bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colonization of Skilled‐Care Facility Residents with Antimicrobial‐Resistant Pathogens
Authors: Trick William E. , Weinstein Robert A. , DeMarais Patricia L. , Kuehnert Matthew J. , Tomaska Wanda , Nathan Catherine , Rice Thomas W. , McAllister Sigrid K. , Carson Loretta A. , Jarvis William R. 
Published: March 2003

OBJECTIVES: To determine the frequency of and risk factors for colonization of skilled‐care unit residents by several antimicrobial‐resistant bacterial species, methicillin‐resistant Stuphylococcus aweus (MRSA), vancomycin‐resistant enterococcus (VRE), or extended‐spectrum‐B‐lactamase‐producing (ESBL‐producing) (ceftazidime resistant) Klebsiella pneumoniae or Escherichia coli. DESIGN: Point‐prevalence survey and medical record review. SETTING: The skilled‐care units in one healthcare facility. PARTICIPANTS: 120 skilled‐care unit residents. MEASUREMENTS: Colonization by each of the four antimicrobial‐resistant pathogens during a point‐prevalence survey, using rectal, nasal, gastrostomy‐tube site, wound, and axillary cultures, June 1–3, 1998; 117 (98%) had at least one swab collected and 1 14 (95%) had a rectal swab collected. Demographic and clinical characteristics were evaluated as risk factors for colonization. All isolates were strain typed by pulsed‐field gel electrophoresis of total genomic deoxyribonucleic acid. RESULTS: Of 117 participants, 50 (43%) were culture positive for ≥1 antimicrobial‐resistant pathogen: MRSA (24%), ESBL‐producing K. pneumoniae (18%) or E. coli (15%), and VRE (3.5%). Of 50 residents culture positive for any of these four antimicrobial‐resistant species, 13 (26%) were colonized by more than one resistant species; only three (6%) were on contact‐isolation precautions at the time of the prevalence survey. Risk factors for colonization varied by pathogen: total dependence on healthcare workers (HCWs) for activities of daily living (ADLs) and antimicrobial receipt for MRSA, total dependence on HCWs for ADLs for ESBL‐producing K. pneumoniae, and antimicrobial receipt for VRE. No significant risk factors were identified for colonization by ESBL‐producing E. coli. Among colonized patients, there was a limited number of strain types for MRSA (24 patients, 4 strain types) and ESBL‐producing K. pneumoniae (21 patients, 3 strain types), and a high proportion of unique strain types for VRE (4 patients, 4 strain types) and ESBL‐producing E. coli (17 patients, 10 strain types). CONCLUSION: A large unrecognized reservoir of skilledcare‐unit residents was colonized by antimicrobial‐resistant pathogens, and co‐colonization by more than one target species was common. To prevent transmission of antimicrobial‐resistant pathogens in long‐term care facilities in which residents have high rates of colonization, infection‐control strategies may need to he modified. Potential modifications include enhanced infection‐control strategies, such as universal gloving for all or high‐risk residents, or screening of high‐risk residents, such as those with total dependence on HCWs for ADLs or recent antimicrobial receipt, and initiation of contact‐isolation precautions for colonized residents.
Endothelial Function in Healthy Younger and Older Hyperhomocysteinemic Subjects
Authors: Hirsch Sandra , De La Maza Pía , Mendoza Laura , Petermann Margarita , Glasinovic Andrea , Paulinelli Paola , Barrera Gladys , Rosenberg Irwin H. , Bunout Daniel 
Published: March 2003

OBJECTIVES: To compare endothelium‐dependent vasomotor response in healthy younger and older subjects without classic cardiovascular risk factors, with high and normal fasting homocysteine (tHcy) levels.DESIGN: We compared endothelium‐dependent vasodilatation, using ultrasound, in healthy younger (aged 18–40) and older (≥70) people with normal (<13 μmol/L) and high (>15 μmol/L) tHcy levels. Exclusion criteria were smoking, personal history of cardiovascular disease, hypertension, chronic diseases, vitamin intake, obesity, abnormal serum lipids levels, and creatinine higher than 130 μmol/L.SETTING: Research laboratory.MEASUREMENTS: In addition to tHcy levels, serum folate and vitamin B12 levels were measured.RESULTS: We studied 17 younger and 12 older hyperhomocysteinemic subjects and respective aged‐matched normohocysteinemic subjects. Endothelium‐dependent vasodilatation was lower in the hyperhomocysteinemic older people (P < .01) than in all younger subjects and in normohomocysteinemic older people. Serum vitamin B12 levels were higher in younger and older normal controls. Folic acid levels were higher in younger controls and in both older groups.CONCLUSIONS: This study shows an effect of high circulating tHcy on vascular reactivity in older people. Because serum levels of tHcy are associated with nutritional status of vitamin B12 and folic acid, prospective studies are necessary to demonstrate the effects of a long‐term nutritional supplementation with vitamins on vascular function and global cardiovascular risk.
Waist Circumference, Body Mass Index, and Risk for Stroke in Older People
Authors: Dey Debashish K. , Rothenberg Elisabet , Sundh Valter , Bosaeus Ingvar , Steen Bertil 
Published: March 2003

