bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of inhibitory T cells induced by an analog of type II collagen in an HLA-DR1 humanized mouse model of autoimmune arthritis
Authors: Kimata Masaru , Cullins David L , Brown Monica L , Brand David D , Rosloniec Edward F , Myers Linda K , Stuart John M , Kang Andrew H 
Published: May 2012

Abstract

Introduction

We used DR1 transgenic mice and covalently linked DR1 multimers to characterize analog-specific inhibitory T cells in collagen-induced arthritis (CIA). Because of the low numbers of antigen-specific T cells in wild-type mice, functional T-cell studies in autoimmune arthritis have been challenging. The use of T-cell receptor (TCR) transgenic mice has provided useful information, but such T cells may not represent the heterogeneous T-cell response that occurs in natural settings. Our focus was to develop tools to identify and characterize the population of immunoregulatory T cells induced in wild-type mice by an analog peptide of CII259-273, which contains amino acid substitutions at positions 263 (N) and 266 (D) (analog peptide A12).

Methods

DR1 multimers, developed by loading empty class II molecules with exogenous peptide, provide a method for visualizing antigen-specific T cells with flow cytometry. However, the low binding avidity of A12 for the major histocompatibility complex (MHC) made this strategy untenable. To overcome this problem, we generated DR1 multimers in which the analog peptide A12 was covalently linked, hoping that the low-avidity analog would occupy enough binding clefts to allow detection of the responsive T cells.

Results

Staining with the tetramer revealed that A12-specific T cells were readily detectable at 10 days after immunization. These CD4(+) T cells are a highly selective subset of the TCR repertoire and have a limited clonality. Analysis of cytokine expression showed that cells detected by tetramer (A12) expressed primarily suppressive cytokines (interleukin-4 (IL-4) and IL-10) in response to collagen, compared with control cells. Although they did not express Fox-p3, they were extremely effective in preventing and suppressing inflammatory arthritis.

Conclusions

In summary, our studies showed that the use of covalently linked multimers allows characterization of analog-specific T cells that are otherwise difficult to detect. The suppressive character of the analog-specific T-cell response suggests that these cells attenuate autoimmunity and differ significantly in phenotype from the inflammatory T cells predominantly found in arthritic joints. Such reagents will become powerful tools to study T-cell responses in RA patients in upcoming clinical trials.
Obese trauma patients are at increased risk of early hypovolemic shock: a retrospective cohort analysis of 1,084 severely injured patients
Authors: Nelson Jana , Billeter Adrian T , Seifert Burkhardt , Neuhaus Valentin , Trentz Otmar , Hofer Christoph K , Turina Matthias 
Published: May 2012

Abstract
Introduction
Morbid obesity and its consequences are considered risk factors for adverse outcome in trauma, although the pathophysiologic mechanisms are incompletely understood. The aim of this study was to compare initial resuscitation, treatment, and short-term outcome of severely injured patients by body mass index (BMI).

Methods
A total of 1,084 severely injured patients with an injury severity score of 16 or greater were enrolled between 1996 and 2009 and grouped according to BMI. Their course of treatment and in-hospital outcome were analyzed by univariate and multivariate comparison.

Results
Of these patients, 603 (55.6%) were of normal weight with a BMI between 18.5 and 24.9, 361 (33.3%) had BMI values between 25 and 29.9, and 90 patients (8.3%) were obese (BMI ≥ 30). Thirty patients (2.8%) had BMI levels below 18.5. All groups were comparable with respect to injury severity, initial resuscitation, and time to ICU admission. There was a tendency towards higher mortality in obese patients (mortality 24.4%) and also overweight patients (mortality 18.8%) when compared with patients with a normal BMI (mortality 16.6%). Obese patients showed the highest mortality on day 0 (8.9% vs. 2.8% in the normal-weight group, P = 0.023), mostly due to persistent shock (6.7%). When corrected for BMI, obese patients are provided significantly lower volumes of intravenous fluids during the initial resuscitation period.

