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Terms modified by ISS Selected AbstractsInvestigating moderate to severe paediatric trauma in the Auckland regionEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2010Louise Couch Abstract Objective: To investigate differences between paediatric patients with moderate to severe trauma admitted from two paediatric ED, with respect to: demographics, patterns of presentation, mechanism of injury, injury severity scores (ISS), interventions and outcome. Method: Retrospective cohort study. Moderate to severe trauma was defined as ISS >9. Paediatric patients admitted to hospital via Starship Children's Emergency or KidzFirst ED, with trauma from 1 May 2003 to 30 April 2004, with ISS >9 were identified using multiple databases. The charts were reviewed and data collected included: demographics, hospital of first presentation, diagnoses, ISS, Paediatric trauma score (PTS), Glasgow coma score (GCS), ventilator hours, length of admission, survival and discharge destination. Descriptive statistics with 95% confidence intervals, Mann,Whitney U -test, ,2 -test and Fisher's exact test were used as appropriate. Results: A total of 393 children with moderate to severe trauma were identified using initial search strategies. Of these, 82 children met the inclusion and exclusion criteria for the study; 42 children were admitted via KidzFirst ED and 40 via Starship Children's ED. There was no statistically significant difference in ISS (P= 0.86), PTS (P= 0.11), GCS (P= 0.62), hours on a ventilator (P= 0.28) and length of stay (P= 0.87) between children admitted from Starship or KidzFirst ED. Conclusion: This study suggests that there are no differences in the numbers or severity of paediatric trauma patients admitted from the Starship and KidzFirst ED. This indicates triage is to the closest ED despite having a tertiary referral centre for paediatric trauma available in Auckland City. [source] Multiple myeloma in elderly patients: prognostic factors and outcomeEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2005Athanasios Anagnostopoulos Abstract:,Objectives:,Purpose of this study was to compare prognostic factors and outcome of patients with multiple myeloma (MM) aged >70 yr at diagnosis with those of younger patients. We also applied the recently proposed International Staging System (ISS) for MM in these patients. Patients and methods:,Among 1,162 newly diagnosed, symptomatic MM patients included in our database, 357 (31%) were >70 yr of age. Clinical and laboratory variables were evaluated in patients >70 yr and in younger patients and were assessed for possible correlation with survival in patients >70 yr of age. Results:,Most clinical and laboratory features were similar in the two groups of patients but older patients presented more frequently with advanced ISS (P = 0.02). Despite similar response rates to primary treatment, younger patients survived longer than patients >70 yr of age (40 vs. 28 months, P = 0.001). There was a longer survival of younger patients than that of older patients diagnosed with ISS stage 1 (median 71 vs. 54 months, P = 0.007) and ISS stage-2 patients (median: 38 vs. 26 months, P = 0.0008) but for patients with ISS stage 3 median survival was similarly poor in the younger and older age group (21 and 20 months, P = 0.283). Other variables associated with impaired prognosis were severe anemia, extensive bone marrow plasmacytosis and elevated serum LDH. Conclusions:,Older patients with MM present more often with advanced ISS and have significantly shorter survival than younger patients. The ISS retained its prognostic significance within the group of elderly patients. [source] Human alcoholism studies of genes identified through mouse quantitative trait locus analysisADDICTION BIOLOGY, Issue 4 2002Marissa A. Ehringer Coding region DNA sequence variants have been recently identified in several QTL candidate genes in a mouse model of differential sensitivity to alcohol [inbred long-sleep (ILS) and inbred short-sleep (ISS)]. This work has been extended into a human population characterized for their initial level of response to alcohol (LR). The coding region of one of the most promising of these candidate genes, zinc finger 133 (Znf133), has been sequenced completely in 50 individuals who participated in alcohol challenges at approximately age 20 and have been followed subsequently for the last 15 years. PCR products were obtained for the protein coding region of ZNF133 using human genomic DNA and directly sequenced using automated sequencers. Novel single nucleotide polymorphisms (SNPs) were detected by analyzing the sequence data using a suite of bioinformatics programs including Consed, Phred, Phrap and Polyphred. Five human SNPs were detected, two that correspond to amino acid changes in the protein, two that are silent DNA changes and one located in an intron. In this small sample, no significant association between any of the SNPs and alcohol diagnosis was detected. A follow-up of these SNPs in a larger sample should allow a more definitive conclusion to be reached. Significantly, the data presented here demonstrate the feasibility of directly testing genes in human alcoholic populations that had been identified first by comparative DNA sequencing of candidate genes located within mouse alcohol-related QTLs, even without detailed knowledge of the gene's function. [source] Lake age and water level affect the turbidity of floodplain lakes along the lower RhineFRESHWATER BIOLOGY, Issue 3 2003F. C. J. M. Roozen SUMMARY 1. We sampled a set of 93 lakes situated in the floodplains of the lower River Rhine in search for morphometric and other factors that explain their variation in clarity. 2. Lakes with a drop in summer water level were less turbid at the time of sampling, mainly because of a lower concentration of inorganic suspended solids (ISS). 3. We also found that older lakes were more turbid than younger lakes and that this was largely because of an increase in phytoplankton. 4. Water clarity was positively related to lake depth and the presence of vegetation. 5. Model calculations indicated that the underwater light climate was strongly affected by chlorophyll and ISS, the latter being the dominant factor affecting Secchi depth. Dissolved organic carbon (DOC) was less important. 6. The high concentration of ISS suggests that intensive resuspension occurs in most of the lakes. Using a simple wave model, and assuming that vegetation protects sediments against resuspension, we could eliminate wind resuspension as an important process in 90% of the lakes, leaving resuspension by benthivorous fish as probably the most important factor determining transparency. 7. Chlorophyll a concentration showed a strong positive correlation to ISS concentration, suggesting that resuspension may also have a positive effect on phytoplankton biomass in these lakes. 