OBJECTIVES:To investigate waist circumference (WC) and body mass index (BMI) at age 70 as risk factors for stroke.DESIGN:Cohort study of 70‐year‐olds with 15‐year follow‐up.SETTING:Geriatric Medicine Department, Göteborg University, Sweden.PARTICIPANTS:Two thousand two hundred eighty‐seven (1,045 men; 1,242 women) 70‐year‐olds examined between 1971 and 1981 in Göteborg, Sweden.MEASUREMENTS:Cox regression model was used to calculate relative risk (RR) and 95% confidence interval (CI) for first‐ever stroke (fatal and nonfatal) in reference to the lowest quartiles of WC and BMI. Tests for trend were performed fitting WC and BMI in their original continuous form.RESULTS:In men and women, RRs for stroke, in the highest WC quartile were 1.65 (95% CI = 1.08–2.51) and 1.31 (95% CI = 0.88–1.92), respectively, after adjustment for cohorts, smoking habit, coronary heart disease (CHD), diabetes mellitus, total cholesterol (TC), systolic blood pressure (SBP), and height at age 70. In men, RR for stroke in the highest BMI quartile (≥28 kg/m2) was 1.68 (95% CI = 1.12–2.53) after adjustment for cohorts, smoking habits, CHD, diabetes mellitus, TC, and SBP at age 70. In women, adjusted RRs for stroke across the BMI quartiles were not significantly different. In men, population attributable fractions of stroke were 24.8% and 25.2% for the highest quartiles of WC and BMI, respectively.CONCLUSIONS:High WC (≥99 cm) and BMI (≥28 kg/m2) are risks for stroke in older men but not in older women.
Preoperative Electrocardiogram Abnormalities Do Not Predict Postoperative Cardiac Complications in Geriatric Surgical Patients
Authors: Liu Linda L. , Dzankic Samir , Leung Jacqueline M. 
Published: March 2003

OBJECTIVES: IPreoperative electrocardiograms (ECGs) are routinely performed on older patients before surgery. Whether patients with abnormalities on preoperative ECGs have an increased likelihood of developing postoperative cardiac complications is unknown. This study was designed to determine whether abnormalities on preoperative ECGs were predictive of postoperative cardiac complications.DESIGN: Prospective observational study.SETTING: One of the teaching hospitals of the University of California, San Francisco, Medical Center.PARTICIPANTS: Five hundred thirteen patients aged 70 and older undergoing noncardiac surgery.MEASUREMENTS: Preoperative ECGs were analyzed using the Minnesota Codes. Predefined preoperative risk factors and in‐hospital postoperative cardiac complications were measured. The association between ECG abnormalities and postoperative cardiac complications was determined by multivariate logistic regression after controlling for clinical covariates. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported.RESULTS: Three hundred eighty‐six of 513 patients (75.2%) had at least one abnormality on their preoperative ECGs. On multivariate analysis, the predictors of postoperative cardiac complications included American Society of Anesthesiologists physical status classification of 3 or greater (OR = 2.5, 95% CI = 1.28–4.89, P = .007) and a history of congestive heart failure (OR = 2.1, 95% CI = 1.1–5.1, P = .034). The presence of abnormalities on preoperative ECGs was not associated with an increased risk of postoperative cardiac complications (OR = 0.63, 95% CI = 0.28–1.40, P = .26).CONCLUSION: Abnormalities on preoperative ECGs are common but are of limited value in predicting postoperative cardiac complications in older patients undergoing noncardiac surgery. These results suggest that obtaining preoperative ECGs based on an age cutoff alone may not be indicated, because ECG abnormalities in older people are prevalent but nonspecific and less useful than the presence and severity of comorbidities in predicting postoperative cardiac complications.
Spinal Cord Stimulation in Peripheral Vascular Disease: A Retrospective Analysis of 95 Cases
Authors: Reig E. , Abejón D. , Del Pozo C. , Wojcikiewicz R. 
Published: March 2003

