bluuebunny/crossref_metadata_2025_split huggingface dataset:
The utility of specific immunoglobulin E measurements in primary care
Authors: Duran‐Tauleria E. , Vignati G. , Guedan M. J. A. , Petersson C. J. 
Published: July 2004

Background:  The identification of atopic patients may not be considered a necessary step in the diagnosis process in primary care. This study investigated the impact of the addition of a specific immunoglobulin E (IgE) antibody test on the current management by primary‐care physicians of patients with respiratory and skin symptoms.Methods:  The study had a prospective before–after design. It was conducted in two geographic areas of Italy and Spain and consisted of two parts, Part I and Part II. In each part patients were recruited according to inclusion and exclusion criteria. After the clinical examination, the patients were classified into one of the following categories using a physician's classification: allergic, nonallergic or uncertain. A blood sample was taken from each included patient for specific IgE antibody determination using a Pharmacia CAP SystemTM, including either Phadiatop Infant (0–5 years of age) or Phadiatop and food mix (fx5e) (>5 years of age). If a positive result was found, an additional 6–26 specific IgE tests were performed. In Part I the result of the specific IgE antibody determinations was not available before the physician's classification was made. In contrast, in Part II, the result of the IgE test was available at the time when the physician's classification was made. Between Part I and Part II an educational intervention for physicians to improve their knowledge of blood testing for IgE‐mediated allergy was carried out.Results:  A total of 721 patients were included in the study. The agreement between classifications based on clinical data and IgE antibody results changed from a kappa coefficient of 0.13 in Part I to 0.86 in Part II. With regard to the allergic status the proportion of uncertain cases was reduced from 26.3% in Part I to 4.1% in Part II. The proportion of patients that were advised to avoid allergens increased from 18% in Part I to 62% in Part II in the group of patients classified both by the clinician and the IgE test.Conclusions:  The use of specific IgE antibody determinations improves the clinical management of patients with allergy related symptoms in primary care, allowing advice to be given on specific allergen avoidance. However, the applicability of this diagnostic tool in different areas and countries should be further assessed in cost‐effectiveness studies.
Assessment by flow cytometry of intracellular cytokine production in the peripheral blood cells of renal transplant recipients
Authors: Magee Colm C , Denton Mark D , Womer Karl L , Khoury Samia J , Sayegh Mohamed H 
Published: July 2004

Abstract:  Introduction:  There is accumulating evidence that non‐invasive immune monitoring may be useful in the early period after renal transplant, particularly with regard to predicting the presence of acute rejection. It is less clear whether chronic allograft nephropathy (CAN) is also associated with consistent changes in peripheral blood or urine cells. We hypothesized that patients with CAN would manifest different patterns of cytokine production (compared with non‐CAN controls), detectable in peripheral blood mononuclear cells (PBMCs).Methods:  Flow cytometry was used to quantify production within PBMCs of multiple cytokines.Results:  A pilot study showed significant differences in cytokine production between healthy controls and transplanted subjects. However, differences between transplanted patients with and without CAN were small and non‐significant.Discussion:  Flow cytometry is a potentially useful method for quantifying cytokine production by PBMCs of renal transplant recipients. The technique is sensitive enough to detect differences between distinct test groups but could not find differences between recipients with and without CAN. This probably reflects the lack of a true difference because pathological changes within the long‐term allograft may simply not be reflected or detected in the total population of PBMCs. Further studies should explore the usefulness of this technique in assaying more defined populations of PBMCs (such as those activated by donor allopeptides) and in serial monitoring of individual patients.
Hypercoagulable state associated with kidney–pancreas transplantation. Thromboelastogram‐directed anti‐coagulation and implications for future therapy
Authors: Burke George W , Ciancio Gaetano , Figueiro Jose , Buigas Rafael , Olson Les , Roth David , Kupin Warren , Miller Joshua 
Published: July 2004