8. In conclusion, in-lake processes, rather than river dynamics, seem to be driving the turbidity of floodplain lakes along the lower River Rhine. [source] Seismotectonics of the Sinai subplate , the eastern Mediterranean regionGEOPHYSICAL JOURNAL INTERNATIONAL, Issue 1 2003Amos Salamon SUMMARY We define the Sinai subplate, from a seismotectonic perspective, as a distinct component in the plate tectonics of the eastern Mediterranean region. This is based on the tectonic characteristics of a comprehensive listing of all ML, 4 recorded seismicity in the region during the 20th century, on newly calculated and recalculated fault plane mechanisms of first P -wave arrivals and on published solutions based on waveform inversion of broad-band data. The low seismicity level and scarcity of strong events in the region required a thorough search for useful data and a careful examination of the reliability of the focal solutions. We gathered all available records of first P -wave onsets from the ISS and ISC Bulletins and the local seismic networks. Altogether, we were able to calculate 48 new focal mechanisms and 33 recalculated ones of events that occurred during the years 1940,1992. With the increasing number of teleseismic and regional broad-band stations in the later years, we added 37 solutions based on teleseismic and regional waveform inversions of events that occurred during 1977,2001. These mechanisms enabled us to examine the seismotectonic character of the Sinai subplate. The strike and rake directions of the calculated mechanisms usually reflect the geometry and the large-scale type of deformation observed along the boundaries of the Sinai subplate,the Dead Sea Transform, the Cypriot Arc convergent zone and the Suez Rift. Nevertheless, along each of these boundaries we found anomalous solutions that attest to the complexity of the deformation processes along plate margins. Earthquakes along the Dead Sea Transform exhibit mainly sinistral transtension and transpression, reflecting its leaky manner and local change in the transform geometry. The presence of other unexpected mechanisms near the transform, however, reflects the heterogeneous deformation it induces around. As expected, thrust mechanisms along the Cypriot Arc mirror its convergent nature and typical curved geometry. Transtension and transpressional solutions in the eastern segment of the arc reflect the sinistral shear motion between Anatolia and Sinai there. However, shear mechanisms found between Cyprus and the Eratosthenes Seamount pose a problem regarding its collision process. Most intriguing of all are ML, 4 thrust and shear solutions found in the Gulf of Suez. They are associated with predominantly normal mechanisms within a rift zone and therefore constitute a unique phenomenon, yet to be deciphered. [source] The Association Between Hypothermia, Prehospital Cooling, and Mortality in Burn VictimsACADEMIC EMERGENCY MEDICINE, Issue 4 2010Adam J. Singer MD Abstract Objectives:, Hypothermia is associated with increased morbidity and mortality in trauma victims. The prognostic value of hypothermia on emergency department (ED) presentation in burn victims is not well known. The objective of this study was to determine the incidence of hypothermia in burn victims and its association with mortality and hospital length of stay (LOS). The study also examined the potential causative role of prehospital cooling in hypothermic burn patients. Methods:, This was a retrospective review of a county trauma registry. The county was both suburban and rural, with a population of 1.5 million and with one burn center. Burn patients between 1994 and 2007 who met trauma registry criteria were included. Demographic and clinical data including prehospital cooling, burn size and depth, and presence of inhalation injury were collected. Hypothermia was defined as a core body temperature of less than or equal to 35°C. Data analysis consisted of univariate associations between patient characteristics and hypothermia. Results:, There were 1,215 burn patients from 1994 to 2007. Mean age (±standard deviation [±SD]) was 29 (±24) years, 67% were male, 248 (26.7%) had full-thickness burns, and 24 (2.6%) had inhalation injury. Only 17 (1.8%) had a burn larger than 70% total body surface area (TBSA). A total of 929 (76%) patients had an initial ED temperature recorded. Only 15/929 (1.6%) burn patients had hypothermia on arrival, and all were mild (lowest temperature was 32.6°C). There was no association between sex, year, and presence of inhalation injury with hypothermia. Hypothermic patients were older (44 years vs. 29 years, p = 0.01), and median Injury Severity Score (ISS) was higher (25 vs. 4, p = 0.002) than for nonhypothermic patients. Hypothermia was present in 6/17 (35%) patients with a TBSA of 70% or greater and in 8/869 (0.9%) patients with a TBSA of <70% (p < 0.001). Mortality was higher in hypothermic patients (60% vs. 3%, p < 0.001). None of the hypothermic patients received prehospital cooling. Conclusions:, Hypothermia on presentation to the ED was noted in 1.6% of all burn victims in this trauma registry. Hypothermia was more common in very large burns and was associated with high mortality. In this series, prehospital cooling did not appear to contribute to hypothermia. ACADEMIC EMERGENCY MEDICINE 2010; 17:456,459 © 2010 by the Society for Academic Emergency Medicine [source] Proliferative activity of plasma cells is the most relevant prognostic factor in elderly multiple myeloma patientsINTERNATIONAL JOURNAL OF CANCER, Issue 5 2004R. García-Sanz Abstract Although multiple myeloma (MM) is predominantly a disease of the elderly, few studies have focused on the identification of prognostic factors in this group of patients. Four hundred twenty five MM patients >65 years were uniformly treated with chemotherapy (MP or VCMP/VBAD). Multivariate analysis identified 4 factors with independent unfavorable prognostic influence: high percentage of S-phase bone marrow plasma cells (>2.5%); elevated ,2 microglobulin (B2M) (>4 mg/L); age >80 years old; and LDH serum levels (above normal limit). The S-phase value was the most powerful independent prognostic factor to discriminate subgroups of patients with different prognosis. Thus, 3 main risk categories could be identified according to S-phase values: ,1%, 1,3% and >3%, with median survivals of 34, 22 and 12 months, respectively (p < 0.0001). Our study also proved the value for elderly patients of the recently developed International Score System (ISS) based on B2M and albumin. Furthermore, the number of S-phase cells helped to subdivide the ISS III Group identifying a subset of patients with very poor prognosis defined by an additional high S-phase, who displayed a median survival of only 8 months. These results demonstrate that elderly patients can be accurately classified according to prognosis, which may be particularly valuable when comparing the efficacy of new treatment strategies. Moreover, our results underline the high prognostic value of proliferative activity