bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term results after conversion from calcineurin inhibitors to sirolimus in renal transplant patients
Authors: Martinez‐Mier Gustavo , Avila‐Pardo Sandro F. , Mendez‐Lopez Marco T. , Budar‐Fernandez Luis F. 
Published: September 2009

Martinez‐Mier G, Avila‐Pardo SF, Mendez‐Lopez MT, Budar‐Fernandez LF. Long‐term results after conversion from calcineurin inhibitors to sirolimus in renal transplant patients. Clin Transplant 2010: 24: 467–473. © 2009 John Wiley & Sons A/S.Abstract: Background:  Calcineurin inhibitors (CNI) toxicity is one of the contributing factors for the development and progression of chronic allograft dysfunction (CAD). Conversion to sirolimus (SRL) from CNI improves renal function kidney in transplant recipients.Methods:  A retrospective review from patients abruptly converted from CNI to SRL over a three yr period is reported.Results:  Thirty‐nine patients were converted 55.2 ± 58 months after renal transplantation. 24 month patient and graft survival was 100% and 92%. Acute rejection incidence was 7.6%. Overall, serum creatinine (SCr) and Cockcroft–Gault creatinine clearance (CGCrCl) improved. In responders, SCr improved from 2.48 ± 0.8 to 1.94 ± 0.8 mg/dL (p < 0.05) CGCrCl improved from 37.8 ± 17.4 to 51.9 ± 23.8 mL/min at two years. An increase in proteinuria was observed from conversion to month 12 in responders (189.4 ± 512.8 to 488.3 ± 890.6 mg/day, p < 0.05) and from conversion to month six in non‐responders (1179.4 ± 2001.1 to 2357 ± 4172.9 mg/day, p < 0.05). Low proteinuria had positive predictive value for renal response after conversion.Conclusion:  Conversion from CNI to SRL with CAD is associated with improved renal function with an increase in proteinuria. Low proteinuria is a possible positive predictive factor for successful conversion.
Kinetics of interferon‐gamma producing cytomegalovirus (CMV)‐specific CD4+ and CD8+ T lymphocytes and the risk of subsequent CMV viremia after allogeneic hematopoietic stem cell transplantation
Authors: Eid A.J. , Brown R.A. , Hogan W.J. , Lahr B.D. , Eckel‐Passow J.E. , Litzow M.R. , Razonable R.R. 
Published: September 2009

Background.Deficiencies in cytomegalovirus (CMV)‐specific T lymphocytes impair the immunologic response against CMV reactivation after allogeneic hematopoietic stem cell transplantation (HSCT).Methods.A time‐dependent analysis was conducted to determine the association between the percentages and kinetics of interferon‐gamma‐producing CMV‐specific CD4+ and CD8+ T lymphocytes and CMV viremia among 30 allogeneic HSCT recipients.Results.Higher percentages of CD4+ T lymphocytes activated with CMVpp65 (hazard ratio [HR]: 2.06; 95% confidence interval [95% CI]: 1.18–3.6;P=0.011) and CMV lysate (HR: 1.18; 95% CI: 0.99–1.42;P=0.072), and higher percentages of CD8+ T lymphocytes activated by CMV immediate early‐1 (HR: 1.2; 95% CI: 1.01–1.43;P=0.038) and CMVpp65 (HR: 1.12; 95% CI: 1.0–1.27;P=0.060) were associated with time‐to‐CMV viremia. Furthermore, a higher degree in the decline of CMV lysate‐activated CD4+ T lymphocytes (HR: 1.14; 95% CI: 0.96–1.36;P=0.125) and CMVpp65‐activated CD8+ T lymphocytes (HR: 1.36; 95% CI: 1.03–1.78;P=0.031) was suggestive of or significantly associated with time‐to‐CMV viremia.Conclusions.Higher levels of CMV‐specific CD4+ and CD8+ T lymphocytes were associated with subsequent CMV viremia after HSCT. The association between CMV viremia and the degree of decline in CMV‐specific T lymphocytes suggests that severe disruption in homeostatic CMV‐specific immune environment contributes to the immunopathogenesis of CMV after allogeneic HSCT.
Brain natriuretic peptide is a good predictor for outcome in cardiac surgery
Authors: Elíasdóttir S. B. , Klemenzson G. , Torfason B. , Valsson F. 
Published: September 2009