Abstract: Background: The clinical consequences of type 1 diabetes mellitus (IDDM) include diabetic triopathy: retinopathy, nephropathy, and neuropathy, as well as microangiopathy, accelerated atherosclerotic disease, and hypercoagulability. The etiology of the hypercoagulability is multifactorial, involving various clotting factors or pathways (for example platelets, fibrinogen, individual components of the clotting system and/or fibrinolysis in different studies). The development of end‐stage renal disease (ESRD), with the uremia‐related platelet effect has the potential to protect from the existing hypercoagulable state. This has important implications for surgery, particularly simultaneous pancreas–kidney (SPK) transplantation, where the pancreas has historically been prone to thrombosis. This has led us to perform intra‐operative thromboelastograms (TEG's) to evaluate the patient's current coagulation status.Methods: A TEG was performed in 85 SPK recipients along with a control group of 54 non‐diabetic kidney transplant (KT) recipients.Results: For each of the 4 TEG coagulation parameters, the SPK recipients were significantly more hypercoagulable than the non‐diabetic KT recipients. The use of intra‐operative heparin is based on the degree of hypercoagulability by TEG and degree of operative hemostasis. There has been one PT lost to thrombosis (1%) in the first week following transplantation during this time.Conclusion: The use of TEG is a helpful adjunct to SPK surgery, demonstrating the patient's current coagulation status. Nearly all SPK recipients (type 1 IDDM with ESRD) have been demonstrated to be hypercoagulable. The TEG allows the judicious use of anti‐coagulation at the time of surgery, and beyond.
Pre‐transplant elevations of interleukin‐12 and interleukin‐10 are associated with acute rejection after renal transplantation
Authors: Fitzgerald Jason T , Johnson Jeremy R , Perez Richard V 
Published: July 2004

Abstract:  Background:  Methods for predicting patients at higher risk for rejection before transplantation may help improve outcomes. We hypothesized that pre‐transplant elevations of serum interleukin‐12 (IL‐12), a pro‐inflammatory cytokine, would predict acute rejection, while pre‐transplant IL‐10, an immunoregulatory cytokine, would be down‐regulated in patients subsequently experiencing acute rejection.Materials and methods:  Thirty patients experiencing acute rejection after cadaveric renal allograft transplantation and a control group of 30 patients, undergoing the same procedure but without the occurrence of rejection, were identified. Serum samples taken before transplantation from each patient were then analyzed quantitatively for IL‐12 and IL‐10 using ELISA assays.Results:  The mean pre‐transplant serum IL‐12 level was higher in patients who subsequently underwent acute rejection vs. those who did not (181 ± 143 pg/mL vs. 81.2 ± 71.5 pg/mL, respectively, p = 0.007). Unexpectedly, pre‐transplant serum IL‐10 levels were also elevated in patients who underwent rejection (559 ± 293 pg/mL vs. 332 ± 163 pg/mL, respectively, p = 0.002). Multivariate analysis demonstrated that elevations of IL‐12 and IL‐10 were independent risk factors for rejection when adjusted for confounding variables.Conclusions:  Pre‐transplant elevations of IL‐12 and, unexpectedly, IL‐10 are associated with acute rejection after cadaveric renal transplantation and may be useful in predicting which patients are at increased immunological risk at the time of transplantation. Further studies are necessary to assess the role of occult systemic inflammation in contributing to poor outcomes after transplantation.
Arginine vasopressin and serum nitrite/nitrate concentrations in advanced vasodilatory shock
Authors: Dünser M. W. , Werner E. R. , Wenzel V. , Ulmer H. , Friesenecker B. E. , Hasibeder W. R. , Mayr A. J. 
Published: July 2004