Conclusion
In contrast to the mostly American literature, only a low percentage of trauma patients at a European trauma center are obese. These patients are at risk of higher mortality from persistent hemorrhagic shock in the initial phase after trauma, which may potentially be related to relative hypovolemia during the resuscitation period. In the later course of treatment, no significant differences exist with respect to specific complications, hospital stay, or in-hospital mortality.
Effects of increasing compliance with minimal sedation on duration of mechanical ventilation: a quality improvement intervention
Authors: Amaral Andre CKB , Kure Lars , Jeffs Angie 
Published: May 2012

Abstract
Introduction
In the past two decades, healthcare adopted industrial strategies for process measurement and control. In the industry model, care is taken to avoid minimal deviations from a standard. In healthcare there is scarce data to support that a similar strategy can lead to better outcomes. Briefly, when compliance is high, further attempts to improve uptake of a process are seldom made. Our intensive care unit (ICU) improved the compliance with minimizing sedation from a high baseline of 80.4% (95% CI: 66.9 to 90.2) to 96.2% (95% CI: 95.2 to 97.0) 12 months after a quality improvement initiative. We sought to measure whether this minute improvement in compliance led to a reduction in duration of mechanical ventilation.

Methods
We collected data on compliance with the process during 12 months. A trained data collector abstracted data from charts every other day. Our database contains data for length of mechanical ventilation, mortality, type of admission, and acute physiology and chronic health evaluation (APACHE) II scores for the 12 months before and after the process improvement.
To control for secular trends we used an interrupted-time series with adjustment for auto-correlation. We calculated the expected length of mechanical ventilation on each month by the end of the intervention period, and calculated the fitted value for the post-intervention months.

Results
We included 1556 patients. There was an immediate effect of the intervention (regression coefficient = -0.129, P value < 0.001) and the secular trend was a determinant of length of mechanical ventilation (regression coefficient = 0.010, P value = 0.004). The trend post-intervention was not significant (regression coefficient = 0.004, P value = 0.380).
The relative change in the length of mechanical ventilation was 14.5% (IQR 13.8% to 15.8%) and the total expected decrease in mechanical ventilation days was 502.7 days (95% CI 300.9 to 729.1) over one year.

Conclusions
In a system already working at high levels of compliance, outcomes can still be improved. Our intervention was successful in reducing the length of mechanical ventilation. ICUs should have a process of quality assurance in place to provide constant monitoring of key quality of care processes and correct deviations from the proposed standard.
Nonadherence to Oral Mercaptopurine and Risk of Relapse in Hispanic and Non-Hispanic White Children With Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group
Authors: Bhatia Smita , Landier Wendy , Shangguan Muyun , Hageman Lindsey , Schaible Alexandra N. , Carter Andrea R. , Hanby Cara L. , Leisenring Wendy , Yasui Yutaka , Kornegay Nancy M. , Mascarenhas Leo , Ritchey A. Kim , Casillas Jacqueline N. , Dickens David S. , Meza Jane , Carroll William L. , Relling Mary V. , Wong F. Lennie 
Published: May 2012

Purpose Systemic exposure to mercaptopurine (MP) is critical for durable remissions in children with acute lymphoblastic leukemia (ALL). Nonadherence to oral MP could increase relapse risk and also contribute to inferior outcome in Hispanics. This study identified determinants of adherence and described impact of adherence on relapse, both overall and by ethnicity. Patients and Methods A total of 327 children with ALL (169 Hispanic; 158 non-Hispanic white) participated. Medication event-monitoring system caps recorded date and time of MP bottle openings. Adherence rate, calculated monthly, was defined as ratio of days of MP bottle opening to days when MP was prescribed. Results After 53,394 person-days of monitoring, adherence declined from 94.7% (month 1) to 90.2% (month 6; P < .001). Mean adherence over 6 months was significantly lower among Hispanics (88.4% v 94.8%; P < .001), patients age ≥ 12 years (85.8% v 93.1%; P < .001), and patients from single-mother households (80.6% v 93.1%; P = .001). A progressive increase in relapse was observed with decreasing adherence (reference: adherence ≥ 95%; 94.9% to 90%: hazard ratio [HR], 4.1; 95% CI,1.2 to 13.5; P = .02; 89.9% to 85%: HR, 4.0; 95% CI, 1.0 to 15.5; P = .04; < 85%: HR. 5.7; 95% CI, 1.9 to 16.8; P = .002). Cumulative incidence of relapse (± standard deviation) was higher among Hispanics (16.5% ± 4.0% v 6.3% ± 2.2%; P = .02). Association between Hispanic ethnicity and relapse (HR, 2.6; 95% CI, 1.1 to 6.1; P = .02) became nonsignificant (HR, 1.8; 95% CI, 0.6 to 5.2; P = .26) after adjusting for adherence and socioeconomic status. At adherence rates ≥ 90%, Hispanics continued to demonstrate higher relapse, whereas at rates < 90%, relapse risk was comparable to that of non-Hispanic whites. Conclusion Lower adherence to oral MP increases relapse risk. Ethnic difference in relapse risk differs by level of adherence—an observation currently under investigation.
Dual Effect of Metformin on Breast Cancer Proliferation in a Randomized Presurgical Trial
Authors: Bonanni Bernardo , Puntoni Matteo , Cazzaniga Massimiliano , Pruneri Giancarlo , Serrano Davide , Guerrieri-Gonzaga Aliana , Gennari Alessandra , Trabacca Maria Stella , Galimberti Viviana , Veronesi Paolo , Johansson Harriet , Aristarco Valentina , Bassi Fabio , Luini Alberto , Lazzeroni Matteo , Varricchio Clara , Viale Giuseppe , Bruzzi Paolo , DeCensi Andrea 
Published: May 2012

