bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASDIN Original Investigations: Inflow Reduction by Distalization of Anastomosis Treats Efficiently High‐Inflow High‐Cardiac Output Vascular Access for Hemodialysis
Authors: Chemla Eric S. , Morsy Mohamed , Anderson Liz , Whitemore Andrea 
Published: January 2007

AbstractThe arteriovenous fistula used for vascular access for hemodialysis may contribute to development of congestive heart failure. Theses patients can present with frequent episodes of congestive hear failure. Traditional management of high‐inflow, a high‐cardiac‐output fistula generally involves either closure or banding. Although high‐output state can be controlled, the lifeline of the patient is lost. We describe a series of 17 hemodialysis patients (10 men and 7 women) in whom a novel inflow reduction method was employed. All patients had symptoms of heart failure (15 brachiocephalic fistulas and two brachioaxillary bypass grafts) and a fistula inflow rate above 1600 ml/min. The inflow reduction procedure included ligation of the brachial anastomosis and reconstruction of the fistula by using an expanded polytetrafluoroethylene (Gore‐Tex Intering) vascular graft in a bypass from the radial artery. The mean (± SD) time between fistula creation and the inflow reduction procedure was 30 ± 17 months. The mean access inflow rate decreased significantly after the inflow reduction procedure, from 3135 ± 692 to 1025 ± 551 ml/min (p =0.0001). The mean cardiac output rate decreased from 8 ± 3.1 to 5.6 ± 1.7 l/min (p = 0.001) with resolution of symptoms. During the follow‐up period thrombosis or stenosis developed in seven patients, three of whom underwent surgical revision. Thirteen of the seventeen accesses (77%) subjected to the inflow reduction procedure remained patent. Access loss was due to failed fistuloplasty or thrombosis. To our knowledge, this is the first report demonstrating that inflow reduction obtained by distalization of the anastomosis of the access fistula is feasible and safe for managing high‐inflow, high‐cardiac‐output fistulas. Longer and larger studies of the inflow reduction procedure and its benefits are needed.
Treatment of Refractory Central Vein Stenosis in Hemodialysis Patients with Stents
Authors: Maya Ivan D. , Saddekni Souheil , Allon Michael 
Published: January 2007

AbstractCentral venous stenosis is a frequent complication in hemodialysis patients, which can manifest clinically with ipsilateral upper extremity edema. When symptomatic, it is usually treated by percutaneous transluminal angioplasty. When angioplasty is unsuccessful, stent deployment is a therapeutic option. The goal of the present study was to evaluate the primary and secondary patency of refractory central vein stenosis after treatment with a stent. Using a prospective vascular access database we retrospectively identified 23 patients presenting with unilateral upper extremity edema and a significant (> 50%) central vein stenosis, who underwent stent placement due to refractory stenosis following angioplasty. The primary (unassisted) central vein patency was determined from the initial intervention to the next angioplasty for recurrent central vein stenosis, and the secondary (assisted) patency from the initial intervention to permanent central vein occlusion. An immediate technical success was achieved in all patients after the stent deployment. However, the median primary central vein patency was only 138 days, with a 19% patency at 1 year. Recurrence of ipsilateral edema was always due to in‐stent restenosis. The median secondary central vein patency was 1036 days, with a 64% patency at 1 year. In patients with symptomatic central vein stenosis that is refractory to percutaneous transluminal angioplasty, stent deployment provides short‐term relief of the stenosis and ipsilateral upper extremity edema. However, long‐term symptomatic relief can be achieved with multiple subsequent interventions in many patients.
Dialysis Rounds: Cinacalcet‐Induced Hungry Bone Syndrome
Authors: Lazar Eric S. , Stankus Nicole 
Published: January 2007