Background:  Arginine‐vasopressin (AVP) can successfully stabilize hemodynamics in patients with advanced vasodilatory shock. It has been suggested that inhibition of cytokine‐induced nitric oxide production may be an important mechanism underlying AVP‐induced vasoconstriction. Therefore, serum concentrations of nitrite/nitrate (NOx), the stable metabolite of nitric oxide, were measured in patients suffering from advanced vasodilatory shock treated with either AVP in combination with norepinephrine (NE) or NE alone.Methods:  This trial was a separate study arm of a previously published prospective, randomized, controlled study on the effects of AVP in advanced vasodilatory shock. Thirty‐eight patients were prospectively randomized to receive a combined infusion of AVP (4 U h−1) and NE, or NE infusion alone. Serum NOx concentrations were measured at baseline, 24, and 48 h after randomization. The increase in mean arterial pressure during the first hour after study enrollment was documented in all patients.Results:  No difference in NOx concentrations was found between groups throughout the study period. AVP patients demonstrated a significantly greater increase in mean arterial pressure than NE patients (22 ± 10 vs. 5 ± 9 mmHg; P < 0.001). The magnitude of pressure response to AVP was not correlated with NOx concentrations before start of AVP infusion (Pearson's correlation coefficient, −.009; P = 0.971).Conclusion:  Cardiovascular effects of AVP infusion in advanced vasodilatory shock are not mediated by a clinically relevant reduction in serum NOx concentrations. Therefore, hemodynamic improvement of patients in advanced vasodilatory shock during continuous infusion of AVP has to be attributed to other mechanisms than inhibition of nitric oxide synthase. In addition, the magnitude of pressure response to AVP is not correlated with baseline concentrations of NOx.
Effectiveness and efficiency of intensive care medicine: variable costs in different diagnosis groups
Authors: Iapichino G. , Radrizzani D. , Simini B. , Rossi C. , Albicini M. , Ferla L. , Colombo A. , Pezzi A. , Brazzi L. , Melotti R. , Rossi G. ,   for the GiViTI group (Italian Group for the Evaluation of Interventions in Intensive Care Medicine)
Published: July 2004

Background:  To establish the effectiveness of ICU treatment and the efficiency in the use of resources in patients stratified according to 10 diagnosis and two levels‐of‐care. To propose strategies aimed at reducing costs and improving efficiency in each patient group.Methods:  Multicentre prospective observational study. ICUs enrolled two cohorts of up to 10 consecutive patients with ICU stay ≥48 h. Each with one of these diagnoses: trauma, brain‐trauma, brain‐hemorrhage, stroke, acute‐on‐chronic‐obstructive‐pulmonary disease, lung‐injury/acute respiratory distress syndrome, heart failure, and scheduled/unscheduled abdominal surgery. The presence of active‐life support divides high from low level‐of‐care treatments. Variable ICU costs were collected daily (bottom‐up) for 21 days. We evaluated effectiveness (hospital survival) and efficiency (hospital‐survivors variable‐cost as a ratio of overall cost).Results:  Forty‐two Italian general ICUs recruited 529 patients in 5 months. Mean ICU variable‐costs significantly differed with diagnosis and level‐of‐care. Costs were positively affected by ICU length‐of‐stay, by duration of active‐treatment. Outcome variably influenced costs. Medians of variable‐costs per patient (1715 Euro) and patient‐groups efficiencies (60.7%) identified four possible combinations between (low and high) cost and (low and high) efficiency groups. Moreover, efficiency was better than effectiveness in stroke, brain‐hemorrhage and trauma, while it was worse in heart failure, acute‐on‐COPD or acute‐lung injury. Overall ICU cost attributed only to survivors ranged from 699 (scheduled surgical) to 5906 (unscheduled surgical) Euro. Cost of non‐survivors distributed to all patient was between 95 (scheduled‐surgical) to 1633 (unscheduled‐surgical) Euro.Conclusions:  Analysis of variable patient‐specific cost was used as a tool to assess intensive care performance in patient subgroups with different diagnosis and levels‐of‐care.
Pulmonary net release of tissue‐type plasminogen activator during porcine primary and secondary acute lung injury
Authors: Nyberg A. , Fagerberg A. , Ahlqvist M. , Jern C. , Seeman‐Lodding H. , Åneman A. 
Published: July 2004

Background:  Tissue‐type plasminogen activator (tPA) is a key mediator of fibrinolysis. Matching of pulmonary perfusion and ventilation is a critical denominator of oxygenation in acute lung injury (ALI). This study investigates pulmonary venoarterial plasma tPA gradients in association with acute ALI induced by bronchoalveolar lavage (BAL) and endotoxinemia (ETX).Methods:  Twenty‐one anaesthetized, ventilated pigs were allocated to control (CTRL, n=5), bronchoalveolar saline lavage (BAL, n=8) or infusion of Escherichia coli endotoxin (ETX, n=8). Total tPA was analyzed in plasma (ELISA calibrated for porcine tPA). The inflammatory response was assessed by TNFa levels (ELISA). All variables were assessed at baseline and 2 h following ALI.Results:  Bronchoalveolar lavage and ETX induced similar increases in pulmonary shunt whereas pulmonary vascular resistance was significantly more increased in ETX animals. Cardiac output remained stable in BAL animals but decreased in ETX animals. The pulmonary venoarterial tPA plasma gradient increased in ETX animals, yielding a positive pulmonary net flux of tPA, which was absent in BAL animals. TNFα levels increased in ETX, but not in BAL, animals. A significant correlation was observed between TNFα and tPA plasma levels in ETX animals. All variables remained unchanged in CTRL animals.Conclusion:  Plasma changes of tPA levels support a pulmonary release of tPA in early experimental ALI induced by acute ETX but not lavage, and are related to the inflammatory response. Despite increased vascular fibrinolytic capacity in ETX animals, pulmonary dysfunction was not different from BAL animals. The results demonstrate the close relation between inflammation and coagulation in early ALI.
Glucocorticoid regulation of the inflammatory response to injury
Authors: Yeager M. P. , Guyre P. M. , Munck A. U. 
Published: July 2004

