bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addition of sildenafil to bosentan monotherapy in pulmonary arterial hypertension
Authors: Mathai S. C. , Girgis R. E. , Fisher M. R. , Champion H. C. , Housten-Harris T. , Zaiman A. , Hassoun P. M. 
Published: November 2006

Combination therapy has been recommended for the treatment of pulmonary arterial hypertension (PAH). However, there is scant information on combination therapy after failure of monotherapy, particularly in patients with scleroderma-associated PAH (PAH-SSD).From a group of 82 consecutive patients with PAH who received initial bosentan monotherapy, a total of 13 idiopathic PAH (IPAH) and 12 PAH-SSD patients requiring additional therapy with sildenafil were studied. Sildenafil was added for clinical deterioration based upon symptoms, New York Heart Association (NYHA) classification or 6-min walk distance (6MWD). Clinical data and haemodynamics were collected at baseline. Assessments were made at 1–3-month intervals.At baseline, there were no differences in demographics, NYHA classification, haemodynamics or 6MWD between the two groups. After initiation of bosentan, both groups experienced clinical improvement but ultimately deteriorated (median time to monotherapy failure 792versus458 days for IPAH and PAH-SSD patients, respectively). After addition of sildenafil, more IPAH patients tended to improve in NYHA class (five out of 13versustwo out of 12) and walked further (mean difference in 6MWD 47±77 mversus-7±40 m) compared with PAH-SSD patients.In conclusion, addition of sildenafil after bosentan monotherapy failure improved New York Heart Association class and 6-min walk distance in idiopathic pulmonary arterial hypertension patients but failed to improve either parameter in scleroderma-associated pulmonary arterial hypertension patients. Additional studies are needed to assess the tolerability and efficacy of this combination in patients with scleroderma-associated pulmonary arterial hypertension.
Lung and blood mononuclear cell responses of tuberculosis patients to mycobacterial proteins
Authors: Sable S. B. , Goyal D. , Verma I. , Behera D. , Khuller G. K. 
Published: November 2006

The differences in specificity of human lung and peripheral lymphocytes for mycobacterial antigens (Ag) need to be evaluated in order to identify vaccine candidates against pulmonary tuberculosis (TB).Therefore, the present study examined the response to low molecular weight secretory proteins ofMycobacterium tuberculosisin bronchoalveolar lavage (BAL) and peripheral blood mononuclear cells (PBMCs) from minimal pulmonary TB and non-TB patients.Ag85A, Ag85B, culture filtrate protein (CFP)-31, CFP-22.5, CFP-21,M. tuberculosisprotein-64 and an as yet uncharacterised 19 kDa protein were found to be predominantly recognised by BAL cells of TB patients on the basis of lymphocyte proliferation and significant interferon-γ release. However, recognition of CFP-8, 6-kDa early secreted antigenic target, CFP-10, CFP-14.5,M. tuberculosissecretory protein-17 and five other as yet uncharacterised low molecular weight polypeptides was found to be high on the basis of lymphocyte proliferation at the level of PBMCs. Furthermore, BAL macrophages, and not blood monocytes, were found to produce nitric oxide (NO) in response to mycobacterial Ags. Among polypeptides predominantly recognised by BAL lymphocytes, only Ag85A and Ag85B were found to induce both NO and interleukin-12 (p40) by alveolar macrophages.In conclusion, the present results indicate heterogeneity in antigen recognition by bronchoalveolar lavage cells and peripheral mononuclear blood cells of minimal tuberculosis patients, and also suggest the utility of antigen 85 complex polypeptides for the development of a future mucosal antituberculous vaccine.
Predictors of outcome in idiopathic rapidly progressive glomerulonephritis (IRPGN)
Authors: Alexopoulos Efstathios , Gionanlis Lazaros , Papayianni Ekaterini , Kokolina Elizabeth , Leontsini Maria , Memmos Dimitrios 
Published: November 2006

Abstract

Background
Small vessel vasculitides are known to follow a devastating course towards end-stage renal disease, unless treated with immunosuppressive regiments. We investigated the value of clinical, histological and immunohistochemical parameters as predictors of outcome at diagnosis in patients with pauci immune necrotizing glomerulonephritis.

