bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unexplained seizures, confusion or hallucinations: think Hashimoto encephalopathy
Authors: Alink Jorien , De Vries Tjalling W. 
Published: February 2008

AbstractAim: Hashimoto encephalopathy (HE) is a serious but treatable condition that is probably underdiagnosed. We summarize and review all published cases to delineate the disease and to alert paediatricians so that they recognize the disease in children.Methods: We searched three data sources, PubMed, Cochrane and Embase, to find the articles on the subject.Results: Twenty‐five children (85.8% girls) were reported being diagnosed with HE. The median age was 14 years (range 9–18 years). The most frequent clinical symptoms were seizures (80%), confusion (52%), headache (40%), hallucinations (32%) and ataxia (36%). Antimicrosomal antibodies were demonstrated in all patients, other diagnostic methods were not specific. Treatment with steroids was effective with 55% of patients showing complete recovery.Conclusion: We recommend measuring antimicrosomal antibodies in all children with unexplained seizures, hallucinations or confusion and, if positive, initiating treatment with prednisolone.
Digital phonocardiography as a screening tool for heart disease in childhood
Authors: Germanakis Ioannis , Dittrich Sven , Perakaki Rousa , Kalmanti Maria 
Published: February 2008

AbstractAim: To evaluate the performance of experienced cardiologists by use of digital phonocardiography for the correct identification of heart disease and innocent murmurs in children.Methods: Two independent paediatric cardiologists blindly evaluated 83 digital phonocardiograms obtained from consecutive paediatric cardiology outpatients. Each observer had to document the presence and characteristics of murmurs (intensity, quality, location), the presence of additional abnormal auscultatory findings (systolic click, second heart tone abnormalities) and whether he would recommend echocardiography (ECHO). The accuracy of their diagnoses was tested against the ECG diagnosis within two severity levels of heart disease.Results: Twenty‐three out of 24 cases (95.8%) with moderate‐to‐severe heart defects and 12 to 13 out of 19 cases (63.2%–68.4%) with trivial‐to‐mild heart defects were correctly identified by phonocardiography. Additionally, 37 to 38 out of 40 cases (92.5%–95.0%) without ECHO evidence of heart disease were correctly interpreted as having innocent murmurs. The level of agreement between the two observers was substantial regarding their recommendations for ECHO (kappa, κ= 0.83) and in identifying abnormal murmurs (κ= 0.78).Conclusion: Evaluation of digital phonocardiography by experienced cardiologists could allow for correct identification of moderate‐to‐severe forms of heart disease while preventing the majority of children with innocent murmurs from unnecessary referral.
Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint
Authors: Honda Kosuke , Natsumi Yoshiko , Urade Masahiro 
Published: February 2008

Objectives:  The relationship of bony changes in the condylar surfaces in articular disc displacement without reduction in temporomandibular joint (TMJ) was investigated using diagnostic imaging. The study also evaluated whether the bony changes in the condylar surfaces limit disc and condyle motion, and produce pathological joint sounds.Materials and methods:  Thirty‐seven joints in 28 patients diagnosed with degenerative bony changes in the condylar surfaces radiographically and anterior disc displacement without reduction using magnetic resonance imaging (MRI) were studied. The bony changes were assessed by radiographic examination and classified into two types: pathological bone changes (PBCs) including erosion, osteophyte formation and deformity, and adaptive bone changes (ABCs) including flattening and concavity. MRI was performed on the TMJ to examine the configuration and position of the discs. Joint sounds in the TMJ were determined using electrovibratograghy with a joint vibration analysis.Results:  The articular disc motion to the condyle in the PBC group was smaller than in the ABC group irrespective of the configuration of the disc, even though there were no significant differences between the two types of bony changes in the disc position during jaw closing. The joint vibration analysis of the TMJ showed that joint sounds with a higher frequency were observed in the PBC group than in the ABC group. High energy levels needed to produce the higher frequencies (over 300 Hz) were observed only in the PBC group.
Changes of Leaf Morphological, Anatomical Structure and Carbon Isotope Ratio with the Height of the Wangtian Tree (Parashorea chinensis) in Xishuangbanna, China
Authors: He Chun‐Xia , Li Ji‐Yue , Zhou Ping , Guo Ming , Zheng Quan‐Shui 
Published: February 2008