Purpose Metformin is associated with reduced breast cancer risk in observational studies in patients with diabetes, but clinical evidence for antitumor activity is unclear. The change in Ki-67 between pretreatment biopsy and post-treatment surgical specimen has prognostic value and may predict antitumor activity in breast cancer. Patients and Methods After tumor biopsy, we randomly allocated 200 nondiabetic women with operable breast cancer to either metformin 850 mg/twice per day (n = 100) or placebo (n = 100). The primary outcome measure was the difference between arms in Ki-67 after 4 weeks adjusted for baseline values. Results Overall, the metformin effect on Ki-67 change relative to placebo was not statistically significant, with a mean proportional increase of 4.0% (95% CI, −5.6% to 14.4%) 4 weeks apart. However, there was a different drug effect depending on insulin resistance (homeostasis model assessment [HOMA] index > 2.8, fasting glucose [mmol/L] × insulin [mU/L]/22.5; Pinteraction = .045), with a nonsignificant mean proportional decrease in Ki-67 of 10.5% (95% CI, −26.1% to 8.4%) in women with HOMA more than 2.8 and a nonsignificant increase of 11.1% (95% CI, −0.6% to 24.2%) with HOMA less than or equal to 2.8. A different effect of metformin according to HOMA index was noted also in luminal B tumors (Pinteraction = .05). Similar trends to drug effect modifications were observed according to body mass index (P = .143), waist/hip girth-ratio (P = .058), moderate alcohol consumption (P = .005), and C-reactive protein (P = .080). Conclusion Metformin before surgery did not significantly affect Ki-67 overall, but showed significantly different effects according to insulin resistance, particularly in luminal B tumors. Our findings warrant further studies of metformin in breast cancer with careful consideration to the metabolic characteristics of the study population.
Comparative Analysis of the Value of Allogeneic Hematopoietic Stem-Cell Transplantation in Acute Myeloid Leukemia With Monosomal Karyotype Versus Other Cytogenetic Risk Categories
Authors: Cornelissen Jan J. , Breems Dimitri , van Putten Wim L.J. , Gratwohl Alois A. , Passweg Jakob R. , Pabst Thomas , Maertens Johan , Beverloo H. Berna , van Marwijk Kooy Marinus , Wijermans Pierre W. , Biemond Bart J. , Vellenga Edo , Verdonck Leo F. , Ossenkoppele Gert J. , Löwenberg Bob 
Published: May 2012

Purpose To determine to what extent allogeneic hematopoietic stem-cell transplantation (alloHSCT) quantitatively reduces relapse in acute myeloid leukemia with monosomal karyotype (MK-AML) compared with alternative postremission therapy and how it compares with other cytogenetic subcategories. Patients and Methods Of 2,560 patients (younger than age 61 years) without core-binding factor abnormalities including 305 patients with MK-AML receiving first-line induction treatment, 1,975 patients (77%) achieved remission, and 1,588 received consolidation in the first complete remission (CR1) after two induction cycles. Consolidation treatment of 107 patients with MK-AML consisted of alloHSCT (n = 45), chemotherapy (n = 48), or autologous HSCT (n = 14). Results The 5-year overall survival after start of consolidation was 19% for patients with MK-AML who received alloHSCT and 9% for those who received chemotherapy or autoHSCT (P = .02). Relapse-free survival (RFS) at 5 years was 17% versus 7% (P = .003). Cox regression analysis was performed with alloHSCT as a time-dependent covariate. Hazard ratios (HRs) associated with alloHSCT for relapse and RFS were 0.30 (95% CI, 0.24 to 0.37; P < .001), and 0.52 (95% CI, 0.43 to 0.62; P < .001), respectively. HRs were similar in MK-AML and the other cytogenetic subgroups. Conclusion AlloHSCT, applied as consolidation in CR1, is associated with a significant reduction of relapse and improvement of survival in MK-AML, with the same relative reduction of relapse or death as in other cytogenetic risk categories.
Early Origins of the Metabolic Syndrome: Role of Small Size at Birth, Early Postnatal Weight Gain, and Adult IGF-I
Authors: Kerkhof Gerthe F. , Leunissen Ralph W. J. , Hokken-Koelega Anita C. S. 
Published: May 2012