Abstract: Spinal Cord Stimulation is one of the interventionist treatments used for treating diverse chronic pain syndromes.This study analyses retrospectively 95 patients diagnosed as suffering from grave peripheral arteriopathy in Fontaine state III (36 patients) and Fontaine state IV (56 patients). Eight patients required a minor amputation and 29 a major amputation. Those patients diagnosed as suffering from diabetes (diabetic arteriopathy) had a higher rate of amputation, above all those diagnosed as Fontaine group III. The most frequent complication was incorrect stimulation (22 cases), which necessitated the repositioning of the electrode.
Does intraarticular morphine improve pain control with femoral nerve block after anterior cruciate ligament reconstruction? (Vanderbilt University Medical Center, Nashville, TN) American Journal of Sports Medicine 2001;29:327–332.
Authors: McCarthy Eric C. , Spindler Kurt P. , Tingstad Ed , Shyr Yu , Higgins Michael 
Published: March 2003

In a prospective, randomized, double‐blinded manner, the authors of this study compared the effects of a preoperative intraarticular injection of morphine (5 mg) or a placebo, combined with a postoperative femoral nerve block, on postoperative pain. Sixty‐two patients underwent an arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. No statistical difference between the 2 groups was evident in terms of age, sex, weight, operative time, volume of bupivacaine received with the femoral nerve block, or tourniquet use or tourniquet time. A comparison of the visual analog pain scale scores revealed no statistical difference between the groups at any point after the operation. Both groups had a significant decrease in visual analog scale scores after the femoral nerve block. No significant difference in postoperative narcotic medication use was evident in the recovery room or at home. A post hoc analysis revealed that the study power reached 87% with a significance level of 5%. Conclude that the postoperative femoral nerve block was effective and intraarticular morphine provided no additional benefit.Comment by Alan David Kaye, M.D., Ph.D., and Erin Bayer, M.D. This prospective, randomized, double blinded study compared the effects of preoperative intraarticular injection of morphine or a placebo along with postoperative femoral “three‐in‐one” block on postoperative pain. 62 patients underwent arthroscopic ACL reconstruction under general anesthesia. After induction of anesthesia, patients were injected with either morphine 5 mg or placebo along with local anesthetics intraarticularly. Femoral nerve blocks were performed in the recovery room with a total of 3 mg/kg bupivacaine. The VAS of pain was assessed immediately postoperatively and at six time points afterward up to 24 hours. This study concluded that there were no statistical differences between the two groups comparing VAS. Also no significant difference was observed in postoperative narcotic use in the recovery room or at home. The study included antiemetics; however, the results did not include if the morphine group had a larger incidence of nausea or vomiting postoperatively. Finally, the authors suggest that there are no advantages to use of intraarticular morphine with a femoral nerve block post‐operatively. A future study employing preoperative femoral nerve block with or without use of intraarticular morphine might be interesting to see on arthroscopic ACL repairs to obtain adequate analgesia as the authors suggested.
An in vivo rat model to study calcitonin gene related peptide release following activation of the trigeminal vascular system. (Department of Neurology, University of Essen, Essen, Germany) Pain. 2001;92:101–106.
Authors: Limmroth Volker , Katsarava Zaza , Liedert Bernd , Guehring Hans , Schmitz Kerstin , Diener Hans‐Christoph , Michel Martin C. 
Published: March 2003