Methods
In 34 patients the percentage and evolution stage of crescents, the presence of glomerular necrosis, the degree or severity of arteriosclerosis, as well as the extent of tubulointerstitial infiltration, interstial fibrosis and tubular atrophy were assessed. Monoclonal antibodies were used to identify infiltrating macrophages, α-SMA(+) and PCNA(+) cells, the expression of integrins α3β1 and LFA-1β, the adhesion molecule ICAM-1, the growth factor TGF-β1 and the terminal complement component C5b-9.

Results
24 pts (70.6%) showed a complete or partial response to the treatment. The follow-up period was 20 ± 22 months. At multivariate analysis, serum CRP (p = 0.024), the intensity of tubular expression of C5b-9 (p < 0.0001) as well as the extent of glomerular and tubular expression of α3β1 integrin (p = 0.001 and 0.008 respectively) independently predicted the response to treatment. The response rate was better in ANCA(+) pts (p = 0.008). The extent of interstitial infiltrate (p < 0.0001), the severity of tubulointerstitial fibrosis (p < 0.0001) and the severity of tubular TGF-β1 expression (p < 0.0001) were independent predictors of long term outcome of renal function.

Conclusion
Patients with ANCA-associated renal vasculitis seem to respond better to the treatment. Acute phase reactants, such as CRP, implying a more intense parenchymal inflammatory reaction, as well as the intensity of the de novo expression of C5b-9 and the glomerular and tubular expression of α3β1 integrin predict the response to therapy. The severity of TIN lesions and of the tubulo-interstitial TGF-β1 and C5b-9 expression predict an unfavourable outcome.
Do carotenoid-based sexual traits signal the availability of non-pigmentary antioxidants?
Authors: Bertrand Sophie , Faivre Bruno , Sorci Gabriele 
Published: November 2006

SUMMARY
Carotenoid-based signals are thought to be indicators of male quality because they must be obtained from the diet and might thus indicate the ability of individuals to gather high-quality food. However, carotenoids are also known to have important physiological functions as immunoenhancers and antioxidants, and, as such, carotenoid-based sexual traits have also been suggested to reflect the health and antioxidant status of their bearers. This last idea is based on the hypothesis that carotenoids that are allocated to sexual signals are no longer available for the detoxification system. Recently, this hypothesis has been challenged on the grounds that the antioxidant activity is not the main biological role of carotenoids. Instead,carotenoid-based sexual traits might signal the availability of other non-pigmentary antioxidant molecules that might protect carotenoids from free radical attacks and make them available for sexual advertisements. We tested this hypothesis in the zebra finch, a passerine species with a carotenoid-based signal: the colour of the bill. We simultaneously manipulated the availability of carotenoids and of a non-pigmentary antioxidant(melatonin) in the drinking water. If the antioxidant properties of melatonin protect carotenoids from oxidation, we predict that birds supplemented with melatonin should have redder bills than birds not supplemented with melatonin,and that birds supplemented with carotenoids and melatonin should have redder bills than birds supplemented with carotenoids alone. Our findings are in agreement with these predictions since carotenoid and melatonin supplementation had an additive effect on bill colour. To our knowledge this is the first experimental evidence that a non-pigmentary antioxidant enhances the expression of a carotenoid-based sexual trait.
Active ammonia transport and excretory nitrogen metabolism in the climbing perch,Anabas testudineus, during 4 days of emersion or 10 minutes of forced exercise on land
Authors: Tay Yi L. , Loong Ai M. , Hiong Kum C. , Lee Shi J. , Tng Yvonne Y. M. , Wee Nicklaus L. J. , Lee Serene M. L. , Wong Wai P. , Chew Shit F. , Wilson Jonathan M. , Ip Yuen K. 
Published: November 2006

