bluuebunny/crossref_metadata_2025_split huggingface dataset:
TLR4 signalling in the intestine in health and disease
Authors: Fukata M. , Abreu M.T. 
Published: January 2008

The colonic epithelium is lined along its apical membrane with ∼1014 bacteria/g of tissue. Commensal bacteria outnumber mammalian cells in the gut severalfold. The reason for this degree of commensalism probably resides in the recent recognition of the microbiome as an important source of metabolic energy in the setting of poorly digestible nutrients. As in many themes in biology, the host may have sacrificed short-term benefit, i.e. nutritional advantages, for long-term consequences, such as chronic inflammation or colon cancer. In the present review, we examine the role of TLR (Toll-like receptor) signalling in the healthy host and the diseased host. We pay particular attention to the role of TLR signalling in idiopathic IBD (inflammatory bowel disease) and colitis-associated carcinogenesis. In general, TLR signalling in health contributes to homoeostatic functions. These include induction of antimicrobial peptides, proliferation and wound healing in the intestine. The pathogenesis of IBD, ulcerative colitis and Crohn's disease may be due to increased TLR or decreased TLR signalling respectively. Finally, we discuss the possible role of TLR signalling in colitis-associated neoplasia.
First Report of Chestnut Ink Disease by Phytophthora katsurae on Chestnut in Korea
Authors: Oh E. , Lee S. H. , Kim K. H. , Lee J. K. , Shin K. C. 
Published: January 2008

Since the late 1970s, chestnut (Castanea spp.) has been one of the most commonly cultivated nuts for human consumption in Korea. In 1998, as much as 100,000 t of chestnut seeds were produced from 79,000 ha of plantations for export (2). Most cultivated chestnuts are hybrids of Castanea crenata and C. mollissima that have resulted in 27 cultivars commonly grown in Korea. In 2004, dead trees of two cultivars (Tsukuba and Ginyose) from different locations were found with black ooze emanating from reddish, sunken tissues on the trunks. When the bark was peeled off, a distinct necrotic region was observed on the basal trunk with the discoloration extending up and girdling the trunk. In November 2006, a Phytophthora species was isolated from the necrotic areas with a CARP selective medium (4). Eleven isolates were obtained from three locations: Hadong, Hapcheon, and Youngqwang. The isolates produced numerous homothallic oogonia (34.0 to 46.2 × 21.9 to 26.7 μm) with warty protuberances on the surface. Antheridia were amphigynous with long, funnel-shaped stalks at the base of the oogonia. The formation of papillate, ovoid to obpyriform sporangia (17.0 to 38.9 × 14.6 to 29.2 μm) was induced by cold treatment in filtered (through 25-μm particle retention) creek water or deionized water. Chlamydospores were not observed. Comparison of the rDNA ITS sequence using ITS1/4 (3) showed 99.6% similarity to P. katsurae (GenBank Accession No. AF266771) with three base pair differences. All eleven isolates showed identical ITS sequences. Pathogenicity studies were conducted on excised three 15-cm-long × 5-cm-diameter logs from each of three chestnut cultivars (Moriwase, Parkmi 2, and Ibuki). Bark (5 mm in diameter) was taken with a cork borer on each log followed by inoculation with a 5-mm agar disk of two isolates, PH.K01 and PH.K07. The logs were placed in a moist chamber for 7 days. Noninoculated controls consisted of log sections from each cultivar treated with agar disks. The pathogencity test was repeated three times. The entire log of cv. Parkmi 2 became necrotic, whereas the other two cultivars developed only small lesions (P < 0.0001). The noninoculated control logs of each cultivar did not develop lesions and no pathogen was reisolated from them. This suggests that cultivars differ in susceptibility. P. katsurae (synonym = P. castaneae) was first described from Japan in 1931. P. cambivora, P. cinnamomi, and P. katsurae are commonly responsible for ink disease on chestnut species in Europe, the United States, and Asia (1). The impact of P. katsurae on chestnut production in Korea is currently unknown. References: (1) A. Boutard et al. The West. Chestnut. 3:6, 2001. (2) S. H. Lee et al. J. Korean For. Soc. 95:61, 2006. (3) E. Oh et al. Forest Pathol. 36:388, 2006. (4) T. J. White et al. Page 315 in: PCR Protocols. Academic Press Inc., New York, 1990.
First Report of Anther Smut Caused by Microbotryum violaceum on Forked Catchfly (Silene dichotoma) in Turkey
Authors: Berner D. , Tunali B. 
Published: January 2008

