bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving anaphylaxis management in a pediatric emergency department
Authors: Arroabarren E. , Lasa E. M. , Olaciregui I. , Sarasqueta C. , Muñoz J. A. , Pérez‐Yarza E. G. 
Published: June 2011

To cite this article: Arroabarren E, Lasa EM, Olaciregui I, Sarasqueta C, Muñoz JA, Pérez‐Yarza EG. Improving anaphylaxis management in a pediatric emergency department. Pediatric Allergy Immunology 2011; 22: 708–714.AbstractBackground:  The management of anaphylaxis in pediatric emergency units (PEU) is sometimes deficient in terms of diagnosis, treatment, and subsequent follow‐up. The aims of this study were to assess the efficiency of an updated protocol to improve medical performance, and to describe the incidence of anaphylaxis and the safety of epinephrine use in a PEU in a tertiary hospital.Methods:  We performed a before–after comparative study with independent samples through review of the clinical histories of children aged <14 years old diagnosed with anaphylaxis in the PEU according to the criteria of the European Academy of Allergy and Clinical Immunology (EAACI). Two allergists and a pediatrician reviewed the discharge summaries codified according to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) as urticaria, acute urticaria, angioedema, angioneurotic edema, unspecified allergy, and anaphylactic shock. Patients were divided into two groups according to the date of implantation of the protocol (2008): group A (2006–2007; the period before the introduction of the protocol) and group B (2008–2009; after the introduction of the protocol). We evaluated the incidence of anaphylaxis, epinephrine administration, prescription of self‐injecting epinephrine (SIE), other drugs administered, the percentage of admissions and length of stay in the pediatric emergency observation area (PEOA), referrals to the allergy department, and the safety of epinephrine use.Results:  During the 4 years of the study, 133,591 children were attended in the PEU, 1673 discharge summaries were reviewed, and 64 cases of anaphylaxis were identified. The incidence of anaphylaxis was 4.8 per 10,000 cases/year. After the introduction of the protocol, significant increases were observed in epinephrine administration (27% in group A and 57.6% in group B) (p = 0.012), in prescription of SIE (6.7% in group A and 54.5% in group B) (p = 0.005) and in the number of admissions to the PEOA (p = 0.003) and their duration (p = 0.005). Reductions were observed in the use of corticosteroid monotherapy (29% in group A, 3% in group B) (p = 0.005), and in patients discharged without follow‐up instructions (69% in group A, 22% in group B) (p = 0.001). Thirty‐three epinephrine doses were administered. Precordial palpitations were observed in one patient.Conclusion:  The application of the anaphylaxis protocol substantially improved the physicians’ skills to manage this emergency in the PEU. Epinephrine administration showed no significant adverse effects.
Age‐dependent changes of serum soluble CD30 concentration in children
Authors: Chrul Slawomir , Polakowska Ewa 
Published: June 2011

Chrul S, Polakowska E. Age‐dependent changes of serum soluble CD30 concentration in children.  Pediatr Transplantation 2011: 15: 515–518. © 2011 John Wiley & Sons A/S.Abstract:  CD30 was originally described as a marker on Reed‐Sternberg cells in Hodgkin lymphoma. The extracellular portion of CD30 is proteolytically cleaved from CD30(+) cells, to produce a soluble form of the molecule (sCD30) detectable in serum. Measurement of sCD30 concentration in serum has been suggested to be a potential tool in monitoring of inflammatory status in variety of diseases. Several investigators reported the relevance for sCD30 as a predictive marker for allograft rejection following organ transplantation. The aim of the study was to verify whether sCD30 serum concentrations may be affected by an age in healthy children. Heparinized venous blood was taken from 78 healthy children. For the analysis of sCD30 levels, the commercially available sCD30 ELISA was used. The sCD30 was detected in all serum samples and concentrations ranged from 6.75 to 68.07 ng/mL. The statistical analysis of all individuals showed that sCD30 concentration was significantly age depended (r = −0.618, p < 0.0001). When sCD30 concentrations were analyzed in regard to gender, no significant differences were identified in age subgroups.
Rituximab treatment for recurrence of nephrotic syndrome in a pediatric patient after renal transplantation for congenital nephrotic syndrome of Finnish type
Authors: Chaudhuri Abanti , Kambham Neeraja , Sutherland Scott , Grimm Paul , Alexander Steven , Concepcion Waldo , Sarwal Minnie , Wong Cynthia 
Published: June 2011

