bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exchange versus simple transfusion for acute chest syndrome in sickle cell anemia adults
Authors: Turner Jeff M. , Kaplan Jason B. , Cohen Hillel W. , Billett Henny H. 
Published: February 2009

BACKGROUND: There are scant data regarding the relative efficacy of exchange transfusion (XC) versus simple transfusion (ST) for treatment of sickle cell anemia acute chest syndrome (ACS).STUDY DESIGN AND METHODS: Twenty patients who received XC for ACS were compared with 20 ST patients. Hemoglobin (Hb) levels, platelet and white blood cell counts, lactate dehydrogenase (LDH), indirect bilirubin, and temperature were used to assess disease severity. Primary outcome was postprocedure length of hospital stay; secondary outcome was total length of stay.RESULTS: Cohorts were similar with regard to age; sex; prior ACS episodes; echocardiogram results; and antibiotic, bronchodilator, and hydroxyurea use. Maximum temperature recorded was higher in the XC group (39.1°C vs. 38.4°C, p = 0.02), but LDH, WBCs, and indirect bilirubin were comparable. Admission Hb levels were higher for XC (XC 8.6 g/dL vs. ST 7.4 g/dL, p = 0.02) and XC had higher peak Hb levels during hospitalization (10.4 ± 1.4 g/dL vs. 9.3 ± 1.0 g/dL, p ≤ 0.01). No differences were demonstrable in postprocedure length of stay (XC 5.6 days vs. ST 5.9 days, p = 0.82) or total length of stay (XC 8.4 days vs. ST 8.0 days, p = 0.76). A total of 10.3 ± 3.0 units were transfused for XC compared to 2.4 ± 1.2 units for ST (p < 0.001).CONCLUSIONS: Based on postprocedure length of stay or total length of stay, we could not detect a difference in the efficacy of XC compared to ST in populations despite red blood cell product usage fourfold higher in the XC group. We suggest that it is time for an adequately powered, randomized trial to examine the true risk:benefit ratio of XC in ACS.
Impact of individual‐donation nucleic acid testing on risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission by blood transfusion in South Africa
Authors: Vermeulen Marion , Lelie Nico , Sykes Wendy , Crookes Robert , Swanevelder Johanna , Gaggia Lilian , Le Roux Martin , Kuun Eben , Gulube Sam , Reddy Ravi 
Published: February 2009

BACKGROUND: In 2005, the South African National Blood Service introduced individual‐donation (ID) nucleic acid test (NAT) screening for human immunodeficiency virus (HIV) RNA, hepatitis C virus (HCV) RNA, and hepatitis B virus (HBV) DNA. At the same time the use of ethnic origin to prioritize the transfusion of blood according to a hierarchy of residual risk was discontinued.STUDY DESIGN AND METHODS: ID‐NAT (Ultrio on Procleix Tigris, Chiron) and serology (PRISM, Abbott) repeat test and confirmation testing algorithms were designed to enable differentiation between false‐positive and true‐NAT and ‐serology yields. After 1 year, the NAT and serology yield rates in first‐time, lapsed, and repeat donors were analyzed and used to estimate the residual risk of HIV, HBV, and HCV infections by blood transfusion.RESULTS: The HIV, HBV, and HCV ID‐NAT window phase yield rates in 732,250 blood donations were 1:45,765, 1:11,810, and 1:732,200, respectively. Seven of 16 HIV window phase donations with viral loads above 16,000 copies/mL were HIV p24 antigen enzyme‐linked immunosorbent assay positive. PRISM detected anti‐HIV and hepatitis B surface antigen (HBsAg) in 89.4 and 73.9% of early infections in repeat donors. The Procleix assay detected viremia in 99.7 and 95.5% of anti‐HIV– and HBsAg‐positive first‐time donors. In these donors, the occult HBV DNA carrier rate was 1:5200. The residual transmission risk of ID‐NAT HIV, HBV, and HCV window phase donations was estimated at 1:479,000, 1:61,500, and 1:21,000,000 respectively.CONCLUSION: One‐year ID‐NAT screening of 732,250 donations interdicted 16 HIV, 20 HBV, and 1 HCV window phase donations and 42 anti‐hepatitis B core antigen–reactive infections during an early recovery or a later stage of occult HBV infection.
Transfusion of platelet components prepared with photochemical pathogen inactivation treatment during a Chikungunya virus epidemic in Ile de La Réunion
Authors: Rasonglès Patrice , Angelini‐Tibert Marie France , Simon Philip , Currie Caroline , Isola Herve , Kientz Daniel , Slaedts Marc , Jacquet Michele , Sundin David , Lin Lily , Corash Laurence , Cazenave Jean Pierre 
Published: February 2009