Abstract Leaf morphological and anatomical structure and carbon isotope ratio (δ13C) change with increasing tree height. To determine how tree height affects leaf characteristics, we measured the leaf area, specific leaf mass (ratio of leaf mass to leaf area [LMA]), thickness of the total leaf, cuticle, epidermis, palisade and sponge mesophyll, stomata traits and δ13C at different heights of Parashorea chinensis with methods of light and scanning electron microscopy (SEM) and isotope‐ratio mass spectrometry. The correlation and stepwise regression between tree height and leaf structure traits were carried out with SPSS software. The results showed that leaf structures and δ13C differed significantly along the tree height gradient. The leaf area, thickness of sponge mesophyll and size of stomata decreased with increasing height, whereas the thickness of lamina, palisade mesophyll, epidermis, and cuticle, ratios of palisade to spongy thickness, density of stomata and vascular bundles, LMA and δ13C increased with tree height. Tree height showed a significant relationship with all leaf indices and the most significant relationship was with epidermis thickness, leaf area, cuticle thickness, δ13C. The δ13C value showed a significantly positive relationship with LMA (R = 0.934). Our results supported the hypothesis that the leaf structures exhibited more xeromorphic characteristics with the increasing gradient of tree height.
RAPID DETECTION OF FRANCISELLA TULARENSIS BY THE IMMUNOAFFINITY ASSAY ABICAP IN ENVIRONMENTAL AND HUMAN SAMPLES
Authors: GRUNOW ROLAND , MIETHE PETER , CONLAN WAYNE , FINKE ERNST‐JÜRGEN , FRIEDEWALD STEFFEN , PORSCH‐ÖZCÜRÜMEZ MUSTAFA 
Published: February 2008

ABSTRACTFrancisella tularensis is the causative agent of tularemia, a severe zoonotic infectious disease. The natural reservoir of the bacteria is not yet known precisely, but it may persist for over a year in water or mud. It is naturally maintained and spread by various terrestrial and aquatic mammals, and outbreaks in humans are often paralleled by enzootics or epizootics. The reasons for this seem to be multifactorial, though not well understood. Therefore, for epidemiological and outbreak investigations, a rapid hand‐held assay would be helpful. Here we described a column‐based immunofiltration assay called ABICAP, which has several characteristics that permit its application under field conditions. The assay can be performed within 25 min, with a detection limit of 103 bacteria. Further validation of the assay included the analytical range, precision, detection limit and performance for different human, animal and environmental sample matrices, accuracy, recovery, reproducibility and stability. PRACTICAL APPLICATIONSThe assay is an interesting tool applicable for the rapid detection of F. tularensis in various specimens under laboratory and field conditions. It can be used for the identification of reservoirs of F. tularensis in epidemiological studies, for the detection of sources of infection in outbreak situations of tularemia and in laboratory investigation of animal and human specimens. The methodological platform can be adapted to the detection of other microbiological agents and antigens.
Benefits of Red Blood Cell Transfusion: Where is the Evidence ?
Authors: Spahn Donat R. 
Published: February 2008

SUMMARYThe aim of the present article is to summarize existing evidence of benefits of red blood cell transfusion and to dicuss studies that failed to document such effects. In specific situations with organ dysfunction caused by extreme acute anemia, transfusion of red blood cells has been shown to be an efficacious treatment. In most of these studies, this was achieved by transfusion of fresh, mostly autologous, red blood cells. Large studies have failed to demonstrate an outcome benefit in liberally transfused patients; in contrast, there is strong evidence that liberal transfusion of red blood cells adversely affects morbidity and mortality in surgical and critically ill patients. Judicious and restrictive use of red blood cell transfusion is thus indicated.
Utilization of Autologous Transfusion Technologies for Allogeneic‐blood‐free Cardiac Transplantation in Pediatric Patients
Authors: Potter Paul S. 
Published: February 2008