Chaudhuri A, Kambham N, Sutherland S, Grimm P, Alexander S, Concepcion W, Sarwal M, Wong C. Rituximab treatment for recurrence of nephrotic syndrome in a pediatric patient after renal transplantation for congenital nephrotic syndrome of Finnish type.Abstract:  Congenital nephrotic syndrome (CNS) of the Finnish type due to mutation in the NPHS‐1 gene results in massive proteinuria due to structural abnormality in the glomerular slit diaphragm, and is usually refractory to immunosuppressive therapy. Patients eventually require bilateral nephrectomy and renal replacement therapy, with transplantation being the ultimate goal. Post‐transplant recurrence of nephrotic syndrome occurs in about 25% of children and is thought to be immune‐mediated secondary to antibodies formed against the nephrin protein in renal allograft. Conventional therapy with calcineurin inhibitors (CNI), cyclophosphamide and corticosteroids with or without plasmapheresis often fails to achieve remission resulting in graft loss in 12‐16%. There is limited experience with use of rituximab (RTX) in pediatric organ transplant recipients. We report the first case of post‐transplant recurrence of nephrotic syndrome in a 4‐yr‐old child with CNS due to NPHS‐1 mutation in whom CNI, corticosteroid and cyclophosphamide therapy was unsuccessful, but who achieved remission after depletion of B cells with RTX, associated with a decrease in the level of anti‐nephrin antibodies. The child remains in remission 5 yr following treatment. Our experience suggests that activated B cells may play a pivotal role in the recurrence of nephrosis after renal transplantation in children with CNS.
Effect of Cryopreservation on Apoptotic‐like Events and its Relationship with Cryocapacitation of Buffalo (Bubalus bubalis) Sperm
Authors: Kadirvel G , Periasamy S , Kumar S 
Published: June 2011

ContentsThis study investigated the apoptosis‐like events associated with cryopreservation process and their relationship with cryocapacitation in buffalo (Bubalus bubalis) sperm. A total of 49 semen ejaculates from seven bulls were studied for structural changes in sperm following cryopreservation. Apoptotic changes were detected by assays specific for translocation of phosphatidylserine (PS) to the cell surface, alterations in membrane permeability and mitochondrial membrane potential (MMP), and DNA integrity. A significant (p < 0.01) percentage of cryopreserved sperm showed externalization of PS and early apoptotic changes and lowered MMP when compared with the fresh sperm. Freezing and thawing of sperm increased permeability to YOPRO‐1, an impermeant fluorescent dye. However, on TUNEL staining, cryopreserved sperm showed no breach in DNA integrity. The sperm capacitation status was evaluated by chlortetracycline (CTC) fluorescence pattern, in which a significant (p < 0.01) percentage of cryopreserved sperm were found to be capacitated. The capacitated sperm (Pattern B) was positively correlated with the aforementioned apoptotic events. In conclusion, cryopreservation process induced early apoptosis‐like changes in buffalo sperm, and a close link exists between cryocapacitation and apoptosis during cryopreservation of sperm.
Genetic divergence and geographical variation in the deep‐water Conus orbignyi complex (Mollusca: Conoidea)
Authors: Puillandre Nicolas , Meyer Christopher P. , Bouchet Philippe , Olivera Baldomero M. 
Published: June 2011

Puillandre, N., Meyer, C. P., Bouchet, P. & Olivera, B. M. (2011). Genetic divergence and geographical variation in the deep‐water Conus orbignyi complex (Mollusca: Conoidea). —Zoologica Scripta, 40, 350–363.The cone snails (family Conidae) are a hyperdiverse lineage of venomous gastropods. Two standard markers, COI and ITS2, were used to define six genetically divergent groups within a subclade of Conidae that includes Conus orbignyi; each of these was then evaluated based on their shell morphology. We conclude that three forms, previously regarded as subspecies of C. orbignyi are distinct species, now recognized as C. orbignyi, C. elokismenos and C. coriolisi. In addition, three additional species (C. pseudorbignyi, C. joliveti and C. comatosa) belong to this clade. Some of the proposed species (e.g. C. elokismenos) are possibly in turn complexes comprising multiple species. Groups such as Conidae illustrate the challenges generally faced in species delimitation in biodiverse lineages. In the case of C. orbignyi complex, they are not only definable, genetically divergent lineages, but also considerable geographical variation within each group. Our study suggests that an intensive analysis of multiple specimens within a single locality helps to minimize the confounding effects of geographical variation and can be a useful starting point for circumscribing different species within such a confusing complex.
Winch and Anscombe on Ethics and Religion
Authors: Mounce Howard 
Published: June 2011