Forked catchfly (Silene dichotoma Ehrh.), family Caryophyllaceae, is a common and native plant in rangelands and pastures in Turkey. It is also an introduced plant that is widely distributed in North America. In May of 2007, approximately 20 forked catchfly plants on the campus of Ondokuz Mayis University in Samsun, Turkey were found diseased with the anther smut fungus Microbotryum violaceum (Pers.:pers.) G. Deml & Oberw. (Basidiomycota, Microbotryomycetes, Microbotryales [3], Microbotryaceae). All anthers in all flowers of diseased plants were smutted. Diseased flowers were collected, air dried, and sent to the quarantine facility of the Foreign Disease-Weed Science Research Unit (FDWSRU), USDA/ARS, Fort Detrick, MD. Teliospores within the flowers were extracted and observed microscopically. Teliospores were globose, 6 to 9 μm (mean 6.5 μm) in diameter, pale violet, with reticulate walls, and matching the description of M. violaceum (4). Nucleotide sequences for the internal transcribed spacers (ITS 1 and 2) and 5.8S ribosomal region (GenBank Accession No. EU122308) were aligned with other sequences in GenBank with the BLAST algorithm. Sequences of this isolate aligned 99% with sequences of other isolates of M. violaceum, M. lychnidis-dioicae (A.P. de Candolle ex J.I. Liro) G. Deml & F. Oberwinkler, and M. silenes-inflatae (A.P. de Candolle ex J.I. Liro) G. Deml & F. Oberwinkler and clustered with other M. violaceum isolates. M. violaceum is an obligate parasite of many plant species in the Caryophyllaceae family, and the fungus has been widely studied as a model for population genetics and evolutionary biology (2). To our knowledge, this is the first report of M. violaceum parasitizing forked catchfly in Turkey, and is the only report of this fungus-plant interaction in Asia Minor (1). The fungus has not been reported from this plant in North America (1). A voucher specimen has been deposited with the U.S. National Fungus Collections (BPI 878235) and living spores are being maintained at FDWSRU. References: (1) D. F. Farr et al. Fungal Databases. Systematic Botany and Mycology Laboratory. Online publication. ARS, USDA, 2007. (2) T. Giraud. Heredity 93:559, 2004. (3) D. S. Hibbett et al. Mycol. Res. 111:509, 2007. (4) K. Vánky. European Smut Fungi. Gustav Fischer Verlag, Stuttgart, Germany, 1994.
Maternal cardiac function and uterine artery Doppler at 11–14 weeks in the prediction of pre‐eclampsia in nulliparous women
Authors: Khaw A , Kametas NA , Turan OM , Bamfo JEAK , Nicolaides KH 
Published: January 2008

Objective  To assess maternal cardiac function in nulliparous women in the first trimester of pregnancy and evaluate its potential role for predicting pre‐eclampsia and small for gestational age (SGA).Design  Prospective, observational, cross‐sectional study.Setting  Maternity unit of a teaching hospital.Population  Nulliparous women with singleton pregnancies presenting consecutively for routine antenatal care (n= 534).Methods  Two‐dimensional and M‐mode echocardiography and uterine artery Dopplers were carried out at 11‐14 weeks.Main outcome measures  Cardiac output (CO), stroke volume (SV), mean arterial pressure (MAP), total vascular resistance and uterine artery pulsatility index (UAPI) were compared in four outcome groups according to the development of pre‐eclampsia and/or SGA.Results  Compared with the normal outcome group (n= 457), in those with pre‐eclampsia but not SGA (n = 8), CO and MAP were increased; in the group with pre‐eclampsia and SGA (n= 19) MAP, TRP and UAPI were increased and in the group with SGA but no pre‐eclampsia (n= 50) total peripheral resistance and UAPI were increased. Independent predictors of pre‐eclampsia were MAP, SV and UAPI and of SGA SV and UAPI.Conclusions  Alterations in maternal cardiac function and UAPI are observed in the first trimester of pregnancy in nulliparous women that subsequently develop pre‐eclampsia and/or SGA.
Fear of childbirth: predictors and temporal changes among nulliparous women in the Danish National Birth Cohort
Authors: Laursen M , Hedegaard M , Johansen C 
Published: January 2008