Background and aim:  The heart secretes brain natriuretic peptide (BNP) in response to myocardial stretch. The aim of this study was to determine whether adverse effects after cardiac surgery were associated with higher serum BNP levels pre‐operatively.Methods:  One hundred and thirty‐five patients undergoing various cardiac procedures were included in the study, and N‐terminal pro‐BNP (NT‐pro‐BNP) was measured pre‐operatively. Post‐operative complications were defined as follows: (i) a post‐operative length of stay in the intensive care unit (ICU) exceeding 48 h; (ii) mortality at 28 days; (iii) the need for inotropic agents and/or intra‐aortic balloon pump (IABP); and (iv) renal failure. Serum NT‐pro‐BNP values were compared for patients with and without complications. The serum NT‐pro‐BNP level was also correlated with the euroSCORE and ejection fraction (EF).Results:  Pre‐operative serum NT‐pro‐BNP levels were significantly higher in patients with an ICU length of stay of more than 2 days or death prior to post‐operative day 28 (3118 ng/l vs. 705 ng/l; P < 0.001). Pre‐operative serum NT‐pro‐BNP levels were also significantly higher in patients needing inotropic agents (2628 ng/l vs. 548 ng/l; P < 0.001) or IABP insertion (3705 ng/l vs. 935 ng/l; P = 0.001) or developing renal failure (2857 ng/l vs. 945 ng/l; P < 0.001) post‐operatively. The correlation between the serum NT‐pro‐BNP level and euroSCORE was good (r = 0.658; P < 0.001). The receiver operating characteristic (ROC) curves were used to assess the ability of serum NT‐pro‐BNP, euroSCORE and EF to predict outcome after cardiac surgery. This revealed an area under the ROC curve for the length of stay in the ICU or mortality at 28 days of 0.829 for serum NT‐pro‐BNP, 0.814 for euroSCORE and 0.328 for EF assessed by transesophageal echocardiography, indicating that the pre‐operative serum NT‐pro‐BNP level is a good prognostic indicator for outcome after cardiac surgery.Conclusion:  Serum NT‐pro‐BNP is a good predictor for complications after cardiac surgery, and is as good as euroSCORE and better than EF.
Applicability of tools to assess pain in elderly patients after cardiac surgery
Authors: PESONEN A. , SUOJARANTA‐YLINEN R. , TARKKILA P. , ROSENBERG P. H. 
Published: September 2009

Background: Post‐operatively, elderly patients with impaired vision and cognitive dysfunction may experience difficulties understanding standard pain assessment tools such as the 10‐cm Visual Analogue Scale (VAS) and the Verbal Rating Scale (VRS). Thus, there is a need to identify more feasible post‐operative pain assessments for elderly patients. With this goal in mind, we compared the VAS and VRS with two more expressive tools: the 50‐cm Red Wedge Scale (RWS) and the Facial Pain Scale (FPS).Methods: Cardiac surgery patients (73 ± 5 years, mean ± SD) were allocated to an RWS (n=80) or an FPS (n=80) group. Pain was assessed at rest and after movement during the first 4 days after tracheal extubation. The RWS or FPS assessments were repeated after 10 min. All patients completed the VRS and VAS.Results: The rates of successful pain measurement on study day 1 were: VRS 86%, VAS 62%, RWS 78%, and FPS 60%. Pain measurements with the RWS correlated with the VAS (r=0.758, P<0.001) and weaker with the VRS (r=0.666, P<0.001) measurements. Pain measurements with the FPS correlated well with the VAS (r=0.873, P<0.001) and weaker with the VRS (r=0.583, P<0.001) measurements. With all scales, success rates improved during the study period.Conclusion: In elderly patients, immediately after cardiac surgery, the VRS is the most feasible pain scale, followed by the RWS. The traditional 10‐cm VAS is unsuitable for pain measurement in this population.
Systematic follow‐up increases incidence of anaphylaxis during adverse reactions in anesthetized patients
Authors: MALINOVSKY J.‐M. , DECAGNY S. , WESSEl F. , GUILLOUX L. , MERTES P. M. 
Published: September 2009