SUMMARYThe climbing perch, Anabas testudineus, inhabits large rivers,canals, stagnant water bodies, swamps and estuaries, where it can be confronted with aerial exposure during the dry season. This study aimed to examine nitrogen excretion and metabolism in this fish during 4 days of emersion. Contrary to previous reports, A. testudineus does not possess a functional hepatic ornithineurea cycle because no carbamoyl phosphate synthetase I or III activity was detected in its liver. It was ammonotelic in water, and did not detoxify ammonia through increased urea synthesis during the 4 days of emersion. Unlike many air-breathing fishes reported elsewhere, A. testudineus could uniquely excrete ammonia during emersion at a rate similar to or higher than that of the immersed control. In spite of the fact that emersion had no significant effect on the daily ammonia excretion rate, tissue ammonia content increased significantly in the experimental fish. Thus, it can be concluded that 4 days of emersion caused an increase in ammonia production in A. testudineus, and probably because of this, a transient increase in the glutamine content in the brain occurred. Because there was a significant increase in the total essential free amino acid in the experimental fish after 2 days of emersion,it can be deduced that increased ammonia production during emersion was a result of increased amino acid catabolism and protein degradation. Our results provide evidence for the first time that A. testudineus was able to continually excrete ammonia in water containing 12 mmol l-1NH4Cl. During emersion, active ammonia excretion apparently occurred across the branchial and cutaneous surfaces, and ammonia concentrations in water samples collected from these surfaces increased to 20 mmol l-1. It is probable that the capacities of airbreathing and active ammonia excretion facilitated the utilization of amino acids by A. testudineus as an energy source to support locomotor activity during emersion. As a result, it is capable of wandering long distance on land from one water body to another as reported in the literature.
Surgical and nonsurgical treatment of penetrating injuries to the cervical esophagus
Authors: Mandal Ashis K. , Bui Hum D. , Oparah Sonny S. 
Published: November 2006

AbstractWe presented two patients with gunshot wounds and one patient with a stab wound of the cervical esophagus, managed conservatively, which resulted in no deaths. Results of eight studies of cervical esophageal injuries are reviewed and presented in Table I. One must consider both the surgical and conservative methods of management in planning treatment for the given patient.
Nasal turbinate resection for relief of nasal obstruction.
Authors: Martinez Serge A. , Nissen Alan J. , Stock Curt R. , Tesmer Tim 
Published: November 2006

AbstractSurgical correction of mechanical nasal airway obstruction is commonly attempted by means of septoplasty or submucous resection. In spite of these procedures, patients continue to present postoperatively with inadequate nasal airflow due to hypertrophied turbinates. Partial resection of turbinate mucosa, submucous turbinate resection, electrocautery and outfracture of turbinates provide additional improvement but are incomplete procedures.Total inferior turbinectomies have been performed on 40 patients over the past 5 years; 29 of these patients have been followed from 2 to 60 months postoperatively by clinical examination and by formal questionnaire. Twenty‐five patients described a marked improvement of their nasal breathing, 3 had mild improvement, and 1 had no improvement at all. Only 1 patient, 1 year postoperatively, described excessive dryness, 2 described mild dryness, 3 described excessive secretions and none complained of foul smell or pain postoperatively. All patients had patent airways by clinical examination by at least 2 otolaryngologists.The inferior turbinates play a role in humidification and temperature regulation of inspired air. The removal of them, however, does not seem to be fraught with the morbidity which has heretofore been attributed to this procedure.
Benign lipoblastoma in the neck causing respiratory insufficiency
Authors: Gammelgaard Niels , Jørgensen Karsten , Lund Claus 
Published: November 2006

AbstractA benign lipoblnstoma in the neck, causing respiratory insufficiency and ipsilateral ptosis and miosis, in a 9‐month‐old girl is reported, followed by a short discussion about the nomenclature, genesis, differential diagnosis and behavior of this rare condition.
Congenital rubella syndrome: Function of equilibrium of 80 cases with deafness
Authors: Nishida Yukiaki , Ueda Kohji , Fung Kin‐Ching 
Published: November 2006

AbstractThe equilibrium function of 80 deaf children with congenital rubella syndrome, aged 12, was examined by the caloric and righting reflex tests. Of these 80 children, 24 (30%) had vestibular hypofunction, 6 (7.6%) were suspect, and the remaining 50 (62.5%) were normal. Of all 160 ears tested, vestibular hypofunction was proven in 21.3%, suspect in 5.6%, and normal in the rest. There was no correlation between the incidence of vestibular hypofunction and the degree of hearing loss. Of the 30 children with vestibular hypofunction, 14 (47%) showed a normal righting reflex, suggesting the working of a compensatory mechanism. Of the 50 children with normal caloric responses, 26% revealed an abnormal righting reflex. This discrepancy might be accounted for by an otolith organ injury or minimal brain dysfunction.
Safety and tolerability of the implantable recurrent laryngeal nerve stimulator
Authors: Wernicke J. F. , Friedman Michael , Caldarelli David D. 
Published: November 2006