Objectives  To describe the association between fear of childbirth and social, demographic and psychological factors in a cohort of 30 480 healthy nulliparous women with uncomplicated singleton pregnancies.Design  Nationwide population‐based study.Setting  The Danish National Birth Cohort.Population  Healthy nulliparous women (n= 30 480) with singleton pregnancies.Methods  Data from computer‐assisted telephone interviews twice in pregnancy linked with national health registers.Main outcome measures  Characteristics of women with fear of childbirth in early (mean, 16 weeks) and late pregnancy (mean, 32 weeks) and changes in fear of childbirth between 1997 and 2003.Results  Low educational level, lack of a social network, young age and unemployment were associated with fear of childbirth, as were being a smoker and having low self‐rated health. The odds ratio for fear of childbirth among women with anxiety symptoms was 4.8 (4.1–5.7) after adjustment for socio‐demographic, lifestyle, fertility and depression variables. During the study period, the prevalence of fear of childbirth was stable. Fear of childbirth was reported by 7.6% in early pregnancy and 7.4% in late pregnancy. Only 3.2% of the women expressed fear of childbirth in both interviews.Conclusions  The prevalence of fear of childbirth among healthy nulliparous women with singleton pregnancies did not increase during the study period. Fear of childbirth among nulliparous women was most often seen in individuals with few social and psychological resources. Testing the women twice, we found the same prevalence of fear in early and late pregnancy, but found that half the women who expressed fear during early pregnancy had no fear later in pregnancy, an effect that was counterbalanced by a similar number of women who became fearful between the two interviews.
Lumbar Puncture First: An Alternative Model for the Investigation of Lone Acute Sudden Headache
Authors: Schull Michael J. 
Published: January 2008

AbstractSubarachnoid hemorrhage (SAH) is a diagnosis often considered in patients presenting to the ED with acute sudden headaches, but with normal physical examinations. Standard of care today is for these patients to be investigated by noncontrast CT scan followed by lumbar puncture (LP) for negative CTs. However, given that most investigated patients have benign headaches, most of the CT and LP results are normal. The authors studied, by means of a theoretical analysis, the impact of an alternative diagnostic model, in which LP would be the first (and, in most cases, only) diagnostic test for patients suspected of SAH who meet lone acute sudden headache (LASH) criteria. Given reasonable assumptions, for every 100 patients investigated, the “LP‐first” model would result in 79 to 83 fewer CT scans and only seven to 11 additional LPs, as compared with traditional strategies. Among ED headache patients meeting LASH criteria, the authors believe use of this model could result in more efficient use of resources, minimal additional morbidity, and equal diagnostic accuracy for SAH.
Reliability and Validity of a New Five‐level Triage Instrument
Authors: Wuerz Richard C. , Milne Leslie W. , Eitel David R. , Travers Debbie , Gilboy Nicki 
Published: January 2008

AbstractObjectives: Triage is the initial clinical sorting process in hospital emergency departments (EDs). Because of poor reproducibility and validity of three‐level triage, the authors developed and validated a new five‐level triage instrument, the Emergency Severity Index (ESI). The study objectives were: 1) to validate the triage instrument against ED patients' clinical resource and hospitalization needs, and 2) to measure the interrater reliability (reproducibility) of the instrument. Methods: This was a prospective, observational cohort study of a population‐based convenience sample of adult patients triaged during 100 hours at two urban referral hospitals. Validation by resource use and hospitalization (criterion standards) and reproducibility by blinded paired triage assignments compared with weighted kappa analysis were assessed. Results: Five hundred thirty‐eight patients were enrolled; 45 were excluded due to incomplete evaluations. The resulting cohort of 493 patients was 52% female, was 26% nonwhite, and had a median age of 40 years (range 16‐95); overall, 159 (32%) patients were hospitalized. Weighted kappa for triage assignment was 0.80 (95% CI = 0.76 to 0.84). Resource use and hospitalization rates were strongly associated with triage level. For patients in category 5, only one‐fourth (17/67) required any diagnostic test or procedure, and none were hospitalized (upper confidence limit, 5%). Conversely, in category 1, one of twelve patients was discharged (upper confidence limit, 25%), and none required fewer than two resources. Conclusions: This five‐level triage instrument was shown to be both valid and reliable in the authors' practice settings. It reproducibly triages patients into five distinct strata, from very high hospitalization/resource intensity to very low hospitalization/resource intensity.
Electrocardiographic ST‐segment Elevation The Diagnosis of Acute Myocardial Infarction by Morphologic Analysis of the ST Segment
Authors: Brady William J. , Syverud Scott A. , Beagle Charlotte , Perron Andrew D. , Ullman Edward A. , Holstege Christopher , Riviello Ralph J. , Ripley Anne , Ghaemmaghami Chris A. 
Published: January 2008

