bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction*
Authors: Smith M. N. A. , Best D. , Sheppard S. V. , Smith D. C. 
Published: June 2008

SummaryThe usefulness of mannitol in the priming fluid for cardiopulmonary bypass is uncertain in patients with normal renal function, and has not been studied in patients with established renal dysfunction. We studied 50 patients with serum creatinine between 130 and 250 μmol.l−1 having cardiac surgery. Patients were randomised to receive mannitol 0.5 g.kg−1, or an equivalent volume of Hartmann’s solution, in the bypass prime. There were no differences between the groups in plasma creatinine or change in creatinine from baseline, urine output, or fluid balance over the first three postoperative days. We conclude that mannitol has no effect on routine measures of renal function during cardiac surgery in patients with established renal dysfunction.
Predicting adverse outcomes of cardiac surgery with the application of artificial neural networks
Authors: Peng S‐Y , Peng S‐K 
Published: June 2008

SummaryRisk‐stratification models based on pre‐operative patient and disease characteristics are useful for providing individual patients with an insight into the potential risk of complications and mortality, for aiding the clinical decision for surgery vs non‐surgical therapy, and for comparing the quality of care between different surgeons or hospitals. Our study aimed to apply artificial neural networks (ANN) models to predict mortality and morbidity after cardiac surgery, and also to compare the efficacy of this model to that of the logistic regression model and Parsonnet score. The accuracy of the ANN, logistic regression and Parsonnet score in predicting mortality was 83.8%, 87.9% and 78.4%. The accuracy of the ANN, logistic regression and Parsonnet score in predicting major morbidity was 79.0%, 74.3% and 68.6%. The area under the receiver operating characteristic curves (AUC) of the ANN, logistic regression and Parsonnet score in predicting in‐hospital mortality were 0.873, 0.852 and 0.829. The AUCs of the ANN, logistic regression and Parsonnet score in predicting major morbidity were 0.852, 0.789 and 0.727. The results showed the ANN models have the best discriminating power in predicting in‐hospital mortality and morbidity among these models.
Medication‐related patient safety incidents in critical care: a review of reports to the UK National Patient Safety Agency*
Authors: Thomas A. N. , Panchagnula U. 
Published: June 2008

SummaryWe reviewed all patient safety incidents reported to the UK National Patient Safety Agency between 1st August 2006 and 28th February 2007 from intensive care or high dependency units. Incidents involving medications were then categorised. 12 084 incidents were submitted from 151 organisations (median 40, range 1–634/organisation). 2428 incidents were associated with medication use involving 355 different drugs, most commonly morphine (207 incidents), gentamicin (190 incidents) and noradrenaline (133 incidents). Noradrenaline (55 incidents of harm) and insulin (48 incidents of harm) were most commonly associated with patient harm. Sixty‐one percent of medication incidents were associated with drug administration and 26% with prescription. Two hundred and eighty‐seven medication incidents caused temporary harm and 43 more than temporary harm. Five per cent of medication incidents were associated with staff communication during transfer from theatre or recovery. Categorisation of medication‐associated incidents has allowed us to suggest changes to improve the reporting of incidents and to improve medication safety.
Laryngeal mask airway and tracheal tube cuff pressures in children: are clinical endpoints valuable for guiding inflation?
Authors: Ong M. , Chambers N. A. , Hullet B. , Erb T. O. , Von Ungern‐Sternberg B. S. 
Published: June 2008

SummaryWe prospectively assessed common clinical endpoints for their usefulness in avoiding hyperinflation of the cuffs of laryngeal mask airways (slight outward movement) and tracheal tubes (disappearance of an audible leak around the cuff during manual ventilation < 20 cmH2O) in 640 children. Cuff pressures were measured at induction and immediately before emergence from anaesthesia. With the laryngeal mask airway (sizes 1–4), the median cuff pressures ranged from 90 to > 120 cmH2O at induction and 105 to > 120 cmH2O before emergence. With tracheal tubes (sizes 3–7 mm), median cuff pressures were 40–60 cmH2O at induction and 45–70 cmH2O at emergence. With the use of nitrous oxide a consistent rise in cuff pressure was observed between the first and second readings whereas cuff pressures remained constant when nitrous oxide was not used. The use of clinical endpoints alone was associated with significant hyperinflation of cuffs with both devices in almost all patients, with an exacerbation when nitrous oxide was used. In order to avoid unnecessary cuff hyperinflation in laryngeal mask airways and tracheal tubes, the routine use of cuff manometers is mandatory in children.
The anaesthetic management of children with anterior mediastinal masses
Authors: Hack H. A. , Wright N. B. , Wynn R. F. 
Published: June 2008