BACKGROUND: During the Chikungunya virus (CHIKV) epidemic on Ile de La Réunion, France, more than 30% of 750,000 inhabitants were infected. Local blood donation was suspended to prevent transfusion‐transmitted infection (TT‐CHIKV). To sustain the availability of platelet (PLT) components, the Établissement Français du Sang implemented universal pathogen inactivation (INTERCEPT, Cerus Europe BV) of PLT components (CPAs). The study assessed the safety of PLT components treated with pathogen inactivation transfused in routine clinical practice.STUDY DESIGN AND METHODS: This was a retrospective observational study using patient medical records and the AFSSAPS hemovigilance database (eFIT) to identify TT‐CHIKV and adverse events (AEs) classified as acute transfusion reactions (ATRs) to PLT components prepared with pathogen inactivation.RESULTS: During 1 year, 1950 INTERCEPT‐CPAs were transfused to 335 adult, 51 pediatric, and 41 infant patients. Nineteen AEs were observed in 15 patients and 10 were classified as ATRs. Eight ATRs occurred in 6 pediatric hematology‐oncology patients. No ATRs were observed in infants. The most frequently reported signs and symptoms were Grade 1 urticaria, itching, chills, fever, and anxiety. No cases of transfusion‐related acute lung injury, TT‐sepsis, or TT‐CHIKV were detected.CONCLUSIONS: INTERCEPT‐CPAs were well tolerated in a broad range of patients, including infants. ATR incidence was low and when present ATRs were of mild severity.
A modeling framework for evaluation and comparison of trigger strategies for switching from minipool to individual‐donation testing for West Nile virus
Authors: Biggerstaff Brad J. , Petersen Lyle R. 
Published: February 2009

BACKGROUND: To decrease the likelihood of transmission from donations containing West Nile virus (WNV) levels below minipool nucleic acid test (MP‐NAT) detection limits, blood centers switch from MP‐NAT to individual‐donation testing (ID‐NAT) after detection of MP‐NAT–positive donations. The effectiveness of strategies to trigger or discontinue ID‐NAT screening is largely unknown.STUDY DESIGN AND METHODS: Twenty‐seven strategies to trigger and discontinue ID‐NAT screening were evaluated with a statistical model based on known dynamics of WNV infection and historical data on WNV prevalence among blood donations. Breakthroughs were defined as WNV immunoglobulin M antibody–negative, viremic (RNA‐positive) donations that could only be identified by ID‐NAT, but were screened by MP‐NAT. Effectiveness (proportional reduction of breakthroughs relative to MP‐NAT screening alone) and efficiency (absolute reduction of breakthroughs relative to the number of tests performed) were estimated by simulating donation years of varying outbreak severities over a range of blood collection frequencies.RESULTS: Most strategies were effective (>75% reduction in breakthroughs) when daily donations exceeded 560. In larger centers (1008 donations daily), effectiveness of trigger‐on strategies based on absolute number of MP‐NAT–positive donations improved, but worsened for strategies using rate‐based criteria. Effectiveness increased slightly by triggering on one MP‐NAT–positive rather than two and increased substantially by increasing the duration from 7 to 14 days that no ID‐NAT–positive donations are detected before resuming MP‐NAT.CONCLUSION: Most trigger strategies become effective when test results from at least 560 donations daily are considered. A 14‐day ID‐NAT period may improve safety relative to the increase in the number of tests performed.
Dead man talking: sustained utility of data from archaic paternity tests
Authors: Wenk Robert E. , Chiafari Francis A. 
Published: February 2009

