICE PATTERNS IN HAEMODIALYSIS VASCULAR ACCESS: PREDICTORS FOR UNSUCCESSFUL CANNULATION
Authors: Van Loon Magda M. , Kessel Alphons G.H. , Van Der Sande Frank M. , Tordoir Jan H.M. 
Published: May 2009

SUMMARYBackground: Little is known about the relationship of cannulation practices in dialysis facilities with the frequency of failed cannulations, complications and subsequent vascular access (VA) failure. Methods: In an observational study the incidence of mis‐cannulations and related complications were observed. Patient characteristics, comorbidities and VA characteristics like type of VA were correlated with occurrence of cannulation‐related complications. In addition, the cannulation technique and practice patterns like needle direction, tourniquet use and years of experience of dialysis nurses were registered. Results: During the study period, 37% of patients with autogenous arteriovenous fistulae (AVF), and 19% of patients with arteriovenous grafts (AVG) had more than 10 miscannulations. Cannulation‐induced haematoma resulted into single‐needle (SN) and catheter dialysis in 40% of the patients. The use of central venous catheters (CVC) and SN dialysis were significant predictors of VA failure (p <0.0001). Conclusion: This study demonstrated a high incidence of unsuccessful cannulation procedures and cannulation‐related complications necessitating catheter and SN dialysis. The type and location of the VA is significantly related to occurrence of unsuccessful and complicated cannulation.
PATIENTS’ EXPERIENCE OF TRANSITION ONTO HAEMODIALYSIS: A QUALITATIVE STUDY
Authors: Mitchell Annie , Farrand Paul , James Hayley , Luke Rob , Purtell Rachel , Wyatt Katrina 
Published: May 2009

SUMMARYTransition onto haemodialysis is a time of increased psychosocial difficulty, yet, many renal patients exhibit personal resilience in continuing to lead productive lives. Using a positive psychological methodology, this qualitative study aims to identify factors identified by patients as helpful in the transition onto haemodialysis. Semi‐structured interviews were undertaken with 10 patients within six months of starting haemodialysis. Interpretive content analysis identified three main themes (each with subthemes) in patients’ accounts—preparation, cognitive style and social support. Limited differences arose between patients who underwent a gradual versus acute transition onto haemodialysis. Themes are discussed with reference to implications for practice development.
COMPARISON OF INTRAVENOUS IRON SUCROSE VERSUS LOW‐MOLECULAR‐WEIGHT IRON DEXTRAN IN CHRONIC KIDNEY DISEASE
Authors: Sinha Smeeta , Chiu Diana Y.Y. , Peebles George , Kolakkat Shabeer , Lamerton Elizabeth , Fenwick Sean , Kalra Philip A. 
Published: May 2009

SUMMARY Background: Low‐molecular‐weight iron dextran (CosmoFer®) is the only form of parenteral iron that can be administered as a total dose infusion (TDI) in the United Kingdom (UK). This study aimed to evaluate the safety and efficacy of TDI CosmoFer in comparison to intravenous iron sucrose infusion (Venofer®) in patients with chronic kidney disease (CKD). Methods and Results: A retrospective study of outpatients with CKD undergoing intravenous TDI CosmoFer or Venofer infusion was conducted at Salford Royal Hospital and Sunderland Royal Hospital. A total of 979 doses of CosmoFer and 504 doses of Venofer were administered. There were three minor adverse events in patients receiving CosmoFer compared with one minor event in a Venofer treated patient. There were no anaphylactoid‐type reactions in either group. Serum haemoglobin, ferritin and transferrin saturation (TSAT) improved significantly 4–6 months postinfusion in both treatment groups. Conclusion: TDI CosmoFer is an efficacious method of replenishing iron stores in CKD patients in an outpatient setting. Furthermore, TDI CosmoFer is safe and not associated with an increase in adverse events compared to Venofer.
Development of a hepatitis C virus relapse model using genome‐length hepatitis C virus ribonucleic acid‐harboring cells possessing the interferon‐α‐resistance phenotype
Authors: Kawai Yoshinari , Ikeda Masanori , Abe Ken‐ichi , Yano Masahiko , Ariumi Yasuo , Dansako Hiromichi , Yamamoto Kazuhide , Kato Nobuyuki 
Published: May 2009

Aim:  The cure rate of current interferon (IFN) therapy is limited to approximately 50% and most of the relapses after therapy are caused by genotype‐1. To develop a relapse model in cell culture, we attempted to obtain genome‐length hepatitis C virus ribonucleic acid (HCV RNA) harboring cells possessing the IFN‐α‐resistance phenotype from previously established OR6 cells, which enabled the luciferase reporter assay for monitoring of HCV RNA replication.Methods:  The IFN‐α‐resistant HCV RNA‐harboring cells and control cells were obtained by the treatment of OR6 cells with and without IFN‐α, respectively. Then, we examined the relapse of HCV in IFN‐α‐resistant HCV RNA‐harboring cells.Results:  Only type I IFN (α and β) showed significantly different anti‐HCV activity between IFN‐α‐resistant HCV RNA‐harboring cells and control cells. There was no significant difference in the anti‐HCV activity of IFN‐γ, fluvastatin, or cyclosporine A between the two types of cells. Furthermore, we showed that fluvastatin or cyclosporine A in combination with IFN‐α could prevent the relapse after therapy in the IFN‐α‐resistant HCV RNA‐harboring cells.Conclusion:  We developed a HCV relapse model in cell culture using IFN‐α‐resistant HCV RNA‐harboring cells. Thus anti‐HCV reagents, which have a mechanism different from IFN‐α, were shown to be useful for preventing a relapse of IFN‐α‐resistant HCV.
Ursodeoxycholic acid in primary sclerosing cholangitis: meta‐analysis of randomized controlled trials
Authors: Shi Jian , Li Zhi , Zeng Xin , Lin Yong , Xie Wei‐Fen 
Published: May 2009

Aims:  The effect of ursodeoxycholic acid (UDCA) treatment on survival and liver histological progression of primary sclerosing cholangitis (PSC) remains uncertain. The aim of the present study was to evaluate the effect and safety of UDCA in PSC.Methods:  Electronic databases including Medline, Embase, Cochrane controlled trials register, Web of Science and PubMed (updated to January 2009) and manual bibliographical searches were carried out. A meta‐analysis of all randomized controlled trials (RCT) comparing UDCA with placebo or no treatment was carried out.Results:  Eight RCT including 465 patients were assessed. UDCA could significantly improve liver biochemistry, but had no effect on pruritus and fatigue. Meta‐analysis of the included RCT showed UDCA had no significant effect on the incidence of death, liver transplantation, and death and/or liver transplantation. However, a significant difference for the incidence of histological improvement was found between the two groups (odds ratio [OR], 9.19; 95% CI: 0.98, 86.15; P = 0.05). Meta‐analysis also indicated a reduction trend of histological deterioration and an improvement trend of cholangiographic changes. These trends were constant in the sensitivity analyses.Conclusion:  The meta‐analysis found that UDCA can improve liver biochemistry and there is a trend towards improvement in liver histology and cholangiography, but has no effect on survival free of transplantation.