SummaryChildren with anterior mediastinal masses may experience serious complications during general anaesthesia. We retrospectively surveyed the records of children with an anterior mediastinal mass who had been admitted to our hospital over a 7 year period. The presence of pre‐operative symptoms or signs, findings of any special investigations performed and the anaesthetic outcome were noted. All radiological investigations were studied and tracheal compression measured. The majority of patients presented with severe clinical signs. There was a poor relationship between clinical signs and size of tumour or tracheal compression on CT scan. Corticosteroids were used prior to diagnosis in 33% of patients, all of whom were considered high risk. A clear diagnosis was made in 95% of these patients. The overall complication rate was 20% and 5% of patients had a serious complication related to anaesthesia. Stridor was the only sign that predicted an anaesthetic complication. Peri‐operative respiratory complications were confined to patients with an isolated tracheal cross‐sectional area less than 30% normal or less than 70% and associated with bronchial compression.
Morphology and distribution of Oligocene and Miocene pockmarks in the Danish North Sea – implications for bottom current activity and fluid migration
Authors: Andresen K. J. , Huuse M. , Clausen O. R. 
Published: June 2008

ABSTRACTThis study gives the first description of 33 mid‐Oligocene and 646 late Miocene pockmarks mapped in the Danish part of the central North Sea. The pockmarks are all highly elongated, with average long‐ and short axes of 2.5 km and 700 m, and average internal depth of 30 m. The Miocene pockmarks strike 140–160° while the Oligocene pockmarks strike 100–105°; paralleling the strike of the major Miocene and Oligocene clinoforms on which they occur. In cross‐sections, the pockmarks appear as U‐, V‐ and W‐shaped or tabular depressions. Based on their geometry and degree of symmetry, three distinct pockmark groups have been distinguished: (A) 58% of the pockmarks are symmetrical, ellipsoidal depressions; (B) 40% are asymmetrical, lunate depressions; and (C) 2% comprise asymmetrical ring‐shaped depressions. Group A pockmarks are interpreted as representative for the first stage in the pockmark development, only influenced by fluid expulsion and subsequent erosion by bottom currents. Group B pockmarks are influenced by bottom current erosion, current and gas winnowing and possibly authigenic carbonate precipitation. Group C pockmarks represent a further development from Group B pockmarks with further winnowing, carbonate precipitation and removal of seafloor sediment to form the ring‐shape. Current erosion has exerted the major influence on the final geometry of 83% of the pockmarks. The pockmarks occur above gas‐mature Jurassic source rocks, modelled to be in the generative window during the late Miocene, and thermogenic gas is suggested as the main fluid involved in the pockmark formation. The timing of gas expulsion from the Jurassic source rocks in combination with loading imposed to the basin by the progradational Miocene clinoforms are interpreted as the main factors controlling the timing and location of the pockmarks. The pockmarks thus tell a story of thermogenic gas venting to the surface and paleo‐current scour of the seabed in the eastern part of the central North Sea during the mid Oligocene and late Miocene.
Pharmacokinetics and clinical efficacy of midazolam in children with severe malaria and convulsions
Authors: Muchohi Simon N. , Kokwaro Gilbert O. , Ogutu Bernhards R. , Edwards Geoffrey , Ward Steve A. , Newton Charles R. J. C. 
Published: June 2008