AbstractAcute myocardial infarction (AMI) is one of many causes of ST‐segment elevation (STE) in emergency department (ED) chest pain (CP) patients. The morphology of STE may assist in the correct determination of its cause, with concave patterns in non‐AMI syndromes and non‐concave waveforms in AMI. Objectives: To determine the impact of STE morphologic analysis on AMI diagnosis and the ability of this technique to separate AMI from non‐infarction causes of STE. Methods: The electrocardiograms (ECGs) of consecutive ED adult CP patients (with three serial troponin I determinations) were interpreted in two‐step fashion by six attending emergency physicians (EPs): 1) the determination of STE by three EPs followed by 2) STE morphologic analysis (either concave or non‐concave) in those patients with STE. The impact of STE morphology analysis was investigated in the identification of AMI and non‐AMI causes of STE. Acute myocardial infarction was diagnosed by abnormal serum troponin I values (>0.1 mg/dL) followed by a rise and fall of the serum marker; STE diagnoses of non‐AMI causes were determined by medical record review. Interobserver reliability concerning STE morphology was determined. Study inclusion criteria included at least three troponin values performed in serial fashion no more frequently than every three hours, initial ED ECG, ED diagnosis, and final hospital diagnosis. Results: Five hundred ninety‐nine CP patients were entered in the study, with 171 (29%) individuals having STE on their ECGs. Of the 171 patients who had STE, 56 had AMI, 50 had unstable angina pectoris (USAP), and 65 had non‐coronary final diagnoses. Forty‐nine patients had non‐concave STE, 46 with AMI and three with USAP; no patient with a non‐coronary diagnosis had a non‐concave STE morphology. The sensitivity and specificity of the non‐concave STE morphology for AMI diagnoses were 77% and 97%, respectively; the positive and negative predictive values for non‐concave morphology in AMI diagnoses were 94% and 88%, respectively. Interobserver reliability in the STE morphology determination revealed a kappa coefficient of 0.87. Conclusions: A non‐concave STE morphology is frequently encountered in AMI patients. While the sensitivity of this pattern for AMI diagnosis is not particularly helpful, the presence of this finding in adult ED chest pain patients with STE strongly suggests AMI. This technique produces consistent results among these EPs.
Faculty Triage Shortens Emergency Department Length of Stay
Authors: Partovi Sirous N. , Nelson Brian K. , Bryan Earl D. , Walsh Matthew J. 
Published: January 2008

Abstract Objective: To determine whether faculty triage (FT) activities can shorten emergency department (ED) length of stay (LOS). Methods: This was a comparison study measuring the impact of faculty triage vs no faculty triage on ED LOS. It was set in an urban county teaching hospital. Subjects were patients presenting to the registration desk between 9 AM and 9 PM on 16 consecutive Mondays (August 2 to November 15, 1999). On eight Mondays, an additional faculty member was stationed at the triage desk. He or she was asked to expedite care by rapid evaluation orders for diagnostic studies and basic therapeutic interventions, and by moving serious patients to the patient care areas. He or she was not provided with detailed instructions or protocols. The ED LOS, time of registration (TIMEREG), inpatient admission status (ADMIT), x‐ray utilization (XRAY), total patients registered each day between 9 AM and 9 PM (TOTREG), and patients who left without being seen (LWBS) were determined using an ED information system. The LOS was analyzed in relation to FT, ADMIT, and XRAY by the Mann‐Whitney U test. The LOS was related to TIMEREG and TOTREG by simple linear regression. Stepwise multiple linear regression models to predict LOS were generated using all the variables. Results: Patients without FT (n? 814) had a mean LOS of 445 minutes. Patients with FT (n? 920) had a mean LOS of 363 minutes. Mean difference in LOS was ‐82 minutes (95% CI ? ‐111 to ‐53), a reduction of 18%. The LOS was also related to: ADMIT +203 minutes (95% CI ? 168 to 238), TOTREG ‐2.7 min/additional patient registered (95% CI ? ‐1.15 to ‐4.3), and TIMEREG +0.14 min/min since 9 AM (95% CI ? 0.07 to 0.21). The LWBS was reduced by 46% with FT. In multiple regression analysis, ADMIT, FT, TIMEREG, and XRAY were all related to LOS, but the model explained only a small part of variance (adjusted R2? 0.093). The faculty cost is estimated to be 11.98/patient. Conclusions: Faculty triage offers a moderate increase in efficiency at this ED, albeit with relatively high cost.
Rochester, New York A Decade of Emergency Department Overcrowding
Authors: Schneider Sandra , Zwemer Frank , Doniger Andrew , Dick Robbin , Czapranski Tim , Davis Eric 
Published: January 2008