Background: The incidence of hypersensitivity reactions during anesthesia is underestimated because clinical symptoms may vary and diagnosis is not obvious. Our aim was to investigate the consequences of a systematic follow‐up of patients on the estimated incidence of allergic reactions during anesthesia.Methods: We conducted a prospective study over a 2‐year period (70,000 anesthesias). When patients were suspected with hypersensitivity reactions or with unexplained adverse reactions during anesthesia, blood was sampled to measure histamine and tryptase, and then skin tests were performed 4–6 weeks later.Results: During the studied period, 39 patients were enrolled in the database. Eight were excluded because of lack of skin tests. Twenty‐two patients had clinical features compatible with immediate hypersensitivity reaction, and nine had reactions rated as ‘unexplained’ by the attending physician. Following systematic investigation, we found 22 hypersensitivity reactions (15 patients with obvious and seven with unexplained reactions) during anesthesia. This increases the estimated incidence of hypersensitivity reactions from 1 : 4667 to 1 : 3180 anesthesias. Tryptase concentrations were increased in only 50% of these patients. In our series, positive and negative predictive values of tryptase at T0 for the diagnosis of anaphylaxis were 100% and 60%, respectively. Latex was the major causative agent, followed by neuromuscular blocking agents and antibiotics.Conclusions: Systematic follow‐up of patients with unexplained reactions during anesthesia increases the estimated incidence of IgE‐mediated hypersensitivity reactions during anesthesia by 50%.
Lateral sagittal infraclavicular block: clinical experience in 380 patients
Authors: GÜRKAN Y. , HOŞTEN T. , SOLAK M. , TOKER K. 
Published: September 2009

Background: The purpose of this study was to evaluate the clinical utility and block success rate of ‘lateral sagittal infraclavicular block (LSIB)’ in a large‐scale clinical study.Methods: Adult patients scheduled for hand, wrist and forearm surgery between March 2005 and June 2007 were prospectively included into the study. Using a nerve stimulator LSIB was performed. In the LSIB technique the puncture site is immediately adjacent to the most medial point of the coracoid process and the anterior surface of the clavicula. The needle is inserted caudally in a sagittal plane, 20° dorsally (downwards), until muscle twitches are observed in synchrony with the stimulation. A Local anesthetic mixture of either 20 ml bupivacaine 5 mg/ml or 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 μg/ml epinephrine (total volume 40 ml) was administered following electrolocation of the median, radial or ulnar nerve.Results: Three‐hundred and eighty patients were included into the study. Block was successful in 341 (89.7%) patients without any need for local anesthetic supplementation. We had complete failure in 17 (4.5%) patients and these patients received general anesthesia. Twenty‐two (5.8%) patients needed either infiltration of local anesthetic at the site of skin incision or supplementation of the block at the axilla. No other complications other than vascular punctures − 25 patients (6.6%) – were observed.Conclusions: LSIB provided a clinically acceptable success rate and our results are in agreement with other studies assessing this approach.
Contributions of myocardial ischemia and heart rate to ST segment changes in patients with or without coronary artery disease
Authors: HÄGGMARK S. , HANEY M. F. , JOHANSSON G. , REIZ S. , NÄSLUND U. 
Published: September 2009

Background: ST changes related to ischemia at different heart rates (HRs) have not been well described. We aimed to analyze ST dynamic changes by vectorcardiography (VCG) during pacing‐induced HR changes for subjects with proven coronary artery disease (CAD) and without (non‐CAD).Methods: Symptomatic CAD patients scheduled for elective surgery were enrolled along with a non‐CAD group. During anesthesia, both groups were placed at multiple ascending levels. VCG ST data, and in particular in ST change vector magnitude (STC‐VM) from baseline, along with arterial and great coronary artery vein (GCV) blood samples were collected to determine regional myocardial lactate production.Results: A total of 35 CAD and 10 non‐CAD patients were studied over six incremental 10 beat/min HR increases. STC‐VM mean levels increased in the CAD group from 9±5 to 131±37 μV (standard deviation) compared with non‐CAD subjects with 8±3–76±34 μV. Myocardial ischemia (lactate production) was noted at higher HRs and the positive predictive value for STC‐VM to detect ischemia was 58% with the negative predictive value being 88%. STC‐VM at 54 μV showed a sensitivity of 88% and a specificity of 75% for identification of ischemia.Conclusions: Both HR and ischemia at higher HRs contribute to VCG ST elevation. Established ST ischemia detection concerning HR levels is suboptimal, and further attention to the effects of HR on ST segments is needed to improve electrocardiographic ischemia criteria.
Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: a randomised, controlled, double‐blinded study
Authors: VOLMANEN P. , SARVELA J. , AKURAL E. I. , RAUDASKOSKI T. , KORTTILA K. , ALAHUHTA S. 
Published: September 2009