SUMMARYThe use of blood products has diminished over the last several years. The avoidance of allogeneic blood not only has the benefit of reduced disease transmission but also reduces other complications such as immunosuppression. While this is a goal for all patients, in the pediatric population this is not a simple matter. In cardiac surgery, red cell volume must be maintained, but platelet function and clotting factors are also of concern. In the pediatric Jehovah's Witness patient for cardiac transplant all concerns take on increased importance. The maximization of perioperative blood management will allow the preservation of all blood components and can be done in such a way as to honor the beliefs and requirements of this religious group. This article will discuss the methodology for the accomplishment of major cardiac surgery in the pediatric patient using no blood products.
Erythropoietin and Iron in the Anemia of Prematurity
Authors: Messer Jean , Escande Benoît , Matis Jacqueline 
Published: February 2008

SUMMARYPremature infants are frequently anemic during the first weeks of life, especially if they are born before 30 weeks of gestational age. This so‐called “anemia of prematurity” has several causes; one is a transitory inadequate production of erythropoietin relative to the degree of anemia. Since 1990, several trials of erythropoietin therapy in the anemia of prematurity have been conducted. They showed a reduction of transfusion requirements in treated infants. The enhancement of erythropoiesis requires the administration of substantial quantities of iron; oral administration is sometimes difficult due to poor gastrointestinal tolerance. It is probable that in the future, the use of intravenous iron may be the solution.
Volume Therapy in Patients with Acute Stroke
Authors: MT Grauer , Woessner R , Haass A , Treib J 
Published: February 2008

SUMMARYIn acute ischemic stroke, because of impaired autoregulation, the perfusion of the ischemic brain region and its neighboring region, the penumbra, depends on blood pressure, cardiac output and rheological characteristics.Improvement of rheological parameters and hemodynamics is therefore a promising therapeutic strategy for ischemic stroke. Volume therapy in acute ischemic stroke attempts to increase cardiac output and blood pressure by increasing cardiac preload through the infusion of colloid and crystalloid solutions. Another important therapeutic avenue is the improvement of rheology through a decrease in hematocrit, plasma viscosity and erythrocyte aggregation. The adequate choice of plasma substitutes allows for a more differentiated volume therapy in acute stroke. With newer, medium‐ or low‐molecular weight hydroxyethyl starches, it is possible to safely use a high‐dose, hemodynamic volume therapy in acute ischemic stroke and improve hemodynamic and rheological parameters without increased risk of hemorrhages.
Alternative Strategies in Platelet Therapy
Authors: Goodnough Lawrence Tim 
Published: February 2008

SUMMARYRecent developments in transfusion practices are prompting re‐evaluation of platelet therapy. For example, the use of single‐donor apheresis products has increased substantially, from 365,000 units in 1989 to 607,000 in 1992 and to 714,000 in 1994, as shown in Table 11; in some regions, apheresis platelets account for 70% of transfusions 2.The use of these components has been driven in part by the need for adequate platelet inventory in order to support cardiac surgery and hematopoietic stem cell transplantation programs, but also in part by commercial interests, in which promotion of the use of leucodepleted platelet products targets surgeons directly3.However, emerging issues related to the handling of the apheresis donor4, 5, the higher costs of apheresis platelets compared to pooled platelet concentrates6 8, and the results of the TRAP (Transfusion‐Related Alloimmunization to Platelets9,10) study have caused renewed debate regarding the role of apheresis platelets compared to platelet concentrates.Furthermore, recent studies have suggested alternative strategies in platelet therapy. These strategies include the platelet threshold for prophylactic platelet transfusion, platelet transfusion dose, and the emerging role of thrombopoietin therapy; these developments will be reviewed in this article.
Erythropoietin in Cancer Surgery
Authors: Gentilini Oreste D. , Gianotti Luca , Vignali Andrea , Braga Marco 
Published: February 2008

SUMMARYPatients with gastrointestinal cancer usually have a sideropenic anemia unresponsive to iron supplementation which is characterized by low levels of endogenous erythropoietin. Anemic patients are not suitable for preoperative autologous blood donation programs and are at high risk for perioperative homologous blood transfusions. Preoperative treatment with recombinant human erythropoietin (r‐HuEPO) has allowed anemic patients to donate autologous blood and reduced homologous blood transfusion after surgery. A dose‐response study showed that 400 U/kg of r‐HuEPO, divided in four doses administered every four days, is the minimum effective dose which increases hemoglobin levels about 10 g/L/week. The red blood cell (RBC) gain was 268 ± 79 mL, which is grossly equivalent to the RBC content of two units of predonated autologous blood. The total charge for this treatment ($280) was substantially lower than in other experiences in which higher doses of r‐HuEPO were given. To maximize erythropoietic response, it is necessary to provide supplementary IV iron (125 mg daily). This results in a normalization of circulating and stored iron, suggesting that the amount was adequate both to sustain the production of new RBCs and to replace tissue stores during r‐HuEPO treatment.
Colloids/Crystalloids J Does Albumin Influence the Mortality Risk?
Authors: Bold Joachim 
Published: February 2008