During the first half of the 20th century, physiologists were interested in the adrenal glands primarily because adrenalectomized animals failed to survive even mild degrees of systemic stress. It eventually became clear that hormones secreted by the adrenal cortex were critical for survival and, in this context, adrenal cortical hormones were widely considered to support or stimulate important responses to stress or injury. With the purification and manufacture of adrenal cortical hormones in the 1930s and 1940s, clinicians suddenly discovered the potent anti‐inflammatory actions of glucocorticoids (GCs). This dramatic, and unexpected, discovery has dominated clinical and laboratory research into GC actions throughout the second half of the 20th century.More recent research is again reporting GC‐induced stimulatory effects on a variety of inflammatory response components. These effects are usually observed at low GC concentrations, close to concentrations that are observed in vivo during basal, unstimulated states. For example, GC‐mediated stimulation has been reported for the hepatic acute‐phase response, for cytokine secretion, expression of cytokine/chemokine receptors, and for the pro‐inflammatory mediator, macrophage migration inhibition factor. It seems clear that the long‐held clinical view that GCs act solely as anti‐inflammatory agents needs to be re‐assessed. Varying doses of GCs do not lead simply to varying degrees of inflammation suppression, but rather GCs can exert a full range of effects from permissive to stimulatory to suppressive.
Is a double‐injection technique superior to a single injection in posterior subgluteal sciatic nerve block?
Authors: Taboada M. , Álvarez J. , Cortés J. , Rodríguez J. , Atanassoff P. G. 
Published: July 2004

Bckground and objectives:  Currently, no information is available on the effects of a double‐injection technique on onset time and efficacy following subgluteal sciatic nerve blockade. We hypothesized that the success rate and time to onset of subgluteal nerve block following a double‐injection technique would be superior to that after a single injection.Methods:  Fifty ASA I or II patients undergoing foot or ankle surgery randomly received a single or double injection subgluteal sciatic nerve block. Group S (n=25) received a single injection of 30 ml of 0.75% ropivacaine to the sciatic nerve. In Group D (n = 25), 15 ml of the same solution was injected to each sciatic nerve component. Completion of sensory and motor blockade, and patient acceptance, was evaluated by a blinded anesthesiologist.Results:  Complete sensory and motor blockade of the foot was achieved faster with the double injection (7.4 [5.9–8.8] min and 12.3 [10.4–14.2] min, respectively) than with the single‐injection technique (12.5 [10.7–14.3] min and 18.8 [16.7–21.0] min, respectively) (P<0.001 and P<0.001, respectively). Success rate and acceptance were similar in both groups. Severe or moderate discomfort during the procedure was less frequent after a single injection (P = 0.013).Conclusions:  Both the single‐ and double‐injection technique for subgluteal sciatic nerve blockade resulted in acceptable anesthesia in most patients. The double injection generated a faster onset of anesthesia than the single injection. However, the double‐injection technique caused more patient discomfort during establishment of the nerve block.
Robust estimation of breeding values in a random regression test‐day model
Authors: Yang R. , Schaeffer L. R. , Jamrozik J. 
Published: July 2004