AbstractThe aim of this paper is to consider in detail a paper in which Peter Winch discusses the absolute nature of the moral ought. Anscombe had argued that the notion of an absolute ought presupposes the idea of divine law. Winch's aim is to show her mistaken. On his view, it is the idea of divine that depends on the notion of an absolute ought.It is argued that Winch is not successful in his criticism. Indeed, were we to accept his assumptions, we should be forced to conclude that the moral ought is not absolute at all, but relative.
OPTIMAL PRICE SETTING IN FIXED‐ODDS BETTING MARKETS UNDER INFORMATION UNCERTAINTY
Authors: Makropoulou Vasiliki , Markellos Raphael N. 
Published: June 2011

ABSTRACTThis paper develops a model of optimal pricing under information uncertainty for fixed‐odds betting markets. The model suggests that bookmakers require a premium for quoting the odds several days before an event. This premium reflects the uncertainty of public information that can be exploited by expert bettors. The model predicts that when bookmakers set optimal prices, expected returns to bettors increase as a monotonic function of winning probabilities. In this manner, an information‐based explanation is given for the celebrated favourite‐longshot bias in fixed‐odds. Using an extensive data‐set of football odds from two major European bookmakers, we estimate the probability of informed betting.
Limits to expansion: transnational corporations and territorial embeddedness in the Japanese temporary staffing market
Authors: COE NEIL M. , JOHNS JENNIFER , WARD KEVIN 
Published: June 2011

AbstractRecent changes to employment legislation have combined with shifting macro‐economic conditions to drive dramatic growth in Japan's temporary staffing industry. Leading transnational staffing agencies have sought to capitalize on this growth as part of their wider globalization strategies but have faced substantial challenges both in entering the market and in their subsequent attempts at expansion. In this article, we explore the ways in which the particularities of the Japanese host market regulatory and institutional environment combine with the inherent characteristics of the temporary staffing business model to challenge the expansionary strategies of these firms. We argue that while transnational firms have sought to adapt their business practices and strategies to the Japanese case, the attributes of the Japanese staffing market mean they have been unable to make significant inroads into the dominant market shares held by their domestic rivals.
Intermedin (adrenomedullin2) stabilizes the endothelial barrier and antagonizes thrombin‐induced barrier failure in endothelial cell monolayers
Authors: Aslam M , Pfeil U , Gündüz D , Rafiq A , Kummer W , Piper HM , Noll T 
Published: June 2011

BACKGROUND AND PURPOSE Intermedin is a member of the calcitonin gene‐related‐peptide (CGRP) family expressed in endothelial cells and acts via calcitonin receptor‐like receptors (CLRs). Here we have analysed the receptors for intermedin and its effect on the endothelial barrier in monolayers of human umbilical vein endothelial cells (HUVECs).EXPERIMENTAL APPROACH We analysed the effect of intermedin on albumin permeability, contractile machinery, actin cytoskeleton and VE‐cadherin in cultured HUVECs.KEY RESULTS Intermedin concentration‐dependently reduced basal endothelial permeability to albumin and antagonized thrombin‐induced hyperpermeability. Intermedin was less potent (EC50 1.29 ± 0.12 nM) than adrenomedullin (EC50 0.24 ± 0.07 nM) in reducing endothelial permeability. These intermedin effects were inhibited by AM22–52 and higher concentrations of αCGRP8–37, with pA2 values of αCGRP8–37 of 6.4 for both intermedin and adrenomedullin. PCR data showed that HUVEC expressed only the CLR/RAMP2 receptor complex. Intermedin activated cAMP/PKA and cAMP/Epac signalling pathways. Intermedin's effect on permeability was blocked by inhibition of PKA but not of eNOS. Intermedin antagonized thrombin‐induced contractile activation, RhoA activation and stress fibre formation. It also induced Rac1 activation, enhanced cell–cell adhesion and antagonized thrombin‐induced loss of cell–cell adhesion. Treatment with a specific inhibitor of Rac1 prevented intermedin‐mediated barrier stabilization.CONCLUSION AND IMPLICATIONS Intermedin stabilized endothelial barriers in HUVEC monolayers via CLR/RAMP2 receptors. These effects were mediated via cAMP‐mediated inactivation of contractility and strengthening of cell–cell adhesion. These findings identify intermedin as a barrier stabilizing agent and suggest intermedin as a potential treatment for vascular leakage in inflammatory conditions.
Cannabinoid CB2 receptor‐mediated regulation of impulsive‐like behaviour in DBA/2 mice
Authors: Navarrete Francisco , Pérez‐Ortiz José M. , Manzanares Jorge 
Published: June 2011