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Midazolam (MDZ), a water‐soluble benzodiazepine, can be administered via several routes, including intravenously (IV), intramuscularly (IM) and buccal routes to terminate convulsions. It may be a suitable alternative to diazepam to stop convulsions in children with severe malaria, especially at peripheral healthcare facilities. The pharmacokinetics of MDZ have not been described in African children, in whom factors such as the aetiology and nutritional status may influence the pharmacokinetics. WHAT THIS STUDY ADDS • Administration of MDZ (IV, IM, or buccal) at the currently recommended dose (0.3 mg kg−1) resulted in rapid achievement of median maximum plasma concentrations of MDZ within the range 64–616 ng ml−1, with few clinically significant cardio‐respiratory effects. A single dose of MDZ rapidly terminated (within 10 min) seizures in all (100%), 9/12 (75%) and 5/8 (63%) children following IV, IM and buccal administration, respectively. Although IM and buccal MDZ may be the preferred treatment for children in the pre‐hospital settings the efficacy appears to be poorer.AIMTo investigate the pharmacokinetics and clinical efficacy of intravenous (IV), intramuscular (IM) and buccal midazolam (MDZ) in children with severe falciparum malaria and convulsions.METHODSThirty‐three children with severe malaria and convulsions lasting ≥5 min were given a single dose of MDZ (0.3 mg kg−1) IV (n = 13), IM (n = 12) or via the buccal route (n = 8). Blood samples were collected over 6 h post‐dose for determination of plasma MDZ and 1′‐hydroxymidazolam concentrations. Plasma concentration–time data were fitted using pharmacokinetic models.RESULTSMedian (range) MDZ Cmax of 481 (258–616), 253 (96–696) and 186 (64–394) ng ml−1 were attained within a median (range) tmax of 10 (5–15), 15 (5–60) and 10 (5–40) min, following IV, IM and buccal administration, respectively. Mean (95% confidence interval) of the pharmacokinetic parameters were: AUC(0,∞) 596 (327, 865), 608 (353, 864) and 518 (294, 741) ng ml−1 h; Vd 0.85 l kg−1; clearance 14.4 ml min−1 kg−1, elimination half‐life 1.22 (0.65, 1.8) h, respectively. A single dose of MDZ terminated convulsions in all (100%), 9/12 (75%) and 5/8 (63%) children following IV, IM and buccal administration. Four children (one in the IV, one in the IM and two in the buccal groups) had respiratory depression.CONCLUSIONSAdministration of MDZ at the currently recommended dose resulted in rapid achievement of therapeutic MDZ concentrations. Although IM and buccal administration of MDZ may be more practical in peripheral healthcare facilities, the efficacy appears to be poorer at the dose used, and a different dosage regimen might improve the efficacy.
Bone mineral density and bone turnover in relation to serum leptin, α‐ketoglutarate and sex steroids in overweight and obese postmenopausal women
Authors: Filip Rafal , Raszewski Grzegorz 
Published: June 2008

SummaryObjective  Recent studies have shown that parallel changes in body weight and bone mass can be partially mediated via circulating leptin. Therefore, among the hormones involved in bone and mineral metabolism, such as oestrogens, testosterone and parathormone, leptin has recently become a subject of considerable interest. The aim of this study was to assess associations between leptin, E2, testosterone, dehydroepiandrosterone sulphate (DHEA‐S), SHBG, α‐ketoglutaric acid (AKG) and bone mineral density (BMD) and bone turnover markers in overweight and obese postmenopausal women.Design  Eighty healthy, postmenopausal Caucasian women were studied. BMD of the lumbar spine (L2–L4) and femoral neck regions were examined using the dual X‐ray absorptiometry (DXA) method. Associations were evaluated in stepwise multiple regression analysis, including information on the possible confounders and effect modifiers, for example, age, years since menopause, height and weight.Results  Femoral neck BMD was positively correlated with weight (r = 0·52, P < 0·000001), body mass index (BMI) (r = 0·48, P < 0·000006), hipline (r = 0·48, P < 0·00006), waistline (r = 0·45, P < 0·00002) and DHEA‐S (r = 0·36, P < 0·0008). Correlations of E2, SHBG, testosterone and leptin, as well as biochemical markers of bone turnover with L2–L4 and femoral neck BMD were not found. In the whole study group, significant predictors of L2–L4 BMD were BMI (β = 0·35, P < 0·01) testosterone (β = 0·27, P < 0·05) and osteocalcin (OC) (β = 0·22, P < 0·05) (R2 = 0·23), while predictors of femoral neck BMD were BMI (β = 0·42, P < 0·001), testosterone (β = 0·24, P < 0·05), E2 (β = 0·19, P < 0·05), as well as osteocalcin (β = 0·20, P < 0·05) (R2 = 0·41). In the subgroup with BMI 30–39·9, the significant predictors of both L2–L4 and femoral neck BMD were testosterone (β = 0·32, P < 0·05, R2 = 0·19; β = 0·33, P < 0·05, R2 = 0·29) and osteocalcin (β = 0·34, P < 0·05, R2 = 0·19; β = 0·45, P < 0·01, R2 = 0·29). In the subgroup with waist : hip ratio (WHR ≥ 0·85, the predictor of L2–L4 BMD was E2 (β = 0·38, P < 0·05) (R2 = 0·21), whereas the predictors of femoral neck BMD were BMI (β = 0·29, P < 0·05) and testosterone (β = 0·35, P < 0·01) (R2 = 0·36).Conclusion  The main endocrine variable predicting lumbar spine BMD in overweight and obese postmenopausal females was testosterone, while the main determinants of femoral neck BMD were both testosterone and E2. No effect was found of serum leptin on examined indicators of bone status.
Revealing a subclinical salt‐losing phenotype in heterozygous carriers of the novel S562P mutation in the α subunit of the epithelial sodium channel
Authors: Riepe Felix G. , Van Bemmelen Miguel X. P. , Cachat Francois , Plendl Hansjörg , Gautschi Ivan , Krone Nils , Holterhus Paul‐Martin , Theintz Gerald , Schild Laurent 
Published: June 2008