AbstractThe recurrent laryngeal nerve (RLN) stimulator has been implanted on a limited basis since 1988 for control of spasmodic dysphonia. A similar vagus nerve stimulator has been implanted in a larger series of patients to control epilepsy. The safety and tolerability of these two stimulators were evaluated. In 113 patients implanted with the vagus nerve stimulator, the complication rate was 0.9%. All patients were monitored for vital signs, electrocardiographic changes, and adverse effects. The absence of changes in vital signs and electrocardiograms during vagal stimulation establishes the safety of this treatment. Since placement of the electrode around the vagus nerve is an easier surgical technique than placement deep to the RLN, it seems reasonable to change the technique to implant the stimulator on the vagus in patients with spasmodic dysphonia.
Neurosecretory endings and target cells in the synaptic cleft of the human vocal cord: An electron microscopic study
Authors: Basterra J. , Duly P. N. , Martorell M. 
Published: November 2006

AbstractThe action of neurotransmitters is of interest in the normal function of the vocal cord since they regulate mucous secretion and vessel caliber. The intersynaptic space between glandular and myoepithelial cells and the corresponding neuroendocrine endings is the area in which these substances are delivered. This area has not been previously studied in the human vocal cord.Specimens from vocal cords have been studied by electron microscopy. In our study, it seems to be clear that there exists a very close contact between myoepithelial cells and secretory nerve endings. This close relationship is likewise observed between these cells and glandular cells.
Breastfeeding, Sensitivity, and Attachment
Authors: Britton John R. , Britton Helen L. , Gronwaldt Virginia 
Published: November 2006

OBJECTIVE. Our goal was to test the hypothesis that breastfeeding is associated with enhanced infant-mother attachment and its antecedent maternal sensitivity.METHODS. Breastfeeding intent and practice were assessed by questionnaires administered to 152 mothers between 32 weeks of gestation and 12 months postpartum. Early maternal sensitivity was measured by the Sensitivity to Cues subscale of the Nursing Child Assessment Satellite Training Feeding Scale at 3 months, and quality of the mother-infant interaction was measured by the Nursing Child Assessment Satellite Training Feeding Scale at 6 months. Security of attachment was evaluated by the Ainsworth Strange Situation at 12 months.RESULTS. A direct relationship between attachment security and breastfeeding practice was not identified. The quality of the mother-infant interaction at 6 months, rather than the type of feeding, predicted security of attachment. However, mothers who chose to breastfeed displayed greater sensitivity in dyadic interactions with their infants 3 months postnatally than those who chose to bottle feed, and intended breastfeeding duration prenatally correlated with sensitivity 3 months postpartum. Although a path analysis failed to demonstrate contributions of early breastfeeding duration to either sensitivity or security, it did substantiate a significant path between prenatal breastfeeding intent and attachment security mediated by sensitivity. In addition, multivariate analyses revealed that early sensitivity among breastfeeding mothers was an independent predictor of the duration of any and exclusive breastfeeding during the first year.CONCLUSIONS. Although the quality of the dyadic interaction in infancy, rather than feeding type, is predictive of attachment security, mothers who choose to breastfeed display enhanced sensitivity during early infancy that, in turn, may foster secure attachment. Among breastfeeding mothers, higher sensitivity is associated with longer duration of breastfeeding during the first postpartum year. These findings suggest a link between attachment security and breastfeeding.
Implementation and Case-Study Results of Potentially Better Practices to Improve the Discharge Process in the Neonatal Intensive Care Unit
Authors: Mills Marla M. , Sims Debra C. , Jacob Jack 
Published: November 2006