BACKGROUND: Almost all relationship analysts now use molecular (DNA) tests to obtain necessary genetic information, yet older blood group tests remain valid. Circumstances may provide blood test results from old reports to avoid trying to sample DNA from inaccessible sources.CASE STUDY: A mother recently claimed that a deceased man (alleged father [AF]) sired her child. Insurance investigation recovered two paternity test reports from an AABB‐accredited laboratory. The 16‐ and 18‐year‐old reports employed blood groups and protein polymorphisms to exonerate two different men. One report contained the multilocus phenotypes of the AF and the other contained the phenotypes of the mother and child at the same loci. A new case was synthesized from the old reports.RESULTS: Genetic inconsistencies (three direct and one indirect) were demonstrated among the nine loci that had been typed in both the AF and the mother‐child pair.CONCLUSION: New relationship tests may be reconstructed from phenotypes reported before the molecular test era. This approach avoids exhumation and other problematic methods of specimen retrieval.
Ranolazine Exerts Potent Effects on Atrial Electrical Properties and Abbreviates Atrial Fibrillation Duration in the Intact Porcine Heart
Authors: KUMAR KAPIL , NEARING BRUCE D. , CARVAS MARCELO , NASCIMENTO BRUNO C.G. , ACAR MARIANA , BELARDINELLI LUIZ , VERRIER RICHARD L. 
Published: February 2009

Introduction: In vitro studies and ambulatory ECG recordings from the MERLIN TIMI‐36 clinical trial suggest that the novel antianginal agent ranolazine may have the potential to suppress atrial arrhythmias. However, there are no reports of effects of ranolazine on atrial electrophysiologic properties in large intact animals. Methods and Results: In 12 closed‐chest anesthetized pigs, effects of intravenous ranolazine (∼9 μM plasma concentration) on multisite atrial effective refractory period (ERP), conduction time (CT), and duration and inducibility of atrial fibrillation (AF) initiated by intrapericardial acetylcholine were investigated. Ranolazine increased ERP by a median of 45 ms (interquartile range 29–50 ms; P < 0.05, n = 6) in right and left atria compared to control at pacing cycle length (PCL) of 400 ms. However, ERP increased by only 28 (24–34) ms in right ventricle (P < 0.01, n = 6). Ranolazine increased atrial CT from 89 (71–109) ms to 98 (86–121) ms (P = 0.04, n = 6) at PCL of 400 ms. Ranolazine decreased AF duration from 894 (811–1220) seconds to 621 (549–761) seconds (P = 0.03, n = 6). AF was reinducible in 1 of 6 animals after termination with ranolazine compared with all 6 animals during control period (P = 0.07). Dominant frequency (DF) of AF was reduced by ranolazine in left atrium from 11.7 (10.7–20.5) Hz to 7.6 (2.9–8.8) Hz (P = 0.02, n = 6). Conclusions: Ranolazine, at therapeutic doses, increased atrial ERP to greater extent than ventricular ERP and prolonged atrial CT in a frequency‐dependent manner in the porcine heart. AF duration and DF were also reduced by ranolazine. Potential role of ranolazine in AF management merits further investigation.
Effect of Electroanatomically Guided Versus Conventional Catheter Ablation of Typical Atrial Flutter on the Fluoroscopy Time and Resource Use: A Prospective Randomized Multicenter Study
Authors: HINDRICKS GERHARD , WILLEMS STEFAN , KAUTZNER JOSEF , DE CHILLOU CHRISTIAN , WIEDEMANN MICHAEL , SCHEPEL SIEP , PIORKOWSKI CHRISTOPHER , RISIUS TIM , KOTTKAMP HANS ,   for the EuroFlutter Investigators
Published: February 2009