SummaryObjective  Pseudohypoaldosteronism type I (PHA1) is a rare inborn disease causing severe salt loss. Mutations in the three coding genes of the epithelial sodium channel (ENaC) are responsible for the systemic autosomal recessive form. So far, no phenotype has been reported in heterozygous carriers.Patients  A consanguineous family from Somalia giving birth to a neonate suffering from PHA1 was studied including clinical and hormonal characteristics of the family, mutational analysis of the SCNN1A, SCNN1B, SCNN1G and CFTR genes and in vitro analysis of the functional consequences of a mutant ENaC channel.Results  CFTR mutations have been excluded. SCNN1A gene analysis revealed a novel homozygous c.1684T > C mutation resulting in a S562P substitution in the αENaC protein of the patient. Functional analysis showed a significantly reduced S562P channel function compared to ENaC wild type. Protein synthesis and channel subunit assembly were not altered by the S562P mutation. Co‐expression of mutant and wild‐type channels revealed a dominant negative effect. In heterozygote carriers, sweat sodium and chloride concentrations were increased without additional hormonal or clinical phenotypes.Conclusion  Hence, the novel mutation S562P is causing systemic PHA1 in the homozygous state. A thorough clinical investigation of the heterozygote SCNN1A mutation carriers revealed increased sweat sodium and chloride levels consistent with a dominant effect of the mutant S562P allele. Whether this subclinical phenotype is of any consequence for the otherwise asymptomatic heterozygous carriers has to be elucidated.
Interferon‐λ1 (interleukin‐29) preferentially down‐regulates interleukin‐13 over other T helper type 2 cytokine responses in vitro
Authors: Srinivas Shekar , Dai Jihong , Eskdale Joyce , Gallagher Grant E. , Megjugorac Nicholas J. , Gallagher Grant 
Published: June 2008

SummaryInterferon (IFN)‐λ1 [interleukin (IL)‐29] is a member of the interferon lambda family (also known as type III interferons), whose members are distantly related to both the type I interferons and members of the IL‐10 family. While IFN‐λ1 has significant antiviral activity, it is also becoming apparent that it has important immunoregulatory properties, especially with regard to the T helper type 2 (Th2) response. Previously, we have shown that IFN‐λ1 is capable of down‐regulating IL‐13 production in an IFN‐γ‐independent manner and that this is mediated in part via monocyte‐derived dendritic cells. Here, we have extended our knowledge of IFN‐λ1 regulation of the human in vitro Th2 response by examining the regulation of three major Th2 cytokines, IL‐4, IL‐5 and IL‐13, by IFN‐λ1. Our results reveal that IFN‐λ1 preferentially inhibits IL‐13 production, compared with IL‐4 or IL‐5. Levels of IL‐13 mRNA, the amount of secreted IL‐13 protein and numbers of IL‐13‐positive CD3+ CD4+ cells were all significantly diminished by IFN‐λ1. IFN‐λ1 significantly decreased some aspects of IL‐4 and IL‐5 production, but its effects were not as consistent as those seen on IL‐13. IFN‐λ1 was also effective at decreasing IL‐13 secretion under conditions designed to support the generation of Th2 cells. Irrespective of whether Concanavalin‐A or T‐cell‐stimulatory microbeads were used, IFN‐λ1 markedly diminished IL‐13 secretion in cultures where IL‐4 had been added. Thus, IFN‐λ1 appears to be an inhibitor of human Th2 responses whose action is primarily directed towards IL‐13 but which may also affect Th2 responses generally and does not invoke a complementary elevation of IFN‐γ secretion.
Protective role of membrane tumour necrosis factor in the host’s resistance to mycobacterial infection
Authors: Allie Nasiema , Alexopoulou Lena , Quesniaux Valerie J. F. , Fick Lizette , Kranidioti Ksanthi , Kollias George , Ryffel Bernhard , Jacobs Muazzam 
Published: June 2008