This report described a new rat model, which allowed the study of calcitonin gene related peptide (CGRP) release from the meninges into venous blood following activation of the trigeminal vascular system. The effects of classical and new antimigraine drugs as acetylsalicylic acid (ASA), sumatriptan and the new high efficacy 5‐HT1B/1D agonist donitriptan (4‐[4‐[2‐(2‐aminoethyl)‐1H‐indol‐5‐yloxyl]acetyl]piperazinyl‐1‐yl] benzonitrile) were evaluated in comparison with the established model of neurogenic inflammation in the meninges. Sumatriptan and donitriptan inhibited CGRP release as well as neurogenic inflammation. ASA, however, attenuated neurogenic inflammation, but not CGRP release, confirming the concept of prejunctional inhibition of CGRP release by 5‐HT1B/1D receptors. This new model allows the further study of prejunctional pharmacology and mechanisms of neuropeptide release in the trigeminal vascular system, which might be crucial for the further development of potent, more effective anti‐migraine drugs.Comment by Leland Lou Basic migraine headache research report with the goal of establishing trigeminal stimulation in rats as an equivalent substitute for the cat model and superior sagittal sinus stimulation is discussed. The 5‐HT receptor agonists appeared to be more efficacious than inflammation suppression with NSAIDs alone. Within the 5‐HT receptor agonists group, donitriptan had a statistical benefit greater than sumitriptan. In summary the rat model results are similar to the cat migraine model with an increase in calcitonin gene related peptide levels and neurogenic inflammation.
Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions. (Medical School Hannover, Hannover, Germany) Neurosurgery. 2001;48:1269–1275.
Authors: Samii Madjid , Bear‐Henney Steffani , Lüdemann Wolf , Tatagiba Marcos , Blömer Ulrike 
Published: March 2003

Forty‐seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years. Immediately after surgery, 75% of the patients experienced significant pain reduction; this value was reduced to 63% during long‐term follow‐up monitoring. Nine patients experienced major complications including subdural hematomas and motor weakness of the lower limb. Improved coagulation electrodes with thermistors that could produce smaller and more accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. Conclude that long‐term follow‐up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long‐lasting satisfactory relief is possible for the majority of individuals with acceptable morbidity rates.Comment by Ron Pawl, M.D. This paper is important for several reasons. It provides a long‐term follow‐up on patients suffering intractable pain after cervical nerve root avulsion from the cord, and results of dorsal root entry zone lesioning using the thermocoagulation technique, where lesions are made at 1 mm intervals covering the length of the cord and one level above and one below the levels of the roots involved. Thirty‐nine of 47 patients had 63% reduction of pain in follow‐up of 2 to 18 years (14 year average). The authors also reported that 9 patients experienced major complications including subdural hematomas and lower extremity weakness, which they attribute to the electrodes used to make the lesions prior to 1989. Using an improved electrode since that time, they report fewer complications. Also, the authors note no correlation between the duration of the pain, the time between the trauma and the surgery, and the time of onset of the pain after trauma with the outcome of the surgery, indicating the procedure is effective, even when carried out years after the onset of the pain. This last concept puts a damper on the idea of centralized pain memory as the mechanism for the chronic pain.
Does Cohn‐fractionated Rh immune globulin transmit viral hepatitis?
Authors: Iwarson S. , Steen Y. , Rybo G. , Hermodsson S. , Antonsson I. , Vietorisz A. 
Published: March 2003

In light of recently raised doubts about the safety of Cohn fraction II globulins, a prospective study on the risk of transmission of viral hepatitis with a Cohn‐fractionated Rh immune globulin (Rhesonativ, KabiVitrum AB, Stockholm, Sweden) was performed in 47 newly delivered mothers. The women were followed regularly for 6 months after the injection of the Rh immune globulin for biochemical, serological, and clinical signs of viral hepatitis.No clinical signs of acute hepatitis were noted during the study, nor were HBsAg or anti‐HBc found in any patient. A slight and transient rise in alanine aminotransferase (ALT) levels was seen in three women, but these never reached 2.5 times the upper normal limit as is the currently used lower limit for a diagnosis of non‐A, non‐B hepatitis. One woman had positive tests for anti‐HBs at 5 and 5.5 months, respectively, after the injection, but serum samples taken before and after this period were all anti‐HBs negative. Nonspecific reactions in the method used probably explained this finding.This prospective study supports the contention that Rhesonativ, a Cohn‐fractionated Rh immune globulin, does not transmit viral hepatitis.
HIV 2 infection among blood donors and other subjects in France
Authors: COUROUCE A.M. ,   THE “RETROVIRUS” STUDY GROUP OF THE FRENCH SOCIETY OF BLOOD TRANSFUSION: F. BARIN, J. BAUDELOT, S. CHAMARET, M. GUEGUEN, C. JANOT, J. M. LEMAIRE, M. MANIEZ, F. MESNIER, L. MOUILLOT, L. NOEL, M. L. NORTH, C. ROUZIOUX AND W. SMILOVICI
Published: March 2003