AbstractCinacalcet is a type II calcimimetic approved for treatment of secondary hyperparathyroidism in patients with end‐stage renal disease. It is generally well tolerated with the most common side effects being nausea and vomiting. Symptomatic hypocalcemia is rare, and persistent hypocalcemia has not been reported to date. We present a case of a 66‐year‐old woman on chronic outpatient hemodialysis who was initiated on cinacalcet when her intact parathyroid hormone was 1091 pg/mL (normal 15–75 pg/dL). Two weeks later she developed diffuse muscle twitching. The patient required a 72‐hour hospitalization and treatment with a continuous intravenous calcium infusion for symptomatic hypocalcemia. The intact parathyroid hormone level at this time was 176 pg/mL. This case is the first report of cinacalcet‐induced prolonged and symptomatic hypocalcemia, closely resembling the hungry bone syndrome described in some patients with secondary hyperparathyroidism following surgical parathyroidectomy.
Fellows' Forum: Withdrawal from Dialysis in End‐Stage Renal Disease: Medical, Social, and Psychological Issues
Authors: Hackett Amy S. , Watnick Suzanne G. 
Published: January 2007

AbstractDialysis withdrawal is common, accounting for over 20% of patient deaths. It is the third leading cause of death among patients receiving dialysis, after cardiovascular disease and infectious complications. Here we present a case of a patient with significant comorbid disease who ultimately elected to withdraw from dialysis. The medical, social and psychological issues encountered by caregivers are reviewed. Additionally we discuss the available data on factors affecting the decision to withdraw, current practice guidelines, and efforts to educate nephrology fellows on end‐of‐life issues.
Cortical Activation Mapping of Epileptiform Activity Derived from Interictal ECoG Spikes
Authors: Lai Yuan , Van Drongelen Wim , Hecox Kurt , Frim David , Kohrman Michael , He Bin 
Published: January 2007

Summary:  Purpose: To develop and evaluate a new cortical activation mapping (CAM) method to obtain the neuronal activation sequences from the cortical potential distributions. Methods: Interictal electrocorticogram (ECoG) recordings were analyzed for eight pediatric epilepsy patients to find the cortical activation maps, which were compared with the patients' seizure‐onset zones identified from ictal ECoG recordings. Various relations between the local activation time and cortical potential were assumed. The most effective relation was determined by accessing their capability to predict the seizure‐onset zone. Computer simulations using a moving dipole source model were also conducted to test the present approach in imaging the propagated cortical activity. Results: In both clinical data analysis and computer simulations, the maximal amplitude proved to be the most effective criterion with which to determine the local cortical activation time. The present method successfully predicted the seizure‐onset zone in seven of eight patients by the CAM analysis of ECoG‐recorded interictal spikes (IISs). For patients with multiple seizure foci, each focus can be revealed by analyzing IISs with different spatial patterns. Conclusions: The time difference between spike peaks of the interictal events in the leading channel and other channels can be effectively defined as the local cortical activation time. The cortical activation mapping method based on this time latency can be used to predict the seizure‐onset zones, suggesting that the present CAM method is useful to assist the presurgical evaluation for the epilepsy patients.
Upregulation of Brain Expression of P‐Glycoprotein in MRP2‐deficient TR‐ Rats Resembles Seizure‐induced Up‐regulation of This Drug Efflux Transporter in Normal Rats
Authors: Hoffmann Katrin , Löscher Wolfgang 
Published: January 2007