SUMMARYEffective fluid therapy is a main stay in the ma nagement of the critically ill patient. The ideal kind of volume replacement in this situation still remains achallenge. To treat hypovolemia, colloids are widely used, and the natural colloid h u man albumin is still preferred for volume therapy in several centers. H oweve r, most studies do not show any bene fits of using albumin with regard to hemodyna mics, organ function or side effects (e. g. hemostasis, renalfunction). Alternative plasma substitutes such as synthetic colloids are associated with some beneficial effects compared to albumin administration (e. g. improved splanchnic perfusion). Given albumin's costs, its use does not appear to be justified, and other solutions (e. g. synthetic colloids) are attractive alternatives. Inspite of some theoretical adva n tages based on our current knowledge, use of albumin cannot be recommended and should be completely avoided.
Efficacy and Safety of Crystalloids and Colloids
Authors: Spahn Donat 
Published: February 2008

SUMMARYCrystalloids and colloids may be used to maintain normovolemia. Crystalloids are generally well tolerated. To increase blood volume by 0.5 L, 2‐2.5 L of crystalloidshave to be administered. In addition, the duration of intravascular persistence is short and thus significant quantities have to be re‐administered following the initial infusion. The administration of large quantities of cry stalloids results in tissue edema. In contrast, 0.5 L of isotonic colloids such as hydroxyethyl starch (HES) and gelatin increase blood volume by approximately 0.5 L and their intravascular persistence is longer than that of crystalloids. However, colloids are associated with some side effects such as anaphylactoid reactions (gelatin > H E S), compromised blood coagulation (HES > gelatin), tissue storage and pruritus (HES > gelatin) and impairment of renal function in kidne y transplantation (HES > gelatin). In clinical ane sthesia, both cry s talloids and colloids need to be combine d. During rapid blood loss, colloids are particularly effective in main taining normovolemia. Using cry s talloids during periods of less severe blood loss may help to avoid side effects.
Hemorrhagic Shock and Early Resuscitation: the Pros
Authors: Carli P. , Incagnoli P. 
Published: February 2008

SUMMARYManagement of trauma patients with hemorrhagic shock in the prehospital setting remains a particularly controversial issue, with opposing approaches used in North America and Europe. The United States, served by emergency medical technicians and paramedics, is based on the “scoop and run‘ approach. The opposite is the case in European countries, where the prehospital teams usually include qualified physicians who can provide sophisticated prehospital care adapted to each patient (the “stay and play” approach). Even if there is controversy about prehospital volume loading in patients with penetrating injuries to the torso, in most cases of trauma patients with hemorrhagic shock, efficient airway control, early mechanical ventilation, prehospital chest tube thoracostomy (in the case of tension pneumothorax) and prehospital volume loading performed by a specialized team with prehospital and in‐hospital experience have been clearly demonstrated to improve patient prognosis. Moreover, physicians on the scene provide not only advanced life support but also analgesia, anesthesia, first diagnosis of injuries and orders for appropriate hospital admissions.
Transfusion Mortality and Morbidity in Orthopedic Surgery
Authors: Carson Jeffrey L. , Reynolds Richard C 
Published: February 2008

SUMMARYRed blood cell transfusions are commonly used in orthopedic surgery and cost billions of dollars annually. The goals of transfusion are to reduce mortality, morbidity and functional impairment that result from anemia and inadequate oxygen delivery. Risks of infections from transfusion are low and continue to decline, but evidence is growing that red cell transfusions are immunosuppressive and predispose patients to postoperative infections. However, there actually are very little data on when transfusion is indicated. Observational data suggest that transfusion does not reduce mortality in patients with pre‐ or postoperative hemoglobin levels >8 g/dL, although no conclusions could be drawn about the effect of transfusion in patients with hemoglobin >8 g/dL. Large well‐performed randomized clinical trials are needed to establish the efficacy of transfusion. Until better data are available, orthopedic surgeons will have to rely on clinical judgement in transfusion decisions. The author recommends using a higher transfusion threshold in patients with cardiovascular disease.
Hyperchloremic Metabolic Acidosis: Is It Clinically Relevant?
Authors: Mythen Michael G. , Hamilton Mark A. 
Published: February 2008