BACKGROUND AND PURPOSE This study evaluated gene expression differences between two mouse strains, characterized by opposite impulsivity‐like traits and the involvement of the cannabinoid CB2 receptor in the modulation of impulsivity.EXPERIMENTAL APPROACH Behavioural tests were conducted to compare motor activity, exploration and novelty seeking, attention and cognitive and motor impulsivity (delayed reinforcement task: session duration 30 min; timeout 30 s) between A/J and DBA/2 mice. Expression of genes for dopamine D2 receptors, CB1 and CB2 receptors were measured in the cingulate cortex (CgCtx), caudate‐putamen (CPu), accumbens (Acc), amygdala (Amy) and hippocampus (Hipp). Involvement of CB2 receptors in impulsivity was evaluated in DBA/2 mice with a CB2 receptor agonist (JWH133) and an antagonist (AM630).KEY RESULTS DBA/2 mice presented higher motor and exploratory activity, pre‐pulse inhibition impairment and higher cognitive and motor impulsivity level than A/J mice. In addition, DBA/2 mice showed lower (CgCtx, Acc, CPu) D2 receptor, lower (Amy) and higher (CgCtx, Acc, CPu, Hipp) CB1 receptor and higher (CgCtx, Acc, Amy) and similar (CPu, Hipp) CB2 receptor gene expressions. Treatment with JWH133 (0.5, 1, 3 mg·kg−1, i.p.) reduced cognitive and motor impulsivity level, accompanied by CB2 receptor down‐regulation (CgCtx, Acc, Amy) but did not modify other behaviours. In contrast, AM630 (1, 2, 3 mg·kg−1, i.p.) improved pre‐pulse inhibition and reduced novelty seeking behaviour in DBA/2 mice.CONCLUSIONS AND IMPLICATIONS CB2 receptors might play an important role in regulating impulsive behaviours and should be considered a promising therapeutic target in the treatment of impulsivity‐related disorders.
Novel opioid cyclic tetrapeptides: Trp isomers of CJ‐15,208 exhibit distinct opioid receptor agonism and short‐acting κ opioid receptor antagonism
Authors: Ross Nicolette C , Reilley Kate J , Murray Thomas F , Aldrich Jane V , McLaughlin Jay P 
Published: June 2011

BACKGROUND AND PURPOSEThe κ opioid receptor antagonists demonstrate potential for maintaining abstinence from psychostimulant abuse, but existing non‐peptide κ‐receptor selective antagonists show exceptionally long activity. We hypothesized that the L‐ and D‐Trp isomers of CJ‐15,208, a natural cyclic tetrapeptide reported to be a κ‐receptor antagonist in vitro, would demonstrate short‐acting, dose‐dependent antagonism in vivo, preventing reinstatement of cocaine‐seeking behaviour.EXPERIMENTAL APPROACHAffinity, selectivity and efficacy of the L‐Trp and D‐Trp isomers for opioid receptors were assessed in vitro in radioligand and GTPγS binding assays. Opioid receptor agonist and antagonist activities were characterized in vivo following i.c.v. administration with the 55°C warm water tail‐withdrawal assay. The D‐Trp isomer, which demonstrated primarily κ‐receptor selective antagonist activity, was further evaluated for its prevention of stress‐ and drug‐induced reinstatement of extinguished cocaine conditioned place preference (CPP).KEY RESULTSThe two isomers showed similar affinity and selectivity for κ receptors (Ki 30–35 nM) as well as κ receptor antagonism in vitro. As expected, the D‐Trp cyclic tetrapeptide exhibited minimal agonist activity and induced dose‐dependent κ‐receptor selective antagonism lasting less than 18 h in vivo. Pretreatment with this peptide prevented stress‐, but not cocaine‐induced, reinstatement of extinguished cocaine CPP. In contrast, the L‐Trp cyclic tetrapeptide unexpectedly demonstrated mixed opioid agonist/antagonist activity.CONCLUSIONS AND IMPLICATIONSThe L‐Trp and the D‐Trp isomers of CJ‐15,208 demonstrate stereospecific opioid activity in vivo. The relatively brief κ opioid receptor antagonism, coupled with the prevention of stress‐induced reinstatement of extinguished cocaine‐seeking behaviour, suggests the D‐Trp isomer could be used therapeutically to maintain abstinence from psychostimulant abuse.
Delirium incidents in three Danish intensive care units
Authors: Svenningsen Helle , Tønnesen Else 
Published: June 2011