Summary:  Purpose: The multidrug resistance protein 2 (MRP2) is a drug efflux transporter that is expressed predominantly at the apical domain of hepatocytes but seems also to be expressed at the apical membrane of brain capillary endothelial cells that form the blood–brain barrier (BBB). MRP2 is absent in the transport‐deficient (TR−) Wistar rat mutant, so that this rat strain was very helpful in defining substrates of MRP2 by comparing tissue concentrations or functional activities of compounds in MRP2‐deficient rats with those in transport‐competent Wistar rats. By using this strategy to study the involvement of MRP2 in brain access of antiepileptic drugs (AEDs), we recently reported that phenytoin is a substrate for MRP2 in the BBB. However, one drawback of such studies in genetically deficient rats is the fact that compensatory changes with upregulation of other transporters can occur. This prompted us to study the brain expression of P‐glycoprotein (Pgp), a major drug efflux transporter in many tissues, including the BBB, in TR− rats compared with nonmutant (wild‐type) Wistar rats. Methods: The expression of MRP2 and Pgp in brain and liver sections of TR− rats and normal Wistar rats was determined with immunohistochemistry, by using a novel, highly selective monoclonal MRP2 antibody and the monoclonal Pgp antibody C219, respectively. Results: Immunofluorescence staining with the MRP2 antibody was found to label a high number of microvessels throughout the brain in normal Wistar rats, whereas such labeling was absent in TR− rats. TR− rats exhibited a significant up‐regulation of Pgp in brain capillary endothelial cells compared with wild‐type controls. No such obvious upregulation of Pgp was observed in liver sections. A comparable overexpression of Pgp in the BBB was obtained after pilocarpine‐induced seizures in wild‐type Wistar rats. Experiments with systemic administration of the Pgp substrate phenobarbital and the selective Pgp inhibitor tariquidar in TR− rats substantiated that Pgp is functional and compensates for the lack of MRP2 in the BBB. Conclusions: The data on TR− rats indicate that Pgp plays an important role in the compensation of MRP2 deficiency in the BBB. Because such a compensatory mechanism most likely occurs to reduce injury to the brain from cytotoxic compounds, the present data substantiate the concept that MRP2 performs a protective role in the BBB. Furthermore, our data suggest that TR− rats are an interesting tool to study consequences of overexpression of Pgp in the BBB on access of drugs in the brain, without the need of inducing seizures or other Pgp‐enhancing events for this purpose.
Postictal Single‐cell Firing Patterns in the Hippocampus
Authors: Zhou Jun‐Li , Lenck‐Santini Pierre‐Pascal , Holmes Gregory L. 
Published: January 2007

Summary: Purpose:Patients with epilepsy have varying degrees of postictal impairment including confusion and amnesia. This impairment adds substantially to the disease burden of epilepsy. However, the mechanism responsible for postictal cognitive impairment is unclear. The purpose of this study was to study single‐cell firing patterns in hippocampal cells after spontaneous seizures in rats previously subjected to status epilepticus.Methods:In this study, we monitored place cells and interneurons in the CA1 region of the hippocampus before and after spontaneous seizures in six epileptic rats with a history of status epilepticus. Place cells fire action potentials when the animal is in a specific location in space, the so‐called place field. Place cell function correlates well with performance in tasks of visual–spatial memory and appears to be an excellent surrogate measure of spatial memory.Results:Twelve spontaneous seizures were recorded. After the seizures, a marked decrease in firing rate of action potentials from place cells was noted, whereas interneuron firing was unchanged. In addition, when place cell firing fields persisted or returned, they had aberrant firing fields with reduced coherence and information content. In addition to postictal suppression of firing patterns, seizures led to the emergence of firing fields in previously silent cells, demonstrating a postictal remapping of the hippocampus.Conclusions:These findings demonstrate that postictal alterations in behavior are not due solely to reduced neuronal firing. Rather, the postictal period is characterized by robust and dynamic changes in cell‐firing patterns resulting in remapping of the hippocampal map.
Clinical Seizure Lateralization in Frontal Lobe Epilepsy
Authors: Bonelli Silvia Beatrice , Lurger Stefanie , Zimprich Fritz , Stogmann Elisabeth , Assem‐Hilger Eva , Baumgartner Christoph 
Published: January 2007