of PC, a parameter that should be considered in routine laboratory investigations of MM. © 2004 Wiley-Liss, Inc. [source] The Efficacy of Factor VIIa in Emergency Department Patients With Warfarin Use and Traumatic Intracranial HemorrhageACADEMIC EMERGENCY MEDICINE, Issue 3 2010Daniel K. Nishijima MD Abstract Objectives:, The objective was to compare outcomes in emergency department (ED) patients with preinjury warfarin use and traumatic intracranial hemorrhage (tICH) who did and did not receive recombinant activated factor VIIa (rFVIIa) for international normalized ratio (INR) reversal. Methods:, This was a retrospective before-and-after study conducted at a Level 1 trauma center, with data from 1999 to 2009. Eligible patients had preinjury warfarin use and tICH on cranial computed tomography (CT) scan. Patients before (standard cohort) and after (rFVIIa cohort) implementation of a protocol for administering 1.2 mg of rFVIIa in the ED were reviewed. Glasgow Coma Scale (GCS) score, Revised Trauma Score (RTS), Injury Severity Score (ISS), INR, and Marshall score were collected. Outcome measures included mortality, thromboembolic complications, and INR normalization. Results:, Forty patients (median age = 80.5 years, interquartile range [IQR] = 63.5,85) were included (20 in each cohort). Age, GCS score, ISS, RTS, initial INR, and Marshall score were similar (p > 0.05) between the two cohorts. Survival was identical between cohorts (13 of 20, or 65.0%, 95% confidence interval [CI] = 40.8% to 84.6%). There were no differences in rate of thromboembolic complications in the standard cohort (1 of 20, 5.0%, 95% CI = 0.1% to 24.9%) than the rFVIIa cohort (4 of 20, 20.0%, 95% CI = 5.7% to 43.7%; p = 0.34). Time to normal INR was earlier in the rFVIIa cohort (mean = 4.8 hours, 95% CI = 3.0 to 6.7 hours) than in the standard cohort (mean = 17.5 hours, 95% CI = 12.5 to 22.6; p < 0.001). Conclusions:, In patients with preinjury warfarin and tICH, use of rFVIIa was associated with a decreased time to normal INR. However, no difference in mortality was identified. Use of rFVIIa in patients on warfarin and tICH requires further study to demonstrate important patient-oriented outcomes. ACADEMIC EMERGENCY MEDICINE 2010; 17:244,251 © 2010 by the Society for Academic Emergency Medicine [source] Tracking control for sampled-data systems with uncertain time-varying sampling intervals and delaysINTERNATIONAL JOURNAL OF ROBUST AND NONLINEAR CONTROL, Issue 4 2010N. van de Wouw Abstract In this paper, a solution to the approximate tracking problem of sampled-data systems with uncertain, time-varying sampling intervals and delays is presented. Such time-varying sampling intervals and delays can typically occur in the field of networked control systems. The uncertain, time-varying sampling and network delays cause inexact feedforward, which induces a perturbation on the tracking error dynamics, for which a model is presented in this paper. Sufficient conditions for the input-to-state stability (ISS) of the tracking error dynamics with respect to this perturbation are given. Hereto, two analysis approaches are developed: a discrete-time approach and an approach in terms of delay impulsive differential equations. These ISS results provide bounds on the steady-state tracking error as a function of the plant properties, the control design and the network properties. Moreover, it is shown that feedforward preview can significantly improve the tracking performance and an online extremum seeking (nonlinear programming) algorithm is proposed to online estimate the optimal preview time. The results are illustrated on a mechanical motion control example showing the effectiveness of the proposed strategy and providing insight into the differences and commonalities between the two analysis approaches. Copyright © 2009 John Wiley & Sons, Ltd. [source] Robust tracking control for a class of MIMO nonlinear systems with measurable output feedbackINTERNATIONAL JOURNAL OF ROBUST AND NONLINEAR CONTROL, Issue 1 2008Ya-Jun Pan Abstract This paper proposes a robust output feedback controller for a class of nonlinear systems to track a desired trajectory. Our main goal is to ensure the global input-to-state stability (ISS) property of the tracking error nonlinear dynamics with respect to the unknown structural system uncertainties and external disturbances. Our approach consists of constructing a nonlinear observer to reconstruct the unavailable states, and then designing a discontinuous controller using a back-stepping like design procedure to ensure the ISS property. The observer design is realized through state transformation and there is only one parameter to be determined. Through solving a Hamilton,Jacoby inequality, the nonlinear control law for the first subsystem specifies a nonlinear switching surface. By virtue of nonlinear control for the first subsystem, the resulting sliding manifold in the sliding phase possesses the desired ISS property and to certain extent the optimality. Associated with the new switching surface, the sliding mode control is applied to the second subsystem to accomplish the tracking task. As a result, the tracking error is bounded and the ISS property of the whole system can be ensured while the internal stability is also achieved. Finally, an example is presented to show the effectiveness of the proposed scheme. Copyright © 2007 John Wiley & Sons, Ltd. [source] ,2 -Stabilization of continuous-time linear systems with saturating actuatorsINTERNATIONAL JOURNAL OF ROBUST AND NONLINEAR CONTROL, Issue 18 2006E. B. Castelan Abstract This paper addresses the problem of controlling a linear system subject to actuator saturations and to ,2 -bounded disturbances. Linear matrix inequality (LMI) conditions are proposed to design a state feedback gain in order to satisfy the closed-loop input-to-state stability (ISS) and the closed-loop finite gain ,2 stability. By considering a quadratic candidate Lyapunov function, two particular tools are used to derive the LMI conditions: a modified sector condition, which encompasses the classical sector-nonlinearity condition considered in some previous works, and Finsler's Lemma, which allows to derive stabilization conditions which are adapted to treat multiple objective control optimization problems in a potentially less conservative framework. Copyright © 2006 John Wiley & Sons, Ltd. [source] Multimedia satellite communications experiments to the international space stationINTERNATIONAL JOURNAL OF SATELLITE COMMUNICATIONS AND NETWORKING, Issue 5 2002Carlo Matarasso Abstract In the present concept of the International Space Station ISS, it is planned to provide the communication services between the European Columbus module of the ISS and the ground equipment via the TDRS (tracking and data relay satellite) network provided by the American NASA (National Aeronautics and Space Agency). Especially because of its low uplink data rate, an unacceptable limitation of the