SUMMARY“First, do no harm. ‘These words have been the doctrine of medicine since its inception. The era of evidence‐based medicine now compels us to provide scientific evidence that we indeed do no harm and that the treatments we prescribe have a beneficial effect. The colloid/crystalloid debate continues to evolve and is as hotly contested now as it was a decade ago. There may be some international differences in the use of colloids or crystalloids, but most of us continue to use both. Whatever our preferred choice of intravenous fluid for the treatment of hypovolemia, clinical outcome studies suggest that “when?” and “how much?” are probably more important questions than “what?”. There are now a wide variety of fluids available to the clinician and most differ markedly in their composition. Aside from the gross classification of IV fluids into colloids and crystalloids, they may be subclassified into balanced or unbalanced categories, i.e., those that contain concentrations of electrolytes similar to those in the plasma and those that do not (see Table 1).The very fact that “normal” saline is unphysiological was recognized many years ago. This fact led Alexis Hartmann to develop Hartmann's solution in an attempt to produce an isotonic alkalizing solution. He recognized the need for proportionately more sodium than chloride1, which led to a solution very similar to Ringer's original2. The existence of hyperchloremic acidosis has been recognized in many areas for some time, e.g., diabetic ketoacidosis and ammonium chloride poisoning, and is generally termed a low‐anion gap acidosis. There is now mounting evidence that the administration of intravenous saline and saline‐based fluids is the commonest avoidable cause of clinically relevant hyperchloremic acidosis.
HES: Is There a Maximal Dose?
Authors: Boldt Joachim 
Published: February 2008

SUMMARYThe pharmacokinetics and pharmacodynamics of the various solutions available for volume replacement therapy differ widely. The natural colloid albumin and the synthetic colloid gelatin can be used in an unlimited manner according to manufacturer instructions. By contrast, dextran and the various hydroxyethyl starch (HES) preparations have manufacturer‐recommended dose limitations. The physical and chemical characteristics of HES are defined by concentration, degree of substitution (DS), mean molecular weight (Mw), and the C2/C6 ratio of substitution. Currently specified dose limitations to minimize unwanted side effects on hemostasis, accumulation and storage are 20 mL/kg for 10% HES 200/0.5 and 33 mL/kg for 6% HES 200/0.5. Other possible HES‐associated side effects are not dose‐dependent (e.g., anaphylaxis) or are similar to those produced by other substances used for volume replacement (e.g., dilution of clotting factors). A new HES, 6% HES 130/0.4, with a lower Mw and a lower DS is a promising substance endowed with improved pharmaco‐chemical properties. It shows significantly less accumulation even after repeated dosing over several days. Thus, there may be no dose limitations at the current level with this new HES preparation.
Capillary Leak and Starches
Authors: Gosling Peter 
Published: February 2008

SUMMARYOne of the earliest features of an acute inflammatory response is an increase in vascular permeability, which allows plasma proteins, including albumin, to move into the interstitial space and cause edema. Systemic capillary permeability is amplified by the kidney and can be monitored by measurement of low‐level urine albumin excretion in the 20 to 200 mg/L range (microalbuminuria). Microalbuminuria reflects rapid changes in systemic capillary permeability, which increases dramatically within a few minutes of injury and usually returns to normal within 6 to 12 hours. Failure of capillary permeability to return to normal is an early predictor of later pulmonary dysfunction and organ failure. Recent studies suggest that, following trauma or surgery, medium‐molecular weight hydroxyethyl starches as opposed to human albumin or gelatine solutions markedly reduce capillary leak, improve pulmonary gas exchange and organ function, and downregulate the acute inflammatory response. It is not clear which mechanisms underlie this microvascular protective effect although blocking of endothelial cell activation may be involved.