Abstract

Background:
The relationship between low birth weight and increased risk for metabolic syndrome (MetS) in later life has been frequently described, but mechanisms underlying this association remain unknown.

Methods:
In 280 young adults of the PROGRAM study, aged 18–24 yr, we investigated associations of birth weight, gain in weight for length during early life, and adult IGF-I sd score (SDS), with number of MetS components (ordinal regression analyses), prevalence of MetS components and MetS (logistic regression analyses), and other metabolic parameters (linear regression analyses). Revised criteria of the National Cholesterol Educational Program (Adult Treatment Panel III) were used to determine components of MetS. The other metabolic parameters were C-reactive protein, insulin sensitivity, trunk fat mass, total cholesterol, and low-density lipoprotein cholesterol.

Results:
More gain in weight for length SDS in the first 3 months of life was significantly associated with an increased number of MetS components [odds ratio (OR) = 1.34], prevalence of low high-density lipoprotein cholesterol (OR = 1.49), prevalence of MetS (OR = 2.51), increased C-reactive protein levels, and lower insulin sensitivity (P = 0.007) at the age of 21 yr. Low birth weight SDS was associated with lower insulin sensitivity (P = 0.036), but low birth weight SDS and adult IGF-I SDS were not significantly associated with any of the MetS components or MetS prevalence at 21 yr.

Conclusion:
Our study demonstrates that higher gain in weight for length in the first 3 months of life is associated with a higher prevalence of MetS at 21 yr, whereas low birth weight and low adult IGF-I are not.
A Self-organized MIMO-OFDM-based Cellular Network
Authors: Grünheid Rainer , Fellenberg Christian 
Published: May 2012

AbstractThis paper presents a system proposal for a self-organized cellular network, which is based on the MIMO-OFDM transmission technique. Multicarrier transmission, combined with appropriate beamforming concepts, yields high bandwidth-efficiency and shows a robust behavior in multipath radio channels. Moreover, it provides a fine and tuneable granularity of space-time-frequency resources. Using a TDD approach and interference measurements in each cell, the Base Stations (BSs) decide autonomously which of the space-time-frequency resource blocks are allocated to the Mobile Terminals (MTs) in the cell, in order to fulfil certain Quality of Service (QoS) parameters. Since a synchronized Single Frequency Network (SFN), i.e., a re-use factor of one is applied, the resource blocks can be shared adaptively and flexibly among the cells, which is very advantageous in the case of a non-uniform MT distribution.
Multi-Objective Topology Design of Industrial Ethernet Networks
Authors: Zhang Lei , Lampe Mattias , Wang Zhi 
Published: May 2012

AbstractThe objective of this paper is to investigate methods to guarantee the network performance of industrial Ethernet networks by an optimized topology design. The proposed approach differs from former works on network design by taking into account the specific requirements of industrial applications, the Quality of Service (QoS) related features of industrial Ethernet protocols, and the increasing network complexity in the industrial field. A multi-objective variable neighbourhood search algorithm (MOVNS) is presented offering a co-design method of physical topology and logical topology to satisfy the requirements of real-time capability, high reliability, and fast recovery time. The result analysis on simulation test cases shows the proposed algorithm can greatly improve the performance of industrial Ethernet networks at a moderate computational complexity.
Preliminary Development of a Rapid Assessment of Supervision Scale for Young Children
Authors: Anderst Jim , Dowd M. Denise , Schnitzer Patricia , Tryon Tom 
Published: May 2012