Summary: Purpose:We systematically analyzed the lateralizing value of clinical seizure semiology in patients with frontal lobe epilepsy (FLE).Methods:We studied the incidence, positive predictive value (PPV), and the lateralizing significance of various clinical symptoms in 228 seizures (s) of 31 patients (p) with medically refractory FLE (17 with left‐sided and 14 with right‐sided seizure onset). Seizures recorded during prolonged video‐EEG monitoring were assessed by two independent reviewers blinded for the patient's clinical data. Analysis was performed both for patients and seizures.Results:Version [16 p (52%); PPV, 94%; p = 0.001; 47 s (21%); PPV, 75%; p = 0.001], unilateral clonic movements [16 p (52%); PPV, 81%; p = 0.021; 32 s (14%); PPV, 81%; p = 0.001], unilateral dystonic posturing [eight p (26%); PPV, 75%; p = 0.289; 46 s (20%); PPV, 80%; p = 0.001], unilateral tonic posturing [10 p (32%); PPV, 80%; p = 0.109; 19 s (7.4%); PPV, 79%; p = 0.019], and unilateral grimacing [10 p (32%); PPV, 100%; p = 0.002; 19 s (8%); PPV, 100%; p = 0.001] were of lateralizing significance, indicating a contralateral seizure onset. Asymmetric ending [five p (16%); PPV, 80%; p = 0.375; nine s (4%); PPV, 89%; p = 0.039] after secondarily generalized tonic–clonic seizures was significantly associated with an ipsilateral seizure onset. Pure ictal vocalizations occurred significantly more frequently in seizures of right hemispheric onset [13 p (42%); PPV, 62%; p = 0.581; 63 s (28%); PPV, 73%; p = 0. 001], whereas in individual patients, this symptom showed no lateralizing significance. The remaining clinical symptoms (figure 4 sign, unilateral hand automatisms, early head turning, postictal nose wiping, and unilateral eye blinking) were not of lateralizing significance in our patients. The results of clinical seizure lateralization corresponded with the final lateralization of the seizure‐onset zone in 81% of our patients.Conclusions:Clinical seizure semiology can provide correct information on the lateralization of the seizure‐onset zone in >80% of patients with medically refractory frontal lobe epilepsy.
Depressive disorders and anti‐parkinson drug treatment: a case register study
Authors: Brandt‐Christensen M. , Lopez A. G. , Nilsson F. M. , Andersen P. K. , Kessing L. V. 
Published: January 2007

Objective:  To estimate the rate of treatment with anti‐parkinson drugs (APD) among patients with depression.Method:  In a nationwide case register linkage study, all persons with a main diagnosis of depression during 5 years were identified. A control group of persons with diagnoses of osteoarthritis was included. The subsequent risk of getting treatment with APD was estimated for the two groups. Statistical analyses involved Poisson's regression and competing risk models.Results:  A total of 14 991 persons were included. The rate of getting APD was 2.57 (95% CI: 1.46–4.52) times higher for persons with depression than for persons with osteoarthritis. Overall, the rate was highest for men. However, women with depression had a 3.89 (95% CI: 1.98–7.62) times higher rate of APD treatment as women with osteoarthritis while no significant difference was found among men.Conclusion:  Provided that prescription of APD reflects the presence of Parkinson's disease, results support a positive statistical association between depressive disorders and Parkinson's disease.
Outcome of systemic and analytic group psychotherapy for adult women with history of intrafamilial childhood sexual abuse: a randomized controlled study
Authors: Lau M. , Kristensen E. 
Published: January 2007

Objective:  Research suggests that group psychotherapy for adults with a history of child sexual abuse (CSA) is generally beneficial. Only few studies have included random assignment. This study compared the effects of analytic (A) and systemic group psychotherapy (S) on CSA.Method:  One hundred and fifty‐one women with intrafamilial CSA were randomly allocated to A or S. Quality of life, psychosocial function, psychological distress, and flashbacks were assessed before and after treatment. Both completer analyses and intent‐to‐treat analyses were carried out.Results:  Eighty‐two patients completed group therapy. Both therapies led to the improved quality of life, fewer psychopathological symptoms, and better overall functioning, but overall the outcome of S was significantly better than the outcome of A.Conclusion:  Women with CSA sequelae benefit from both A and S. In the short‐term, S is both statistically and clinically superior to A. Longer‐term follow‐up data are required for conclusions on maintenance of therapeutic gains.
A relative color approach to color discrimination for malignant melanoma detection in dermoscopy images
Authors: Stanley R. Joe , Stoecker William V. , Moss Randy H. 
Published: January 2007

Background: Skin lesion color is an important feature for diagnosing malignant melanoma. In previous research, skin lesion color was investigated for discriminating malignant melanoma lesions from benign lesions in clinical images. Colors characteristics of melanoma were determined using color histogram analysis over a training set of images. Percent melanoma color and color clustering ratio features were used to quantify the presence of melanoma‐colored pixels within skin lesions for skin lesion discrimination.Methods: In this research, the relative color histogram analysis technique is used to evaluate skin lesion discrimination based on color feature calculations in different regions of the skin lesion in dermoscopy images. The histogram analysis technique is examined for varying training set sizes from the set of 113 malignant melanomas and 113 benign dysplastic nevi images.Results: Experimental results show improved discrimination capability for feature calculations focused in the interior lesion region. Recognition rates for malignant melanoma and dysplastic nevi as high as 87.7% and 74.9%, respectively, are observed for the color clustering ratio computed using the outer 75% uniformly distributed area with a 10% offset within the boundary.Conclusions: Experimental results appear to indicate that the melanoma color feature information is located in the interior of the lesion, excluding the 10% central‐most region. The techniques presented here including the use of relative color and the determination of benign and malignant regions of the relative color histogram may be applicable to any set of images of benign and malignant lesions.
A simple and non‐invasive visualization for assessment of carbonylated protein in the stratum corneum
Authors: Fujita Hiroshi , Hirao Tetsuji , Takahashi Motoji 
Published: January 2007