SummaryTumour necrosis factor‐α (TNF‐α) plays a critical role in the recruitment and activation of mononuclear cells in mycobacterial infection. The role of membrane TNF, in host resistance against Mycobacterium bovis bacille Calmette–Guérin (BCG), was tested in knock‐in mice in which the endogenous TNF was replaced by a non‐cleavable and regulated allele (Δ1–12, TNFtm/tm). While 100% of mice with complete TNF deficiency (TNF−/−) succumbed to infection, 50% of TNFtm/tm mice were able to control M. bovis BCG infection and survived the experimental period. Membrane expressed TNF allowed a substantial recruitment of activated T cells and macrophages with granuloma formation and expression of bactericidal inducible nitric oxide synthase (iNOS). Using virulent Mycobacterium tuberculosis infection we confirm that membrane TNF conferred partial protection. Infection in TNFtm/tm double transgenic mice with TNF‐R1 or TNF‐R2 suggest protection is mediated through TNF‐R2 signalling. Therefore, the data suggest that membrane‐expressed TNF plays a critical role in host defence to mycobacterial infection and may partially substitute for soluble TNF.
Autonomy through identification: a qualitative study of the process of identification used by people with type 2 diabetes
Authors: Moser Albine , Van Der Bruggen Harry , Spreeuwenberg Cor , Widdershoven Guy 
Published: June 2008

Aims and objectives.  The aim of this study is to clarify the process of identification with diabetes as a dimension of autonomy as described by people with type 2 diabetes.Background.  People with type 2 diabetes view autonomy as competency in shaping one's life. This concept of autonomy has seven dimensions, which emerged as categories in prior research. Dynamic processes shape these dimensions of autonomy. One of the dimensions of autonomy is identification.Method.  This study has a qualitative descriptive and exploratory design and an inductive approach as described in grounded theory. Data were collected by means of in‐depth interviews. The sample consisted of 15 people with type 2 diabetes mellitus in a nurse‐led, shared‐care setting in the Netherlands.Results.  The phases of identification are comprehending, struggling, evaluating and mastering. Each phase has its own characteristics. Identifying with the diabetes is a non‐linear, cyclical and continuous process because people with diabetes have to deal with changing conditions.Conclusion.  The dynamics of identification is directed to a process of identifying with diabetes and its care requirement. Recognizing identification as an element of autonomy enables nurses to adopt a more patient‐oriented view of autonomy.Relevance to clinical practice.  Nursing that fosters the process of identification promotes autonomy. This implies that a person with diabetes should be able to identify with the nurse's interventions. Hence it is vital that nurses build supportive partnerships when providing care for such a patient.
Heart transplantation experiences: a phenomenological approach
Authors: Sadala Maria Lúcia Araújo , Stolf Noedir Antônio Groppo 
Published: June 2008

Aim.  The aim of this study was to understand the heart transplantation experience based on patients’ descriptions.Background.  To patients with heart failure, heart transplantation represents a possibility to survive and improve their quality of life. Studies have shown that more quality of life is related to patients’ increasing awareness and participation in the work of the healthcare team in the post‐transplantation period. Deficient relationships between patients and healthcare providers result in lower compliance with the postoperative regimen.Method.  A phenomenological approach was used to interview 26 patients who were heart transplant recipients. Patients were interviewed individually and asked this single question: What does the experience of being heart transplanted mean? Participants’ descriptions were analysed using phenomenological reduction, analysis and interpretation.Results.  Three categories emerged from data analysis: (i) the time lived by the heart recipient; (ii) donors, family and caregivers and (iii) reflections on the experience lived. Living after heart transplant means living in a complex situation: recipients are confronted with lifelong immunosuppressive therapy associated with many side‐effects. Some felt healthy whereas others reported persistence of complications as well as the onset of other pathologies. However, all participants celebrated an improvement in quality of life. Health caregivers, their social and family support had been essential for their struggle. Participants realised that life after heart transplantation was a continuing process demanding support and structured follow‐up for the rest of their lives.Conclusion.  The findings suggest that each individual has unique experiences of the heart transplantation process. To go on living participants had to accept changes and adapt: to the organ change, to complications resulting from rejection of the organ, to lots of pills and food restrictions.Relevance to clinical practice.  Stimulating a heart transplant patients spontaneous expression about what they are experiencing and granting them the actual status of the main character in their own story is important to their care.