Aims: Radiofrequency catheter ablation of typical atrial flutter is one of the most frequent indications for catheter ablation in electrophysiology laboratories today. Clinical utility of electroanatomic mapping systems on treatment results and resource utilization compared with conventional ablation has not been systematically investigated in a prospective multicenter study. Methods and Results: In this prospective, randomized multicenter study, the results of catheter ablation to cure typical atrial flutter using conventional ablation strategy were compared with electroanatomically guided mapping and ablation (Carto®). Primary endpoints of the study were procedure duration and fluoroscopy exposure time, secondary endpoints were acute success rate, recurrence rate, and resource utilization. A total of 210 patients (169 men, 41 women, mean age 63 ± 10 years) with documented typical atrial flutter were included in the study. Acute ablation success, that is, demonstration of bidirectional isthmus block, was achieved in 99 of 105 patients (94%) in the electroanatomically guided ablation group and in 102 of 105 patients (97%) in the conventional ablation group (P > 0.05). Total procedure duration was comparable between both study groups (99 ± 57 minutes vs 88 ± 54 minutes, P > 0.05). Fluoroscopy exposure time was significantly shorter in the electroanatomically guided ablation group (7.7 ± 7.3 minutes vs 14.8 ± 11.9 minutes; P < 0.05). Total recurrence rate of typical atrial flutter at 6 months of follow‐up was comparable between the 2 groups (respectively for the CARTO and conventional group 6.6% vs 5.7%, P > 0.05). The material costs per procedure in the electroanatomically guided and conventional groups (NaviStar® DS vs Celsius® DS) was €3035 (USD 3,870) and €2133 (USD 2,720), respectively. Conclusions: This multicenter study documented that cavotricuspid isthmus ablation to cure typical atrial flutter was highly effective and safe, both in the conventional and the electroanatomically guided ablation group. The use of electroanatomical mapping system significantly reduced the fluoroscopy exposure time by almost 50%, however, at the expense of increased cost of the procedure.
Human Model Simulating Right Ventricular Outflow Tract Tachycardia by High‐Frequency Stimulation in the Left Pulmonary Artery: Autonomics and Idiopathic Ventricular Arrhythmias
Authors: HASDEMIR CAN , ALP ALPAY , AYDIN MEHMET , CAN LEVENT H. 
Published: February 2009

Introduction: Frequent monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia (VT) in patients with structurally normal heart usually arise from the right ventricular outflow tract (RVOT). An animal model simulating RVOT tachycardia by high‐frequency stimulation (HFS) of the sympathetic input to the proximal pulmonary artery (PA) has been previously described. The aim of this study was to similarly induce RVOT tachycardia in humans. Methods: In 9 patients with no history of ventricular arrhythmias, a circumferential catheter was placed in the left, main, and proximal PA to contact the endovascular circumference of the PA. A 50‐ms train of HFS (200 Hz/0.3 ms pulse duration), coupled to atrial pacing, was applied at each bipolar pair of the circumferential catheter. The coupling interval was adjusted so that the 50‐ms train occurred during the ventricular refractory period. Results: In 6 out of 9 patients, HFS in the left PA during dobutamine infusion induced monomorphic PVCs and/or VT with left bundle branch block (LBBB) morphology and inferior axis at an average stimulation level of 12.5 ± 2.7 V. HFS in the main PA and in the proximal PA did not induce any ventricular arrhythmias with the highest energy of 15 V in baseline state and during dobutamine infusion. HFS in the left PA was associated with hiccough in all patients. Conclusion: Stimulation of the sympathetic input to the left PA during dobutamine infusion induces PVCs and/or VT exhibiting LBBB‐morphology and inferior axis, closely simulating clinical RVOT tachycardia in humans.
Utilization of Retrograde Right Bundle Branch Block to Differentiate Atrioventricular Nodal from Accessory Pathway Conduction
Authors: KAPA SURAJ , HENZ BENHUR D. , DIB CHADI , CHA YONG‐MEI , FRIEDMAN PAUL A. , MUNGER THOMAS M. , LADEWIG DOROTHY J. , HAMMILL STEPHEN C. , PACKER DOUGLAS L. , ASIRVATHAM SAMUEL J. 
Published: February 2009