communication services with Columbus is to be expected. In order to investigate possible improvements to this situation, the MEDIS proposal studies the feasibility of a 150 Mbps full duplex communication system to the Columbus Module on via two MEO satellites. A mixed topology with optical inter satellite links and Ka-band up/down-links shall be employed. Also possible liaisons with the Artemis mission will be considered. The MEDIS project is a collaboration of Astrium GmbH, which is project manager, Bosch SatCom, GMD-Fokus and the German Aerospace Center (DLR). The preparation phase of the project will investigate the concept of the communications infrastructure and the experiments that could be realized when the MEOs are launched. This stage has been completed in February 2001. An additional study phase followed, which will be completed with a presentation in July 2002. Briefly the following aspects have been studied by DLR in the preparation phase: the overall concept of experimental communication services for Columbus, the system requirements and network topology, the relevant protocol and hardware architectures, useful satellite constellations and link scenarios. Two phases could follow the preparation phase, in phase one the satellite will be launched and the link will be tested. In phase two the satellites will be connected to the ISS. Copyright © 2002 John Wiley & Sons, Ltd. [source] Can sildenafil treat primary premature ejaculation?INTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2007A prospective clinical study Background: Recently, sildenafil has been demonstrated to be effective in treating premature ejaculation (PE). However, these studies ignored female factors and could not exclude the probability of drug interaction when combined with paroxetine. Therefore, the aim of this study was to evaluate the efficacy and safety of sildenafil alone in the treatment of primary PE, taking female factors into consideration. Methods: One hundred and eighty potent men with primary PE were randomly divided into three groups and followed up for 6 months. Group A were treated with 50 mg sildenafil as needed, group B with 20 mg paroxetine daily and group C with squeeze technique daily. Intravaginal ejaculatory latency time (IELT), PE grade, intercourse satisfactory score (ISS), frequency of intercourse, and adverse effects of drugs were recorded before treatment, and 3 and 6 months after treatment. Results: Compared with pretreatment, the three groups had significant differences in all the parameters after 3 or 6 months treatment, except the frequency of intercourse in Group C (all P = 0.00). However, there were no significant differences between 3 and 6 months. Compared with paroxetine and squeeze technique, after 3 or 6 months, sildenafil had significant differences in all the parameters (all P = 0.00). After 6 months, 1.7%, 18.3% and 36.7% patients in groups A, B and C, respectively, withdrew from the study and 86.7%, 60.0% and 45.0% patients, respectively, wanted to be treated further with the original administration, and this was statistically significant (both P = 0.00). Conclusion: Sildenafil is very effective and safe to treat PE, and has much higher efficacy than paroxetine and squeeze technique. [source] Feeding and anhydrobiosis in bdelloid rotifers: a preparatory study for an experiment aboard the International Space StationINVERTEBRATE BIOLOGY, Issue 4 2004Claudia Ricci Abstract. Here we report the effect of food concentration on the recovery from anhydrobiosis of a bdelloid rotifer, Macrotrachela quadricornifera. Cohorts were either starved, or fed high or low concentrations of food, before being dried and their subsequent recovery rates determined. The rotifers starved for 3 d before anhydrobiosis recovered in significantly higher proportion, and those fed lower food concentration recovered better than those fed higher food concentration. In addition, starvation did not decrease the recovery of other bdelloid species (Philodina roseola and Adineta sp. 1) which were either fed or starved before anhydrobiosis. These results suggest that a successful recovery from anhydrobiosis is not dependent on prior resource level supplied to the bdelloids. However, the lack of resources might not be the only factor in a successful recovery from anhydrobiosis. Observations using scanning electron microscopy of fed individuals of M. quadricornifera entering anhydrobiosis showed that some food remained in the digestive tract. Thus, we propose that the negative effect of rich food may be due to a purely mechanical effect and may be interfering with a proper folding of the rotifer body at the onset of anhydrobiosis. This contribution results from studies carried out in preparation for biological experiments scheduled on the International Space Station (ISS). [source] Validation of Length of Hospital Stay as a Surrogate Measure for Injury Severity and Resource Use Among Injury SurvivorsACADEMIC EMERGENCY MEDICINE, Issue 2 2010Craig D. Newgard MD Abstract Objectives:, While hospital length of stay (LOS) has been used as a surrogate injury outcome when more detailed outcomes are unavailable, it has not been validated. This project sought to validate LOS as a proxy measure of injury severity and resource use in heterogeneous injury populations. Methods:, This observational study used four retrospective cohorts: patients presenting to 339 California emergency departments (EDs) with a primary International Classification of Diseases, Ninth Revision (ICD-9), injury diagnosis (years 2005,2006); California hospital injury admissions (a subset of the ED population); trauma patients presenting to 48 Oregon EDs (years 1998,2003); and injured Medicare patients admitted to 171 Oregon and Washington hospitals (years 2001,2002). In-hospital deaths were excluded, as they represent adverse outcomes regardless of LOS. Duration of hospital stay was defined as the number of days from ED admission to hospital discharge. The primary composite outcome (dichotomous) was serious injury (Injury Severity Score [ISS] , 16 or ICD-9 ISS , 0.90) or resource use (major surgery, blood transfusion, or prolonged ventilation). The discriminatory accuracy of LOS for identifying the composite outcome was evaluated using receiver operating characteristic (ROC) analysis. Analyses were also stratified by age (0,14, 15,64, and ,65 years), hospital type, and hospital annual admission volume. Results:, The four cohorts included 3,989,409 California ED injury visits (including admissions), 236,639 California injury admissions, 23,817 Oregon trauma patients, and 30,804 Medicare injury admissions. Composite outcome rates for the four cohorts were 2.1%, 29%, 27%, and 22%, respectively. Areas under the ROC curves for overall LOS were 0.88 (California ED), 0.74 (California admissions), 0.82 (Oregon trauma patients), and 0.68 (Medicare patients). In general, the discriminatory value of LOS was highest among children, tertiary trauma centers, and