Background/purpose: Stratum corneum (SC) is the interface of body and environment and is continuously exposed to oxidative stress, resulting in oxidative modification of proteins. Consequent carbonylated proteins (CPs) have so far been labeled with 2,4‐dinitrophenyl (DNP) hydrazine and subsequently detected with anti‐DNP antibody. We developed a simpler, non‐invasive method to assess CP level in the SC and applied it to following research.Methods: SC was collected by adhesive tape stripping and its carbonyl groups were labeled with fluorescein‐5‐thiosemicarbazide (FTZ). The staining image was observed by fluorescence microscopy and the average fluorescence intensity of the SC extracted from the image was calculated as stratum corneum carbonylated protein (SCCP) level.Results: By reaction with FTZ, carbonyl groups in the SC could be detected easily. Relatively strong fluorescence was observed in exfoliating scales. Lipid removal from the SC in vitro or in vivo did not show any change in fluorescence intensity, suggesting that carbonyl groups were mainly derived from proteins, not from lipids. SCCP level was higher in the upper layer than the lower layer, and higher in the cheek (sun‐exposed) than the inside of upper arm (unexposed), positively correlated with age especially in male cheek, positively correlated with transepidermal water loss, negatively correlated with water content, and showed a subtle correlation with sebum level. On the other hand, SC collected by cyanoacrylate resin and labeled with FTZ revealed strong fluorescence around the pores in the cheek and on the grooves in the upper arm, suggesting the role of sebum in the generation of SCCP.Conclusion: SCCP was assessed in a simple and non‐invasive method, and suggested to be a novel indicator that reflects some aspect of skin condition.
In vivo study of skin mechanical properties in Raynaud's phenomenon
Authors: Dobrev Hristo 
Published: January 2007

Background/aim: Raynaud's phenomenon (RP) is usually the first symptom in patients with systemic sclerosis (SS) and may precede skin changes by several months or years. Non‐invasive measurements of skin elasticity are very sensitive and appropriate for objective and quantitative evaluation of sclerodermatous skin. The aim of this study was to investigate and compare the mechanical properties of the skin in patients with primary, secondary, and suspected secondary RP.Materials/methods: A total of 63 patients were studied. They were classified as having scleroderma‐type nailfold capillary abnormalities – 17 with indurative phase of scleroderma (group 1), nine with edematous phase of scleroderma (group 2), 18 with suspected secondary RP (group 3) and as having RP‐type nailfold capillary abnormalities, 19 with primary RP (group 4). Thirty‐nine sex‐ and age‐matched healthy individuals with normal nailfold capillaroscopy pattern were also studied as controls. Mechanical properties of the skin were evaluated using a non‐invasive suction device (Cutometer) equipped with a 2 mm probe. Measurements were performed over five anatomic regions: cheeks, volar forearms, wrists, hands, and proximal phalanx of the fingers. The skin mechanical parameters analyzed were distensibility (Uf), elasticity (Ua/Uf) and viscoelasticity (Uv/Ue).Results: Most demonstrative changes were observed over volar forearms. Patients included in groups 1–3 were characterized by significantly lower Uf and higher Uv/Ue compared with patient group 4 and controls. Patient groups 1 and 2 showed significantly lower Ua/Uf, as well. There were no significant differences in skin mechanical parameters between patient group 4 and control group.Conclusion: Mechanical properties of the skin in patients with suspected secondary RP significantly differ from these in patients with primary RP and resemble those in patients with edematous phase of scleroderma. Our findings suggest that the non‐invasive measurements of skin elasticity could be helpful in identifying patients with RP at risk of developing SS.