AbstractOvercrowding is common in emergency departments (EDs) throughout the United States. The history of ED overcrowding in Rochester, New York, is notable due to its unique health care system that introduced the concepts of managed care as early as the 1950s. An effect of this system was to intentionally restrict resources and allow the issue of access to limit utilization. Overcrowding in EDs was severe in the late 1990s‐2000, and became an accepted local standard of care. Objective: To study the strategies to reduce ED overcrowding in Rochester in the last decade. Methods: A descriptive analysis of individual hospital and community efforts to decrease ED overcrowding. Results: Of the strategies tried, those that had little effect on ED overcrowding were based from the ED, such as ambulance diversion. Those that were successful were those that addressed factors external to the ED such as increased flexibility of inpatient resources; float nurses who responded to acute care needs; a transition team (mid‐level provider along with registered nurse (RN)/licensed practical nurse) who cared for inpatients boarded in the ED; integrated services across affiliated hospitals/systems; an early alert system that notified key personnel before “code red” criteria were met; and a multidisciplinary team to round in the ED and analyze resource needs. Current community‐wide initiatives include precise tracking of code red hours; monitoring patient length of stay (LOS) in the ED and inpatient units; education of physicians and nursing homes regarding ED alternatives; exploration of additional resources for subacute and long‐term care; establishing a regional forum to address the nursing shortage; development of an ED triage system to coordinate diversion activities during code red; and consideration of a county‐wide state of emergency when needed. Conclusions: Emergency department overcrowding is the end result of a variety of factors that must be addressed system‐wide.
Effect of an Emergency Department (ED) Managed Acute Care Unit on ED Overcrowding and Emergency Medical Services Diversion
Authors: Kelen Gabor D. , Scheulen James J. , Hill Peter M. 
Published: January 2008

Abstract Objective: To determine the impact of an inpatient, emergency department (ED)‐managed acute care unit (ACU) on ED overcrowding and use of ambulance diversion. Methods: Descriptive observational study with prospectively collected data from a 14‐bed ACU recently opened remote from the main ED. Rates of patients who left without being seen (LWBS) and ambulance diversion frequency and duration were adjusted for ED patient volumes and compared with those for the period immediately before the ACU was opened and with those for a matching time period during the previous year. Results: There were 1,589 patients seen in the ACU during the first ten weeks of operation, representing about 14.5% of the ED volume (10,871). About 33% could be classified as post‐ED management, 20% as admission processing, and the rest as primary evaluation. The number of patients who LWBS decreased from 10.1% of the ED census two weeks prior to opening of the ACU, and from 9.4% during the previous year, to 5.0% (range 4.2%‐6.2%) during the ensuing ten weeks post opening. Ambulance diversion was a mean of 6.7 hours per 100 patients before the unit opened and 5.6 hours per 100 patients during the same time in the previous year, and decreased to 2.8 hours per 100 patients after the unit opened (p < 0.05, respectively). A six‐month pre‐ and two‐month post‐examination revealed that the mean monthly hours of ambulance diversion for the ED decreased by 40% (202 hours vs 123 hours) (p < 0.05) in contrast to a mean increase of 44% (186 hours vs 266 hours) (p < 0.05) experienced by four proximate hospitals. Conclusions: An ED‐managed ACU can have significant impact on ED overcrowding and ambulance diversion, and it need not be located proximate to the ED.