OBJECTIVES:Standardized evaluation tools have been shown to reduce variability in care. The objective of this study was to develop a clinically oriented evaluation tool for the rapid assessment of the adequacy of supervision of a young child.METHODS:The Rapid Assessment of Supervision Scale (RASS) was developed via a 3-step process: (1) a modified Delphi survey of child abuse experts identified the most important characteristics for use in the assessment of adequacy of supervision; (2) the RASS was designed by using standardized definitions and the results of the Delphi survey; and (3) a total of 4 medical professionals evaluated 139 real case scenarios by using the RASS. Reliability and feasibility were assessed.RESULTS:Sixty-seven child abuse experts participated in round 2 of the Delphi process and 50 participated in round 3. The RASS included 9 supervision characteristics identified from the Delphi process, standardized definitions, and a scoring system. The interclass correlation coefficients for interrater reliability of the mean RASS scores and overall supervision classification were 0.63 (95% confidence interval: 0.56–0.70; P = .000) and 0.59 (95% confidence interval: 0.51–0.67; P = .000), respectively, indicating moderate to strong agreement. For intrarater reliability, correlation coefficients for mean RASS scores indicated moderate to high correlation (0.50–0.83). Correlation for overall classification of supervision ranged from low to high (0.27–0.80).CONCLUSIONS:The RASS scale has been shown to be efficient and, in a small sample, to have moderate to substantial interrater agreement. Further development could result in a tool that aids clinicians and researchers in the evaluation of supervision.
The Influence of Equipment Weights on Neonatal Daily Weight Measurements
Authors: Goetz Hermansen Mary , Hermansen Marcus 
Published: May 2012

Purpose: To determine the weight of commonly used pieces of neonatal equipment that can affect the accuracy of daily weight measurements.Design and sample: Twenty-one pieces of equipment commonly attached to the neonate at the time of daily weight measurement were selected for analysis. Three examples of each piece of equipment were weighed; each one was weighed three times. All weights were obtained using a digital electronic diaper scale calibrated to 1 gm accuracy and precision.Main outcome variable: Average weights for pieces of routine nursery equipment.Results: Equipment weights ranged from 1 gm for an umbilical catheter to 23 gm for a pulse oximeter probe. There was no variation among the individual examples for 19 of the 21 pieces of equipment. There was a small variation in weight for the pulse oximeter probe and the arm board, but these variations were of no clinical significance.
A Survey of Skin Care Practices for Premature Low Birth Weight Infants
Authors: Ann Munson Karen , Bare Diane , Hoath Steven , Visscher Marty 
Published: May 2012

Purpose:To provide baseline information about current skin care practices in premature low birth weight infants (<1,000 gm birth weight) in typical NICUs within the U.S.Design:Descriptive survey.Sample:104 hospitals with at least 2,500 deliveries per year and at least 20 Level III NICU beds.Main Outcome Variables:Environmental conditions, bathing practices and products, adhesive products used to secure IVs and endotracheal tubes, skin protectants used with diaper rash, treatment systems for fragile preterm skin, and treatment systems for denuded skin.Results:Most units surveyed based their premature low birth weight skin care protocols on a combination of gestational age and birth weight criteria. One-quarter of the units had no skin care protocols at all. Among the units, there was considerable practice variation with respect to common nursing procedures such as bathing, adhesive application, and wound care.
Complete Congenital Heart Block: A Review and Case Study
Authors: Reneé Klassen Lisa 
Published: May 2012

Complete congenital heart block (CCHB) is a rare disease of the newborn that carries significant morbidity and mortality. It generally occurs as a result of the presence of maternal autoantibodies that are transferred to the fetus and affect the fetal heart, or it may be associated with a congenital structural abnormality of the heart.Infants with CCHB are at risk for diminished cardiac output and the subsequent development of congestive heart failure. Many infants require the placement of a cardiac pacemaker.It is essential that the nurse caring for these infants have a good understanding of the disease process and be familiar with the unique problems that these infants and their families may encounter.
Nurses’ Experiences Working with Families in an NICU During Implementation of Family-Focused Developmental Care
Authors: Heermann Judith , Wilson Margaret 
Published: May 2012

Purpose:To explore and describe nurses’ experiences while working with parents and infants receiving family-focused developmental care (FFDC), to gain insight into the process of changing from a traditional model of care to FFDC.Design:The qualitative design was based on Spradley’s method.Sample:Data were collected by interviewing ten nurses who worked in an NICU during a pilot study of FFDC. Transcripts were analyzed using Spradley’s domain analysis.Findings:Four themes describe aspects of the transition from traditional care to FFDC: (1) negative experiences of FFDC, (2) transitions central to partnering with parents, (3) positive experiences of parental participation, and (4) organizational transitions necessary for the move to a family-centered model of care.Conclusion:Learning to share responsibility with families will require change in the NICU culture as well as in nurses’ role identity.