Introduction:
Defining whether retrograde ventriculoatrial (V‐A) conduction is via the AV node (AVN) or an accessory pathway (AP) is important during ablation procedures for supraventricular tachycardia (SVT). With the introduction of ventricular extrastimuli (VEST), retrograde right bundle branch block (RBBB) may occur, prolonging the V‐H interval, but only when AV node conduction is present. We hypothesized that when AP conduction was present, the V‐A interval would increase less than the V‐H interval, whereas with retrograde nodal conduction, the V‐A interval would increase at least as much as the V‐H interval.
Methods and Results:
We retrospectively reviewed the electrophysiological studies of patients undergoing ablation for AVN reentrant tachycardia (AVNRT) (55) or AVRT (50), for induction of retrograde RBBB during the introduction of VEST, and the change in the measured V‐H and V‐A intervals. Results were found to be reproducible between independent observers. Out of 105 patients, 84 had evidence of induced retrograde RBBB. The average V‐H interval increase with induction of RBBB was 53.7 ms for patients with AVRT and 54.4 ms for patients with AVNRT (P = NS). The average V‐A interval increase with induction of RBBB was 13.6 ms with AVRT and 70.1 ms with AVNRT (P < 0.001). All patients with a greater V‐H than V‐A interval change had AVRT, and those with a smaller had AVNRT.
Conclusions:
Induction of retrograde RBBB during VEST is common during an electrophysiological study for SVT. The relative change in the intervals during induction of RBBB accurately differentiates between retrograde AVN and AP conduction.
Idiopathic Focal Ventricular Arrhythmias Originating from the Anterior Papillary Muscle in the Left Ventricle
Authors: YAMADA TAKUMI , MCELDERRY H. THOMAS , OKADA TARO , MURAKAMI YOSHIMASA , INDEN YASUYA , DOPPALAPUDI HARISH , YOSHIDA NAOKI , TABEREAUX PAUL B. , ALLRED JAMES D. , MUROHARA TOYOAKI , KAY G. NEAL 
Published: February 2009

Introduction: Focal ventricular arrhythmias (VAs) have been reported to arise from the posterior papillary muscle in the left ventricle (LV). We report a distinct subgroup of idiopathic VAs arising from the anterior papillary muscle (APM) in the LV. Methods and Results: We studied 432 consecutive patients undergoing catheter ablation for VAs based on a focal mechanism. Six patients were identified with ventricular tachycardia (VT, n = 1) or premature ventricular contractions (PVCs, n = 5) with the earliest site of ventricular activation localized to the base (n = 3) or middle portion (n = 3) of the LV APM. No Purkinje potentials were recorded at the ablation site during sinus rhythm or the VAs. All patients had a normal baseline electrocardiogram and normal LV systolic function. The VAs exhibited a right bundle branch block (RBBB) and right inferior axis (RIA) QRS morphology in all patients. Oral verapamil and/or Na+ channel blockers failed to control the VAs in 4 patients. VT was not inducible by programmed electrical stimulation in any of the patients. In 4 patients, radiofrequency current with an irrigated or conventional 8‐mm‐tip ablation catheter was required to achieve a lasting success. Two patients had recurrent PVCs after a conventional radiofrequency ablation with a 4‐mm‐tip ablation catheter had initially suppressed the arrhythmia. Conclusions: VAs may arise from the base or middle portion of the APM and are characterized by an RBBB and RIA QRS morphology and focal mechanism. Catheter ablation of APM VAs is typically challenging, and creation of a deep radiofrequency lesion may be necessary for long‐term success.
Determining the In‐Hospital Cost of Bleeding in Patients Undergoing Percutaneous Coronary Intervention
Authors: EWEN EDWARD F. , ZHAO LIPING , KOLM PAUL , JURKOVITZ CLAUDINE , FIDAN DOGAN , WHITE HARVEY D. , GALLO RICHARD , WEINTRAUB WILLIAM S. 
Published: February 2009