higher volume hospitals, although this finding differed by the injury population and outcome assessed. Conclusions:, Hospital LOS may be a reasonable proxy for serious injury and resource use among injury survivors when more detailed outcomes are unavailable, although the discriminatory value differs by age and the injury population being studied. ACADEMIC EMERGENCY MEDICINE 2010; 17:142,150 © 2010 by the Society for Academic Emergency Medicine [source] The early IL-6 and IL-10 response in trauma is correlated with injury severity and mortalityACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009J. STENSBALLE Background: Trauma has previously been shown to influence interleukin (IL)-6 and IL-10 levels, but the association of injury severity and mortality with IL-6 and IL-10 responses in the early phase of accidental trauma remains to be investigated. We wished to describe serum levels of IL-6 and IL-10 in the first 24 h after trauma and to assess the relationship with severity of injury and mortality. Methods: Prospective, descriptive cohort study in a Level 1 trauma centre, Copenhagen, Denmark. We included 265 consecutive adult trauma patients admitted directly from the accident scene during an 18-month period. Serum levels of IL-6 and IL-10 were measured upon arrival and at 6, 12, and 24 h after admittance using an enzyme-linked immunosorbent assay. Correlation analysis was used to assess the relationship between Injury Severity Score (ISS) and levels of IL-6 and IL-10. Analysis of variance was used to describe the IL-6 and IL-10 concentrations in relation to 30-day mortality in a mixed-effect model repeated measures analysis. Results: Mortality was 10.9% (29/265) at 30 days. A significant increase of both IL-6 and IL-10 concentrations was found over time, and a significant correlation was found between ISS and the levels of both IL-6 and IL-10 at all sampling points. Serum concentrations of IL-6 and IL-10 were significantly higher in patients not surviving 30 days (P<0.0001). Conclusion: The early systemic inflammatory response measured as IL-6 and IL-10 in serum is correlated with injury severity and 30-day mortality following trauma. [source] Increased melatonin concentrations in children with growth hormone deficiencyJOURNAL OF PINEAL RESEARCH, Issue 2 2007Michal Karasek Abstract:, A relationship between melatonin and growth hormone (GH) is poorly understood. We compare circadian melatonin rhythms in short children with normal and decreased GH secretion. The analysis included 22 children (20 boys and 2 girls) aged 11.1,16.9 yr (mean ± S.E.M. = 14.1 ± 0.3 yr) with short stature (height SDS below ,2.0). Based on the GH peak in stimulation tests patients were divided into two groups: idiopathic short stature (ISS, n = 11; GH peak , 10 ng/mL) and GH deficiency (GHD, n = 11; GH peak < 10 ng/mL). In all patients the circadian melatonin rhythm was assessed on the basis of nine blood samples, collected in 4-hr intervals during the daytime and 2-hr intervals at night, with dark period lasting from 22:00 to 06:00 hr. Magnetic resonance imaging examination excluded organic abnormalities in central nervous system in all patients. Melatonin concentration at 24:00, 02:00 and 04:00 hr as well as the area under curve of melatonin concentrations (AUC) were significantly higher in the patients with GHD than in individuals with ISS. Significant correlations between GH secretion and melatonin concentrations at 24:00, 02:00 and 04:00 hr, and AUC were also observed. On the basis of these data it seems that the assessment of nocturnal melatonin secretion might be a valuable diagnostic tool used for the improvement of the difficult diagnosis of short stature in children. [source] Cerebellar Gene Expression Profiling and eQTL Analysis in Inbred Mouse Strains Selected for Ethanol SensitivityALCOHOLISM, Issue 9 2005Erik J. MacLaren Background: Inbred Long-Sleep (ILS) and Inbred Short-Sleep (ISS) mice exhibit striking differences in a number of alcohol and drug related behaviors. This study examined the expression levels of more than 39,000 transcripts in these strains in the cerebellum, a major target of ethanol's actions in the CNS, to find differentially expressed (DE) candidate genes for these phenotypes. Methods: Genes that were differentially expressed between the strains were identified using oligonucleotide arrays as well as complimentary DNA arrays. Sequence alignment was used to locate DE genes in the mouse genome assembly. In silico expression QTL (eQTL) mapping was used to identify chromosomal regions likely to control the transcription level of DE genes, and the EASE program identified overrepresented functional themes. The genomic region immediately upstream of the cyclase associated protein homolog 1 (Cap1) gene was directly sequenced from PCR products. Results: Nearly 300 genes were identified as differentially expressed between the cerebella of ILS and ISS. These genes and their corresponding eQTLs map to genomic regions linked to several phenotypes that differ between the ILS and ISS strains, including ethanol preference and cocaine-induced locomotor activation on Chromosomes 4 and 7 respectively. Eight genes were cross-platform validated, four of which are more highly expressed in ILS cerebellum. Three SNPs, one of which disrupts a predicted Sp1 binding site, were found in the upstream region of Cap1, a strong candidate for influencing ethanol phenotypes. Conclusions: Many of these DE genes are candidates to influence ethanol and drug regulated phenotypes because they either map to ethanol related QTLs in the genome or are linked to them through eQTL mapping. Genes involved in calcium ion binding and transcriptional regulation are overrepresented and therefore these gene classes may influence ethanol behaviors in mice and humans. [source] Evaluation of pre-hospital trauma triage criteria: a prospective study at a Danish level I trauma centreACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2007S. H. Kann Background:, The aim of the present study was to evaluate the precision of our trauma triage protocol [based on the American College of Surgeons, Committee on Trauma (ACS COT)] in identifying severely injured defined as an injury severity score (ISS) > 15. Our hypothesis was that isolated mechanism-of-injury criteria were responsible for a significant over-triage leading to over-use of our trauma team. Methods:, Design: A prospective cohort study. Setting: A level I trauma centre, Aarhus, Denmark. Patients and participants: Among all injured patients admitted during a 6-month period in 2003 we identified severely injured. During the study period, trauma team activations were consecutively registered and triage criteria were prospectively collected. Sensitivity, specificity, positive predictive value, over-triage and under-triage were calculated. Results:, Out of 15,162 patients in the emergency department, 848 injured patients were included and 59 (7%) were severely injured. We had 242 trauma team activations with 54 (22%) severely injured. Sensitivity was 92%, specificity 76%, giving an over-triage of 24% and an under-triage of 8%. The positive predictive value was 22%. Among 60 patients with mechanism-of-injury as the only criterion, five were severely injured in contrast to 12 out of 20 patients with mechanism-of-injury combined with physiological and/or anatomical criteria. Conclusion:, The positive predictive value of our triage protocol was low, only 22%. This was mainly as a result of a significant over-triage from isolated mechanism-of-injury criteria. We recommend revision of the triage protocol and reallocation of our trauma team resources. [source] Overtriage in trauma , what are the causes?