Abstract: During a 3 year period, from August 1985 to August 1988, 18 HIV 2‐infected blood donors were detected in France as a result of systematic HIV 1 screening. These sera were characterized as HIV 2 by specific Western blot and synthetic peptides. Within the same period, 40 other HIV 2 infected subjects were identified by our study group, independently of blood donations. Thirty of these 58 subjects living in France originate from West Africa (8 blood donors), 3 (1 blood donor) are Portuguese men who had lived in West Africa and 25 (9 blood donors) are of French origin; among these, 16 have had a known close contact with West Africa.When HIV 2‐infected subjects were asymptomatic, cross reactivity between antibodies to HIV 2 and HIV 1 proteins was generally observed with the two‐step ELISA assays using total HIV 1 proteins; it was poor with the competitive assays and variable with the assays using recombinant proteins. When the subjects had signs of immunodeficiency, cross reactivity decreased.The data confirm that HIV 2 is not widespread in France and that most of HIV 2‐infected but asymptomatic subjects are recognized by several HIV 1 ELISA assays. Accordingly, systematic screening for HIV 2 with an additional test cannot be recommended at the present time, but a combined HIV 1 and HIV 2 test will be useful when available.
Antenatal platelet antibody testing by flow cytometry—results of a pilot study
Authors: Marshall L. R. , Brogden F. E. , Roper T. S. , Barr A. L. 
Published: March 2003

BACKGROUND: Maternal platelet antibodies can cause fetomaternal alloimmune thrombocytopenia (FMAT), which has significant mortality and morbidity even in a first pregnancy. Prenatal diagnosis of FMAT has not previously been possible in the first affected pregnancy.STUDY DESIGN AND METHODS: Using flow cytometry, a sensitive, inexpensive test for the detection of platelet antibodies has been developed. It was adapted for use as a possible antenatal screening test, and 600 pregnant women were tested in a pilot study.RESULTS: In the study group, two women tested positive for platelet‐specific IgG antibodies, one for anti‐HPA‐ 1a and the other for anti‐HPA‐1a with anti‐HLA. In each case, the fetus was found to be affected in utero, and treatment was initiated before successful delivery. Another woman was shown to have a platelet‐ reactive autoantibody without IgG specificity, and her infant was unaffected. A total of 95 (15.8%) of the women tested had HLA antibodies alone, and the majority demonstrated IgG specificity. On follow‐up of 62 infants born to these women, none had thrombocytopenia; thus HLA antibodies were not shown to lead to FMAT in this study.CONCLUSION: The flow cytometry‐based test for platelet antibodies can detect clinically significant maternal antibodies, and it may be that early diagnosis and treatment in utero can enhance outcome in FMAT. A population screening program is planned to determine the predictive power of this test, in addition to its sensitivity, specificity, and efficiency.
Clinical study of recovery and half‐life of vapor‐heated factor VII concentrate
Authors: Rivard G. E. , Kovac I. , Kunschak M. , Thöne P. M. ,   Factor VII Study Group
Published: March 2003

BACKGROUND: The in vivo recovery and half‐life of intermediate‐purity, vapor‐heated factor VII (FVII) concentrate were determined in patients having a congenital deficiency for FVII according to the 1991 guidelines of the International Society for Thrombosis and Haemostasis.STUDY DESIGN AND METHODS: A total of 11 patients received a single infusion of the FVII concentrate. Blood was drawn before infusion and 15 and 30 minutes and 1, 2, 4, 8, 12, and 24 hours after. Recoveries were calculated from the highest FVII activity of the first four blood samples drawn after infusion. The two‐phase linear regression method was used to estimate the half‐life according to the two‐compartment model. In addition, a noncompartmental approach was applied.RESULTS: The mean recovery value obtained for FVII concentrate, 110.53 percent (SD, ± 26.37), indicates rapid and efficient incorporation into the blood stream. Equivalent results were obtained with both pharmacokinetics methods and indicate a very short half‐life for FVII. A half‐life of 6.49 hours (SD, ± 2.42) was obtained with the compartmental method and a half‐life of 5.25 hours (SD, ± 2.42) with the noncompartmental method.CONCLUSION: The half‐life and recovery reported here, along with the specificity of the replacement therapy, the earlier anecdotal cases of clinical efficacy, and the clinical safety of the concentrate with regard to viral infections, recommend vapor‐heated FVII concentrate for the treatment of patients with hereditary FVII deficiency.