Background: Delirium as a result of hospitalization in an intensive care unit (ICU) is defined by a mental state different from the patients' normal state and an acute fluctuating course. Both morbidity and mortality are increased in relation to delirium. The incidence of delirium has been reported from 16% to 87% in international studies primarily in elderly patients. Aims: The purpose of this study was to evaluate the incidence of delirium in adult intensive care patients in Denmark and to identify correlations between delirium, sedatives, opiod analgesics and age. Methods: In a prospective follow‐up study, 139 adult patients were screened for delirium using the confusion assessment method for the ICU (CAM‐ICU) from 48 h after admission to ICU, twice a day until discharged. Results: A total of 41 patients had at least one positive score for delirium, 61 had only negative scores and 37 were too heavily sedated to be scored during the study period. Thus, the incidence of delirium was 40% among patients who were able to be CAM‐ICU scored. Patients who were lightly sedated had a 10‐fold increased risk of delirium. There was no difference in incidence by age. Patients who received Fentanyl were more at risk of developing delirium compared with patients who received other or no analgesics. Sedative drugs did not influence the incidence. Conclusion: In this study delirium occurred in 40% of adult ICU patients of all ages.
Neurovascular assessment in the critically ill patient
Authors: Johnston‐Walker Elizabeth , Hardcastle Jane 
Published: June 2011

Aim: To outline the pathophysiological processes involved in neurovascular impairment and compartment syndrome and examine common contributory factors within the development and clinical presentation of neurovascular impairment in critical care patients with musculoskeletal trauma. Background: Thorough and systematic assessment of neurovascular status in critically ill patients with musculoskeletal trauma is crucial to detect secondary ischaemic injury and implement appropriate and timely treatment of any neurovascular deficits. Method: Current literature relating to neurovascular assessment and associated patient care was reviewed and utilised to outline distinct assessment components, indicators of neurovascular impairment and highlight the important issues for critical care nursing practice. Results: Diminished limb perfusion secondary to vascular impairment and compartment syndrome are well documented. Complications associated with musculoskeletal trauma and surgical intervention can have wide‐ranging effects on the patient's functional ability and overall outcome. It is crucial that appropriate neurovascular assessment is undertaken for patients admitted to the critical care unit following musculoskeletal trauma, crush injury, orthopaedic surgery (involving internal or external fixation of fractures) and those who may have experienced prolonged external pressure from casts or tight‐fitting bandages. Several elements of neurovascular assessment are, however, more complex to undertake in the context of the unconscious or sedated critically ill patient. Conclusions: Effective practice requires that the critical care nurse has a comprehensive understanding of the aetiology, pathophysiology, physiological responses and clinical presentation associated with neurovascular impairment, secondary ischaemia and compartment syndrome. Relevance to clinical practice: Undertaking an effective neurovascular assessment for patients at risk of neurovascular impairment or acute compartment syndrome (ACS) in the critical care setting can be problematic when patients are unable to communicate with the nurse. The risk of long‐term functional impairment or limb loss can be significant in this group of patients, particularly following musculoskeletal trauma. This article reviews the aetiology and pathophysiology of neurovascular impairment in the critical care context and provides guidance for nurses undertaking this important element of nursing assessment with non‐verbal, critically unwell patients. Informed practice in neurovascular assessment has the potential to enable early detection and timely management for these patients, which is crucial to optimise patient outcomes.