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2007O. Uleberg Background:, Different criteria are employed to activate trauma teams. Because of a growing concern about overtriage, the objective of this study was to investigate the performance of our trauma team's activation protocol. Methods:, Injured patients with trauma team activation (TTA), admission to an intensive care unit or surgical intermediate care unit with a trauma diagnosis, or trauma-related death in the emergency department were investigated retrospectively from 1 January 2004 to 31 December 2005. Different TTA criteria were analysed with respect to sensitivity, positive predictive value (PPV) and overtriage (1 , PPV). Results:, Eight hundred and nine patients were included, 185 (23%) of whom had an Injury Severity Score (ISS) of more than 15. The performance of our protocol showed a sensitivity of 87%, PPV of 22% and overtriage of 78%. The mechanism of injury as a TTA criterion had a sensitivity of 14%, PPV of 7% and overtriage of 93%. Physiological/anatomical criteria and interfacility transfer showed higher PPV and less overtriage. Undertriage (no TTA despite ISS > 15) was identified in 23 patients (13%), 18 of whom were hospital transfers. Conclusion:, A TTA protocol based on physiological, anatomical and interfacility transfer criteria seems to yield a higher precision than, in particular, that based on mechanism of injury criteria. Because of substantial overtriage in our hospital, the TTA protocol needs to be re-evaluated. [source] Fine Mapping of Polymorphic Alcohol-Related Quantitative Trait Loci Candidate Genes Using Interval-Specific Congenic Recombinant MiceALCOHOLISM, Issue 11 2002Marissa A. Ehringer Background The inbred long-sleep (ILS) and inbred short-sleep (ISS) strains of mice are widely studied as a model of initial sensitivity to alcohol. Recently, a large comparative DNA sequencing study of candidate genes located within the four Lore quantitative trait loci (QTLs) associated with the ethanol-induced loss of righting reflex in ILS and ISS mice has identified eight genes that contain coding region differences corresponding to amino acid changes. Here, recently developed interval-specific congenic recombinant mice (ISCRs) have been used to map these genes in relationship to newly narrowed QTL regions. Methods Regions of candidate genes containing DNA differences corresponding to previously identified amino acid changes between ISS and ILS mice were amplified from either genomic DNA or complementary DNA from ISCR mice using polymerase chain reaction. The products were purified and directly sequenced to determine the genotypes for each polymorphism. On the basis of these genotypic data, each candidate gene was determined to be located either within or outside of recently narrowed Lore QTL intervals. Results Of these eight candidates with protein-coding differences, five are now excluded from their respective Lore intervals. The other three (Znf142, Ptprn, and Znf133) have been localized to the narrowed QTL intervals. Conclusions These three central nervous system genes (Znf142, Ptprn, and Znf133) represent promising candidates for involvement in the differential sensitivity to alcohol exhibited between ILS and ISS mice. This study also demonstrates how the combination of high-throughput comparative gene sequencing and concomitant genetic fine mapping of QTL regions with ISCRs can be an effective tool for accelerating the process of moving from QTL to gene. [source] Possible Pleiotropic Effects of Genes Specifying Sedative/Hypnotic Sensitivity to Ethanol on Other Alcohol-Related TraitsALCOHOLISM, Issue 10 2002Jeremy C. Owens Background Initial sensitivity to ethanol is a predictor of alcohol abuse that has been studied extensively in both human and animal populations. Selection for initial sensitivity to the sedative/hypnotic effects of ethanol resulted in the long-sleep and short-sleep lines of mice. Some of the genes selected in these lines could also specify differential responses in other ethanol-related phenotypes and, perhaps, for other drugs of abuse. We assessed congenic mice carrying a single quantitative trait locus (QTL) from the inbred long-sleep (ILS) or inbred short-sleep (ISS) strain on the reciprocal background for a number of ethanol- and pentobarbital-related phenotypes. Methods Each congenic strain was tested for ethanol elimination rates at 4.1 g/kg, ethanol-induced ataxia at 2.0 g/kg, ethanol-induced hypothermia at 4.1 g/kg, and pentobarbital-induced loss of righting reflex (LORR) at 60 mg/kg. Additionally, the ILS.ISS congenics were tested for low-dose ethanol-induced activation (LDA) at five doses ranging from 0.6 to 1.2 g/kg ethanol, and the ISS.ILS congenics were tested for LDA at 1.8 g/kg of ethanol. Results There was little difference in the ethanol elimination rate between congenics and background strains, although a modest sex effect was found, with the females eliminating ethanol more rapidly than the males. We were unable to replicate previous differences found in LDA for the Lore1 congenic on the ISS background, because none of the congenics differed from controls for LDA. Lore5 congenics showed a differential effect of pentobarbital-induced LORR in the expected directions. The Lore1 congenics on the ISS background showed more ethanol-induced ataxia than the ISS controls. Additionally, the hypothermic response seems affected by Lore4 and Lore5 and maybe others. Conclusions At least two regions carrying a QTL specifying sensitivity to high doses of ethanol cospecify altered sensitivity in other measures of alcohol action. Specifically, these QTLs clearly affect ethanol-induced hypothermia and pentobarbital-induced LORR and possibly ethanol-induced ataxia. [source] Evidence That the Lore-1 Region Specifies Ethanol-Induced Activation in Addition to Sedative/Hypnotic Sensitivity to EthanolALCOHOLISM, Issue 11 2001Jeremy C. Owens Background: Low-dose ethanol-induced activation (LDA) and initial sensitivity to alcohol are both predictors of alcohol abuse in human populations. Our hypothesis is that one or more genes specifying hypnotic sensitivity also specify LDA. We tested this hypothesis by using congenic mice derived from the inbred long-sleep (ILS) and inbred short-sleep (ISS) strains, which carry an ILS region introgressed onto an ISS background. Methods: LDA was assessed by assigning mice randomly to receive one of five doses of ethanol ranging from 1.2 to 2.4 g/kg. On day 1, animals were injected with saline and placed in a brightly lit activity monitor for 30 min, after which they were returned to their home cages. On day 2, mice were injected with ethanol (20% w/v), their activity was monitored for a 30-min period, and LDA was determined by subtracting day 1 activity. The blood ethanol concentration of each animal was then assessed at 30 min by retro-orbital collection of 25 ,l of blood. Results: Ethanol had a significant effect on the activity of ISS mice, but ILS mice showed no activation at any dose, similar to the activities of the outbred lines. All three congenic strains were activated at several doses. Lore-2 and Lore-5 were not ILS-like (less active than ISS) at any dose. In contrast, ISS.ILS- Lore-1 congenics (carrying an ILS-derived Lore-1 allele on the ISS background) were significantly less activated than the ISS controls at 1.8 and 2.4 g/kg of ethanol. Conclusions: The Lore-2 and Lore-5 congenic regions do not affect LDA. In contrast, the Lore-1 congenic region carries one or more genes specifying both initial hypnotic sensitivity to ethanol and LDA. [source] N -methyl-d-aspartate Receptor Responses Are Differentially Modulated by Noncompetitive Receptor Antagonists and Ethanol in Inbred Long-Sleep and Short-Sleep Mice: Behavior and ElectrophysiologyALCOHOLISM, Issue 12 2000Taleen Hanania Background: Short-sleep (SS) mice exhibit higher locomotor activity than do long-sleep (LS) mice when injected with low doses of ethanol or the noncompetitive N -methyl-D-aspartate receptor (NMDAR) antagonist MK-801 (dizocilpine). SS mice also have higher densities of brain NMDARs. However, two strains of LS X SS recombinant inbred (RI) mice also show differential activation to ethanol and MK-801, but have similar numbers of NMDARs. Here we used inbred LS (ILS) and SS (ISS) mice to investigate further the relationship between NMDARs and sensitivity to the stimulant effects of low doses of ethanol. Methods: Open field activity and spontaneous alternations were measured after saline or drug injection. [3H]MK-801 binding parameters were determined in hippocampus, cortex, striatum, and nucleus accumbens. Extracellular field excitatory postsynaptic potentials (fEPSPs) were recorded in the CA1 region of hippocampal slices. Results: Systemic injection of either ethanol or MK-801 increased locomotor activity to a greater extent in ISS mice than in ILS mice. The competitive NMDAR antagonist 2-carboxypiperazin-4-yl-propyl-1,1phosphonic acid (±CPP) depressed activity of ILS, but not ISS, mice. No strain differences were observed in spontaneous alternations or in the number or affinity of NMDARs in the brain regions examined. Likewise, the magnitudes of hippocampal NMDAR-mediated fEPSPs were similar in ILS and ISS mice and were inhibited to the same extent by a competitive NMDAR antagonist. However, both ethanol and the NMDAR NR2B receptor antagonist ifenprodil inhibited the late component of hippocampal NMDAR fEPSPs to a greater extent in ISS, than in ILS, mice. Conclusions: Differential ethanol- and MK-801-induced behavioral activation in ILS and ISS mice was not associated with differences in NMDAR number. Nonetheless, pharmacological differences in hippocampal NMDAR responsiveness suggest that ISS mice express NMDARs that have a greater sensitivity to noncompetitive, but not competitive, NMDAR antagonists. These differences, which may reflect differences in NMDAR subunit composition, could underlie the differential responsiveness to low doses of ethanol in ILS and ISS mice. [source] Investigating information retrieval support techniques for different information-seeking strategiesJOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 8 2010Xiaojun Yuan We report on a study that investigated the efficacy of four different interactive information retrieval (IIR) systems, each designed to support a specific information-seeking strategy (ISS). These systems were constructed using different combinations of IR techniques (i.e., combinations of different methods of representation, comparison, presentation and navigation), each of which was hypothesized to be well suited to support a specific ISS. We compared the performance of searchers in each such system, designated "experimental," to an appropriate "baseline" system, which implemented the standard specified query and results list model of current state-of-the-art experimental and operational IR systems. Four within-subjects experiments were conducted for the purpose of this comparison. Results showed that each of the experimental systems was superior to its baseline system in supporting user performance for the specific ISS (that is, the information problem leading to that ISS) for which the system was designed. These results indicate that an IIR system, which intends to support more than one kind of ISS, should be designed within a framework which allows the use and combination of different IR support techniques for different ISSs. [source] Malaria Epidemiological Situation in Italy and Evaluation of Malaria Incidence in Italian TravelersJOURNAL OF TRAVEL MEDICINE, Issue 1 2001Roberto Romi Background: Malaria was endemic throughout the country until it was eradicated nearly 50 years ago. Since then, mainly imported malaria cases have been reported to the National Health Service, with an increasing trend. The aim of this study was to present a detailed analysis of the current epidemiological situation of malaria in Italy, and to make a first attempt to calculate the incidence of malaria in Italian international travelers. Methods: An archive of confirmed malaria cases is available at the Istituto Superiore di Sanitá (ISS), the National Institute of Health of Italy, based on the mandatory report system. Data from each case report reported to the ISS from 1989 to 1997 have been analyzed. An evaluation of malaria incidence in Italian travelers has been also performed for the same period, based on the statistics provided by the Ministry of Transport. Results: From 1989 to 1997, a total of 5,898 microscopically confirmed malaria cases have been reported. Of these, 5,773 (97.9%) were imported cases, 106 cases (1.8%) were relapses of Plasmodium vivax or Plasmodium ovale infections, and 19 cases (0.3%) occurred in subjects who had never been out of Italy. During the period of study, 55 deaths due to Plasmodium falciparum malaria were reported, with a mean fatality rate of 1.2%. Malaria incidence in Italians who traveled to Africa was estimated to be 1.5/1000. These figures appeared to be 10,20 and 30,40 times greater than that recorded in travelers to Asia (0.11/1000) and Central-South America (0.04/1000) respectively. Conclusions: From 1989 to 1997, there has been a remarkable increase in the