Objective. The objective of this study was to implement potentially better practices for discharge planning in the NICU.Methods. Each participating hospital completed a self-assessment tool on discharge planning and a staff satisfaction survey. Parent satisfaction data were obtained from an Internet-based survey. Many projects regarding discharge planning were completed at each participating center. A major emphasis was the development of transition points to span discharge planning over the entire hospitalization. Results of compliance with tasks or processes that were identified by the transition points and results of staff and parent satisfaction surveys were monitored over time.Results. The implementation of the transition points at each center demonstrated an improvement in the completion of discharge tasks within the recommended time frame. Combined results of all centers demonstrated a moderate improvement in compliance with transition points from baseline to final measurement in the following areas: unit orientation (56%–81%), identification of a parent feeding plan (74%–92%), completion of cardiopulmonary resuscitation training (55%–72%), and car seat education (42%–63%). Staff survey results showed improvement from baseline to final measurement in the following areas: staff satisfaction with the discharge process (32%–50%), clear documentation of the discharge plan (26%–40%), and clarity of team members' roles in the discharge process (24%–44%). A resource kit on discharge planning was developed for staff and included a section with parent education material. An Internet-based parent satisfaction survey was implemented successfully.Conclusions. All centers that participated in the collaborative made significant strides in the discharge planning process. Overall, parent satisfaction with discharge planning was high, and improvements were noted in staff satisfaction and availability of resource material.
Implementation and Case-Study Results of Potentially Better Practices for Staffing in Neonatal Intensive Care Units
Authors: Rikli Joan , Hegwood Pat , Atwater Amy , Bauman Barbara , Brown Betty Beverly , Carteaux Pat , Hartmann Elaine , Hilton Shadin , Michael Laura , Norton Lori , Secrest Joel , Sprague Pam , Plsek Paul 
Published: November 2006

Objective. Five NICUs that participate in the Vermont Oxford Network Quality Improvement Collaborative have implemented several potentially better practices in an attempt to decrease nurse turnover by 50%. These potentially better practices focus on orientation, rewards and recognition, healthy work environment, nurse–physician collaboration, and nursing autonomy.
Methods. Each unit implemented some or all of the potentially better practices. An Excel spreadsheet tool for tracking turnover rates was developed and used to measure the impact of the potentially better practices on retention. Rates were measured quarterly.
Results. After implementation of the potentially better practices, turnover rates fell at all of the NICUs ranging from 13% to 64%.
Conclusions. Nurse retention is multifactorial. Implementation of the potentially better practices had a positive influence on nurse satisfaction but a varied impact on nurse retention. The impact of larger issues such as pay and staffing levels is significant and may not be influenced at the unit level.
Evaluation and Development of Potentially Better Practices for Perinatal and Neonatal Communication and Collaboration
Authors: Ohlinger Judy , Kantak Anand , Lavin Justin P. , Fofah Ona , Hagen Erik , Suresh Gautham , Halamek Louis P. , Schriefer Janice A. 
Published: November 2006

Objective. The obstetric and neonatal exploratory focus group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative 2002 set out to improve collaboration, communication, and coordination between maternal and neonatal caregivers in 3 areas: the pregnancy at 22 to 26 weeks, measurement of maternal outcomes that are linked with neonatal outcomes, and team performance during high-risk delivery. Antepartum and intrapartum maternal attributes and interventions also were considered important measurements to identify practice variations and their relationship to neonatal outcomes for ongoing obstetric and neonatal collaboration.Methods. Potentially better practices were developed on the basis of evidence in the literature, expert opinion, and internal analysis at the participating perinatal centers. The potentially better practices include development of local guidelines at each center for the care and counseling of pregnant women who are at risk for delivering at the margin of viability; communication strategies for obstetric and neonatology providers relating to high-risk pregnancy treatment plans; team communication and performance at high-risk deliveries; design of organizational structures and processes that facilitate obstetric and neonatal collaboration; and development of perinatal data to evaluate effects of perinatal practices on maternal, fetal, and neonatal outcomes.Results. As a result of the project, participating centers developed local guidelines for pregnancies between 22 and 26 weeks, created a cross-center maternal database that currently is being linked to neonatal outcomes, and completed a pilot study on video simulation of neonatal–perinatal team communication.Conclusions. Increased understanding of practice variation in the management of care for infants who are at the margins of viability, locally developed guidelines, and a focus on improved team communication during delivery can be accomplished with a multicenter collaborative approach.