Background: We hypothesised that intravenous patient‐controlled analgesia (IV PCA) with remifentanil could provide as satisfactory pain relief for labour as epidural analgesia.Methods: Fifty‐two parturients with singleton uncomplicated pregnancies were randomised to receive either IV PCA with remifentanil or epidural analgesia with 20 ml levobupivacaine 0.625 mg/ml and fentanyl 2 μg/ml in saline. The PCA dose of remifentanil was given over 1 min with a lockout time of 1 min. The dose was increased starting from the bolus of 0.1 μg/kg and following a dose escalation scheme up until the individual‐effective dose was reached. The parturients assessed contraction pain (0–10), pain relief (0–4), sedation and nausea during 60 min.Results: Forty‐five parturients were included in the analysis. The median cervical opening was 4 cm before the study and 7 cm after the study. The median pain scores were 7.3 and 5.2 during remifentanil and epidural analgesia, respectively (P=0.009). The median pain relief scores were 2.5 and 2.8 (P=0.17). There was no difference between the groups in the proportion of parturients who discontinued due to ineffective analgesia, nor in the proportion of parturients who would have liked to continue the given medication at the end of the study. Sedation and low haemoglobin oxygen saturation were observed more often during remifentanil analgesia. Foetal heart rate tracing abnormalities were as common in both groups.Conclusions: In terms of pain scores, epidural analgesia is superior to that provided by IV remifentanil. However, there was no difference in the pain relief scores between the treatments.
Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome
Authors: SKULEC R. , KOVARNIK T. , DOSTALOVA G. , KOLAR J. , LINHART A. 
Published: September 2009

Background: Induction of mild hypothermia (MH) in patients resuscitated from cardiac arrest improves their outcome. However, benefits and risks of MH in patients who remain in cardiogenic shock after the return of spontaneous circulation (ROSC) are unclear. We analysed all cardiac arrest survivors who were treated with MH in our intensive coronary care unit (CCU) and compared the outcome of patients with cardiogenic shock syndrome (CSS) with those who were circulatory stable.Methods: We performed retrospective analysis of all consecutive cardiac arrest survivors treated by MH in our CCU from November 2002 to August 2006. They were classified into two groups, according to whether they met the criteria for cardiogenic shock or not before MH initiation.Results: Out of 56 consecutive patients, 28 fulfilled criteria of cardiogenic shock before MH initiation (group A) and 28 were relatively stable (group B). In‐hospital mortality was 57.1% in group A and 21.4% in group B patients (P=0.013). Favourable neurological outcome anytime during hospitalization was found in 67.9% of group A patients and in 82.1% of group B subjects (P=0.355). Favourable discharge neurological outcome was reached in 39.3% in group A and in 71.4% in group B (P=0.031). The complication rate in both groups did not differ.Conclusion: While in‐hospital mortality in cardiac arrest survivors treated by MH was expectably higher in those with cardiogenic shock than in stable patients, the favourable neurological outcome during hospitalization was comparable in both groups. Therefore, induction of MH should be considered in cardiac arrest survivors with CSS after ROSC.
Haemodilution induced by hydroxyethyl starches 130/0.4 is similar in septic and non‐septic patients
Authors: MEYER P. , PERNET P. , HEJBLUM G. , BAUDEL J. L. , MAURY E. , OFFENSTADT G. , GUIDET B. 
Published: September 2009

Background: Fluid therapy induces haemodilution related to plasma volume expansion. The aim of our study was to compare haemodilution after a single hydroxyethyl starches (HES) 130/0.4 infusion in two groups of patients, one with and one without sepsis. We hypothesized that a single HES challenge would induce similar sustained haemodilution in both groups.Methods: In this prospective preliminary study, patients predicted to require a single further volume‐expander infusion were included immediately before receiving 500 ml of 6% HES 130/0.4 over a 15‐min period. No additional fluid was administered over the next 8 h. Haematocrit, and serum albumin and protein were determined immediately before HES infusion then after 1, 2, 3, 4, and 8 h.Results: Twelve patients were included in each group. In both groups, all three haemodilution markers had significantly lower values after 1 h than at baseline. None of the values after 1 and 3 h differed significantly between the two groups. Neither did any of the other study variables show significant differences between the groups with and without sepsis.Conclusion: We found that a starch‐based compound was as effective in inducing haemodilution in patients with sepsis as in controls without sepsis, suggesting that HES may remain within the intravascular space even in patients with sepsis. Haemodilution parameters such as haematocrit, serum albumin and serum protein are useful for assessing the duration of plasma volume expansion induced by fluid therapy in critically ill patients.
Induction and emergence behavior of children undergoing general anesthesia correlates with maternal salivary amylase activity before the anesthesia
Authors: ARAI Y.‐C. P. , KANDATSU N. , ITO H. , SATO Y. , SATAKE Y. , MIZUTANI M. , USHIDA T. , KOMATSU T. 
Published: September 2009