total number of imported malaria cases in Italy, which reached a peak of more than 800 cases/year in 1997. A constant increase in the number of cases affecting foreigners has been reported, while the cases among Italians have remained stable. From 1989 to 1997 the number of Italian intercontinental travelers has nearly doubled, but malaria incidence has remained quite stable. [source] An abnormal nonhyperdiploid karyotype is a significant adverse prognostic factor for multiple myeloma in the bortezomib era,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2010Daryl Tan Multiple myeloma is clinically heterogeneous and risk stratification is vital for prognostication and informing treatment decisions. As bortezomib is able to overcome several high-risk features of myeloma, the validity of conventional risk-stratification and prognostication systems needs to be reevaluated. We study the survival data of 261 previously untreated myeloma patients managed at our institution, where bortezomib became available from 2004 for the treatment of relapse disease. Patient and disease characteristics, and survival data were evaluated overall, and with respect to bortezomib exposure. Overall, the international staging system (ISS), metaphase karyotyping and interphase fluorescence in situ hybridization (FISH) were discerning of survival outcomes, where the median for the entire cohort was 5.2 years. However, when stratified by bortezomib exposure, only metaphase karyotyping was still discriminating of long-term prognosis. The presence of an abnormal nonhyperdiploid karyotype overrides all other clinical and laboratory parameters in predicting for a worse outcome on multivariate analysis (median survival 2.6 years, P = 0.001), suggesting that bortezomib used at relapse is better able to overcome adverse risk related to high tumor burden (as measured by the ISS) than adverse cytogenetics on conventional karyotyping. Metaphase karyotyping provides additional prognostic information on tumor kinetics where the presence of a normal diploid karyotype in the absence of any high-risk FISH markers correlated with superior survival and could act as a surrogate for lower plasma cell proliferation. Am. J. Hematol., 2010. © 2010 Wiley-Liss, Inc. [source] Retrospective comparison of mobilization methods for autologous stem cell transplantation in multiple myeloma,AMERICAN JOURNAL OF HEMATOLOGY, Issue 12 2009Hideki Nakasone The combination of cyclophosphamide and granulocyte-colony stimulating factor (G-CSF) has widely been used to mobilize hematopoietic stem cells (HSCs) for autologous stem cell transplantation (ASCT) for multiple myeloma (MM). Recently, however, alternative approaches such as G-CSF alone or etoposide followed by G-CSF have been investigated. We, therefore, retrospectively analyzed the effects of these mobilization methods on collection yield and disease outcome in ASCT for MM. We reviewed 146 MM patients from whom we intended to collect stem cells. For mobilization, 67, 58, and 21 patients received cyclophosphamide and G-CSF, etoposide and G-CSF, and G-CSF alone (including nonmyelosuppressive chemotherapy followed by G-CSF), respectively. Among them, 136 achieved the target number of HSCs (at least 2 × 106/kg). Lower creatinine and higher albumin levels at diagnosis were significantly associated with successful yield. A lower number of infused HSCs, use of the etoposide for mobilization and high ISS were associated with delayed hematopoietic recovery. The mobilization methods did not significantly affect either the successful collection of more than 2 × 106 CD34-positive cells/kg or PFS after ASCT. G-CSF alone was sufficient for stem cell mobilization for a single ASCT. The optimal approach to collect HSCs in MM remains to be elucidated. Am. J. Hematol., 2010. © 2009 Wiley-Liss, Inc. [source] Impact of vitamin D deficiency on the clinical presentation and prognosis of patients with newly diagnosed multiple myeloma,,AMERICAN JOURNAL OF HEMATOLOGY, Issue 7 2009Alvin C. Ng Vitamin D is a fundamental mediator of skeletal metabolism. It also has important nonskeletal actions. We hypothesized that vitamin D deficiency may play an important role in skeletal morbidity and clinical outcomes in MM. We studied 148 newly diagnosed MM patients from January 1, 2004 through December 31, 2008 who had a serum 25-hydroxyvitamin D [25(OH)D] obtained within 14 days of diagnosis. Subjects with vitamin D deficiency [25(OH)D level less than 50 nmol/L (20 ng/mL)] had higher mean values of serum C-reactive protein (CRP) (2.40 mg/L vs. 0.84 mg/L, P = 0.02) and creatinine (1.75 mg/dL vs. 1.24 mg/dL, P = 0.03) and lower serum albumin values (3.12 g/dL vs. 3.39 g/dL, P = 0.003) compared to subjects without vitamin D deficiency. The prevalence of vitamin D deficiency increased in parallel with International Staging System (ISS): 16% of subjects in Stage I, 20% in Stage II, and 37% in Stage III (P = 0.03) were vitamin D deficient. No differences were detected between the two groups in terms of skeletal morbidity. Association of vitamin D deficiency with higher serum CRP, serum creatinine and ISS stage at time of diagnosis suggests that vitamin D deficiency may portend poorer outcomes in subjects with MM. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] Combinations of cytogenetics and international scoring system can predict poor prognosis in multiple myeloma after high-dose chemotherapy and autologous stem cell transplantation,AMERICAN JOURNAL OF HEMATOLOGY, Issue 5 2009Yoshihiro Inamoto High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard therapy for newly diagnosed multiple myeloma. Combinations of recently proposed prognostic factors such as cytogenetics and international scoring system (ISS) may be useful to predict prognosis after ASCT. This study evaluated 60 consecutive patients who underwent ASCT in four institutes. The median age of patients was 57 years old. Cytogenetic analyses of bone marrow at diagnosis detected metaphase abnormalities in 9 of 51 patients and interphase abnormalities in six of 35 patients (17p13 deletion, t(4;14) and t(14;16)). Seventeen patients had ISS stage 3 at diagnosis. Twenty-five patients who had any of these risk factors were defined as high risk. All patients were conditioned with high-dose melphalan. With a median follow-up of 3.4 years, overall survival and event-free survival at 3 years were significantly worse in high-risk patients (48% vs. 97%; P = 0.0005 and 16% vs. 37%; P = 0.038, respectively) despite the higher CR plus VGPR rate among high-risk patients. In addition, survival at 1 year after progression was significantly worse in high-risk patients despite salvage chemotherapy containing thalidomide (32% vs. 100%, P = 0.0001). Combinations of cytogenetics and ISS could readily predict prognosis. Quality of response is a poor surrogate marker for ultimate outcome. High-risk patients may need more effective treatment. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||