Background: The economic impact of bleeding in the setting of nonemergent percutaneous coronary intervention (PCI) is poorly understood and complicated by the variety of bleeding definitions currently employed. This retrospective analysis examines and contrasts the in‐hospital cost of bleeding associated with this procedure using six bleeding definitions employed in recent clinical trials.
Methods: All nonemergent PCI cases at Christiana Care Health System not requiring a subsequent coronary artery bypass were identified between January 2003 and March 2006. Bleeding events were identified by chart review, registry, laboratory, and administrative data. A microcosting strategy was applied utilizing hospital charges converted to costs using departmental level direct cost‐to‐charge ratios. The independent contributions of bleeding, both major and minor, to cost were determined by multiple regression. Bootstrap methods were employed to obtain estimates of regression parameters and their standard errors.
Results: A total of 6,008 cases were evaluated. By GUSTO definitions there were 65 (1.1%) severe, 52 (0.9%) moderate, and 321 (5.3%) mild bleeding episodes with estimated bleeding costs of $14,006; $6,980; and $4,037, respectively. When applying TIMI definitions there were 91 (1.5%) major and 178 (3.0%) minor bleeding episodes with estimated costs of $8,794 and $4,310, respectively. In general, the four additional trial‐specific definitions identified more bleeding events, provided lower estimates of major bleeding cost, and similar estimates of minor bleeding costs.
Conclusions: Bleeding is associated with considerable cost over and above interventional procedures; however, the choice of bleeding definition impacts significantly on both the incidence and economic consequences of these events.
Québec et la géographie sociale en questions
Authors: VILLENEUVE PAUL 
Published: February 2009

≪  La vie se déroule, bien sûr, comme un film, mais l'observateur ne peut rien saisir sous cette forme, il doit disposer d'images fixes dont la juxtaposition lui donne l'illusion du mouvement par reconstitution. ≫(Raffestin 2007, 157)
Au début des années 1960, deux révolutions sont en marche, la révolution tranquille au Québec et la révolution quantitative en géographie. Bien qu'en apparence non liés, ces deux épisodes de changement relevaient sans doute d'un même ensemble de valeurs axées sur la modernité. Depuis, les transformations vécues au Québec ont donné lieu à de multiples analyses dont certaines font appel à des considérations géographiques. Des cheminements de recherche, dont le mien, s'inscrivent dans cette mouvance. Une première question portait sur la place du Québec au Canada. Elle a donné lieu à des analyses de la dynamique structurelle des régions du pays. Une deuxième question partait du paradoxe contenu dans l'expression ≪ révolution tranquille  ≫: ne mettait‐elle pas en cause, du moins en partie, l'intensification des rapports entre une métropole cosmopolite et une capitale ≪ provinciale  ≫? Et cette capitale, malgré son provincialisme, était‐elle capable, troisième question, d'engendrer des mouvements sociaux progressistes? L'odyssée du Rassemblement populaire de Québec, vécue sur le mode de l'observation participante, suggère une réponse modérément positive. Elle suggère également, et c'est la quatrième question abordée ici, que de tels mouvements urbains changent les rapports entre les acteurs qui y participent, peut‐être plus encore qu'ils ne changent le cadre de vie. Du moins, ceci semble être le cas en ce qui concerne les rapports hommes‐femmes. En somme, après plus de quatre décennies, je garde la conviction qu'une pratique ouverte de la géographie sociale peut mener à des connaissances libératrices.