Background: The parents of the children who undergo surgery experience stress during the pre‐anesthetic period. Such stress influences the mental status of their children, thereby inducing their pre‐anesthetic anxiety and problematic behavior at emergence. Recently, measurement of salivary biomarkers was evaluated as stress biomarkers. Especially, α‐amylase is utilized as an excellent index for psychological stress. In the present study, we tested whether salivary amylase activity of mothers before the surgery of their children correlates with the peri‐operative children's behaviors.Methods: A total of 22 pairs of mothers and children were analyzed. Maternal salivary amylase activity was evaluated at the entrance of the operation room. The children underwent minor plastic surgery under general anesthesia, and induction and emergence behaviors were assessed.Results: The higher the maternal salivary amylase activity, the severer the children's induction anxiety (rs=−0.667, n=22, P<0.0001), and the higher the maternal amylase activity, the severer the children's emergence agitation (rs=0.705, n=22, P<0.0001).Conclusion: Induction and emergence behaviors of children undergoing general anesthesia significantly correlated with their respective maternal salivary amylase activity during the pre‐anesthetic period.
Delayed pharmacological pre‐conditioning effect of mitochondrial ATP‐sensitive potassium channel opener on neurologic injury in a rabbit model of spinal cord ischemia
Authors: KIM K. O. , CHOE G. , CHUNG S. H. , KIM C. S. 
Published: September 2009

Background: Diazoxide, pharmacological openers of mitochondrial ATP‐sensitive potassium channels have been shown to induce early pre‐conditioning in the spinal cord. Here, the authors investigated whether diazoxide also induce delayed pre‐conditioning and thereby reduce neurologic complications using a rabbit model of spinal cord ischemia.Methods: Infrarenal blood flow was interrupted for 20 min in 21 rabbits. Non‐treated control animals received no pre‐treatment. Diazoxide (5 mg/kg) were given 48 h before 20 min ischemia in the 48‐h DZ group, whereas 15‐min DZ group received diazoxide (5 mg/kg) 15 min before 20‐min ischemia. Neurological functions were evaluated using Johnson scores for 3 days after reperfusion, after which, spinal cords were procured for hematoxylin and eosin staining for cell counting.Results: Johnson scores revealed a marked improvement in both the diazoxide‐treated groups vs. the non‐treated control group at 3, 24, 48, and 72 h after reperfusion (P<0.01). The histologic changes were proportional to the Johnson scores, with better preservation of motor neuron numbers in the animals of the 48‐h DZ and 15‐min DZ group relative to the non‐treated controls (81±12, 90±10, 50±23 motor neurons, respectively, P<0.01). No difference was found between the 48‐h DZ group and 15‐min DZ group with respect to the Johnson scores or neuron numbers.Conclusions: The study demonstrates that pre‐treatment with diazoxide 48 h before ischemia, induce delayed pharmacological pre‐conditioning, thereby significantly improving clinical neurologic scores and histologic findings in this animal model.
Intraguild interactions and aphid predators: biological efficiency of Harmonia axyridis and Episyrphus balteatus
Authors: Alhmedi A. , Haubruge E. , Francis F. 
Published: September 2009

AbstractIntroductions of the harlequin ladybird Harmonia axyridis into Belgium for aphid biological control have been followed by declines in native aphid natural enemies. We first examined, in laboratory and field conditions, the impact of larval mobility of either H. axyridis or Episyrphus balteatus, the most abundant native hoverfly in central Europe, on aphid suppression. The hoverfly larvae consumed more aphids (Megoura viciae) in a short term, whereas the ladybird ones were more efficient in a long term. We second investigated the intraguild interactions between H. axyridis and E. balteatus larvae and adults. In larva pairings between the two species in laboratory microcosms containing aphid (M. viciae) infested broad bean (Vicia faba) plants, H. axyridis had an intraguild predation (IGP) advantage over the hoverfly. When conspecific larvae were paired together on aphid‐infested plants, no cannibalism between them was detected. The presence of either H. axyridis or E. balteatus larvae on aphid‐infested plants negatively influenced the ovipositional behaviour of H. axyridis and E. balteatus females; lower numbers of laid eggs were recorded compared to control treatment. Moreover, eggs laid by E. balteatus females were also dropped as victims of predation mainly by H. axyridis larvae. Our results suggest that while the exotic ladybird was more efficient in aphid biological control, larvae and eggs of the native hoverfly species face increased IGP by H. axyridis, which would contribute, as a consequence, to the decline in E. balteatus population following invasion.