SummaryTwo robust estimation procedures were applied to a random regression test‐day model to reduce the effects of test‐day records that are generally labelled as outliers. One robust procedure consisted of estimating residuals (actual observation minus predicted) from the genetic evaluation model, computing the standard deviation of residuals across all records, and restricting the outlier residuals to be within k standard deviations. Thus, a new observation is created for use in the genetic evaluation model. The process is part of the iterations on data to obtain solutions to mixed model equations until no more outliers beyond k standard deviations exist. Four different values of k were examined. The second robust procedure utilizes different weights with each test‐day record. Weights are estimated from the residuals for all observations. Outliers tend to receive smaller weights, and thus, their influence tends to be reduced. In this study, eleven different weight formulas were compared. The objectives were to apply the robust procedures to test‐day milk yield records of Canadian Jersey cattle and to determine the effects on estimated breeding values (EBVs) and rankings of animals. Results were compared to usual best linear unbiased prediction (BLUP) ignoring the outlier problem.
Modelling the effect of nutritional status on pre‐asymptotic and relative growth rates in a random‐bred chicken population
Authors: Aggrey Samuel E. 
Published: July 2004

SummaryThis study was undertaken to use the spline linear regression to model pre‐asymptotic body weight measurements from an unselected random‐bred chicken population fed two different protein diets. The spline linear regression model is a compound function comprising of series of linear models. It was used to compartmentalize growth into segments. The birds raised under the low‐protein diet had four compartments, whereas those raised under the high‐protein diet had three compartments. Whereas the protein level defined the number of splines or compartments, the growth potential demonstrated by the sexes were different. The males under low‐protein diet grew faster than the females under high‐protein diet. Even though both sexes responded to high‐protein diet, a high‐protein diet in females was not enough to raise their growth potential to that of males under low protein levels. The efficiency of growth under the two protein levels were assessed with relative growth. Relative growth rate is the increase in body weight per unit of body weight per unit of time, and it represents the efficiency of an animal as a producer of new body mass material. The maximum relative growth modeled by the Gompertz function for both sexes under the two protein levels were observed at day 6 and hereafter, declined proportionally to a proponent of the amount of growth remaining. Despite the high absolute growth of the birds fed a high‐protein diet compared with their counterparts fed a low‐protein diet, the relative growth rates of the two groups were comparable. Modelling both absolute and relative growth show that the maximum absolute and relative growth rates occur within different time frame, as a result, selecting on absolute growth rate for improved relative growth within the same time frame or vice versa may not achieve the desired selection goal. The use of the spline regression and relative growth models would have practical application for commercial broilers and broiler breeders where growth is either truncated before the asymptote or controlled by dietary and other environmental factors to prevent excessive obesity.
The value of sexed bovine semen
Authors: Madalena F. E. , Junqueira F. S. 
Published: July 2004

SummarySemen sexing may be used in a variety of practical situations, where part (or all) of the herd may be inseminated with X‐ and Y‐chromosome‐enriched semen. Expressions are presented to calculate the net present value of progeny derived from a semen dose, dependent on the values of females and males, and on the efficiency of sexing. Sexed semen allows selling a higher proportion of the more valuable sex and also increases the value of animals retained for breeding through more intense selection. The expressions to economically evaluate sexed semen are quite general but numerical examples are presented for several practical situations of interest in Brazil.
WHAT IS THE STANDARD OF EUS GUIDED FNA IN JAPAN?
Authors: Kida Mitsuhiro , Saito Yoshitake 
Published: July 2004

ABSTRACTAfter the reports by Vilmann and Grimm, endoscopic ultrasonography (EUS) guided fine needle aspiration (FNA) has become popular in the clinical fields, especially in the western world. However, EUS guided FNA is still a special examination in Japan, although it is also becoming popular. At the moment there is no standardization of EUS guided FNA in Japan. According to the questionnaire we put together, most experienced Japanese endosonographers commonly employed a 22 or 21 guage needle for EUS guided FNA. Optimally, EUS guided FNA is repeated to obtain enough tissue and to be confirmed histologically on site; however, it is confirmed macroscopically in more than half of the institutions included in the survey. All institutions used stylet, which is generally pulled back 1–3 cm during the puncture of the center of target lesion and commonly changed the pass way at each stroke. Negative pressure by the suction of 20 cc syringe has been used in most of institutions. Times of strokes varies from less than 10–30 in each institution. About pushing out the sample tissue, half of institutions used a stylet. As mentioned above, on site histo‐cytologist with diff quick staining is optimal for EUS guided FNA; however, most of institutions do not allow this at the moment.In order to widen EUS guided FNA we conducted multicenter study on the standardization of EUS guided FNA with statistical evidence.