bluuebunny/crossref_metadata_2025 huggingface dataset:
The Evaluation of Endothelial Functions in Patients with Celiac Disease
Authors: Sarı Cenk , Bayram Nihal Akar , Doğan Fatma Ebru Akın , Baştuğ Serdal , Bolat Aylin D. , Sarı Sevil Özer , Ersoy Osman , Bozkurt, M.D. Engin
Published: December 2011

Aim: Celiac disease is characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine after the ingestion of wheat gluten or related rye and barley proteins. This study aimed to identify individuals who are at risk of heart failure and increased risk for cardiovascular events by evaluating endothelial function in patients with celiac disease. Materials and Methods: The study included 36 patients with celiac disease and 35 healthy volunteers. After all routine laboratory examination, left ventricular functions were evaluated with standard two‐dimensional, M‐mode conventional Doppler methods. Then, flow‐mediated dilatation and nitroglycerin‐dependent dilatation tests on brachial artery were performed to all patients and controls. Results: A total of 36 celiac patients and 35 healthy volunteers were included in the study. The brachial artery diameter at baseline was similar between both groups. Measured brachial artery diameter after hyperemia was 30.19 ± 4.47 mm in celiac patients and 32.35 ± 3.77 mm in the control group. Differences between two groups were statistically significant (P = 0.031). Flow‐mediated vasodilatation was lower in celiac patients compared with in controls (10.61 ± 2.64% vs 13.09 ± 2.9%; P = 0.0003). Measured endothelium‐independent vasodilatation in the brachial artery before and after nitroglycerin was similar between both groups (P = 0.09 and P = 0.07, respectively). Conclusion: This research which aimed to evaluate endothelial dysfunction in patients with celiac disease is the first in the literature. As a result of this study, we found endothelial dysfunction at the macrovascular level in celiac patients. (Echocardiography 2012;29:471‐477)
Transcatheter Closure of a Large Atrial Septal Defect under Microprobe Transesophageal Echocardiographic Guidance
Authors: Taniguchi Manabu , Akagi Teiji , Kijima Yasufumi , Ito Hiroshi , Sano Shunji
Published: December 2011

We present a case of an atrial septal defect (ASD) in a 59‐year‐old man with an indication for ASD closure who also had a history of chronic obstructive pulmonary disease. Because of his decreased respiratory function with multiple bullae in his lungs, the procedure was performed without general anesthesia under the guidance of fluoroscopy and two‐dimensional (2D) transesophageal echocardiography (TEE) using a transesophageal echocardiographic microprobe (micro‐TEE) (S8‐3t; Philips Medical Systems, Andover, MA, USA). The micro‐TEE probe was inserted into the esophagus smoothly and easily in the supine position without sedation. It revealed a deficient superior‐anterior rim and adequate rims elsewhere, and the maximal diameter of ASD was measured to be 25 mm. Balloon sizing resulted in a stretched defect diameter of 29 mm using the stop‐flow technique. A 30‐mm AMPLATZER Septal Occluder (AGA Medical, Plymouth, MN, USA) was deployed. The micro‐TEE demonstrated that both disks were on the appropriate sides of the interatrial septum and the device was not interfering with surround cardiac structures. Residual shunt flow was not detected with color Doppler. The device was released successfully without any complications. Recently introduced multiplane micro‐TEE can provide adequate information about a large ASD with a less invasive procedure in adult patients. Micro‐TEE has a potential to become a novel imaging option for interventions of the interatrial septum. (Echocardiography 2012;29:E94‐E96)
Learning from Barcelona: Discourse, Power and Praxis in the Sustainable City
Authors: McDONOGH GARY W.
Published: December 2011

In the 2004 Forum for World Cultures, Barcelona politicians and intellectuals situated sustainability as a key issue for global and local debate. This event also distilled historical experiences of place, contact and conflict that have shaped Barcelona as a global city, while subsequent discussions illuminate the complexities of the creation of an urban culture of sustainability as contemporary urban social practice. Reading sustainability as myth and practice in both spatial and temporal contexts reveals the extent to which ecological commitments combine changes in urban policy, rhetorical statements, positioning within more general competitions for urban branding and citizen responses. Drawing on archival and cultural analysis as well as longterm ethnography, this paper examines Barcelona's search for social ecological policy and the complications of multiple visions and practices of sustainable development.
Sustainable Food vs. Unsustainable Politics in the City of Palermo: The Case of an Organic Farmers' Market
Authors: ORLANDO GIOVANNI
Published: December 2011

The island of Sicily, Italy, and its main city, Palermo, appear an ideal scenario for sustainable food provisioning: the former being the first region in Italy for organically cultivated land, the latter Italy's fifth largest city. This article explores ideals and practices of sustainable urban food systems through an example of environmental consumer activism in Palermo. It does this by narrating the story of an organic farmers' market created by citizens and producers. The article reflects critically on understandings of food‐related ‘sustainability’ held by the actors involved, showing the difficulties of operationalizing the concept for qualitative, socio‐cultural research. It also highlights the potential of grass‐roots activism among consumers and farmers. With particular reference to the Palermitan context, this potential runs counter to an enduring image of the southern Italian region as a place where civil society initiatives are wanting. By analyzing the market's history from its inception to its demise due to difficulties with the center‐right‐wing municipality, the article shows that it is the political element, rather than the cultural one, that often constrains grass‐roots activism in Sicily. These problems of power and political representation raise a crucial question: can a consumer mobilization become a tool for social and environmental transformation in locales where institutions are not already favorably disposed, at least to a certain degree, to the values of such mobilization?
Wiped Out by the “Greenwave”: Environmental Gentrification and the Paradoxical Politics of Urban Sustainability
Authors: CHECKER MELISSA
Published: December 2011

This essay examines the intersection of environmental justice activism and state‐sponsored sustainable urban development—how is environmental justice activism enabled or disabled in the context of rapid urban development, consensual politics and the seemingly a‐political language of sustainability? Drawing on ethnographic research conducted in the Harlem neighborhood of New York City, I define a process I refer to as “environmental gentrification,” which builds on the material and discursive successes of the environmental justice movement and appropriates them to serve high‐end development. While it appears as politically‐neutral, consensus‐based planning that is both ecologically and socially sensitive, in practice, environmental gentrification subordinates equity to profit‐minded development. I propose that this process offers a new way of exploring the paradoxes and conundrums facing contemporary urban residents as they fight to challenge the vast economic and ecological disparities that increasingly divide today's cities.
Damage Development in Confined Borosilicate and Soda‐Lime Glasses
Authors: Dannemann Kathryn A. , Anderson Charles E. , Chocron Sidney , Spencer James F.
Published: December 2011

Post‐test microscopy evaluations were performed on borosilicate (Borofloat® 33) and soda‐lime (Starphire®) glass specimens following confined compression tests. These included optical and electron microscopy investigations of select specimens tested at low strain rates with confinement pressures up to 1 GPa. Specimens were evaluated following removal of the confinement sleeve or holder. The objective of this work was to investigate the flow and failure behavior of both glasses due to compressive loading with confinement. The observations provide an insight into the damage process that occurs during projectile impact/penetration into transparent armor. Highlights of the microscopy evaluations are compared and contrasted for the two glasses of interest. A damage mechanism is proposed based on comparison of the mechanical response data with the post‐test microscopy findings.
Gadolinium Aluminate Garnet (Gd3Al5O12): Crystal Structure Stabilization via Lutetium Doping and Properties of the (Gd1−xLux)3Al5O12 Solid Solutions (x = 0–0.5)
Authors: Li Jinkai , Li Ji‐Guang , Zhang Zhongjie , Wu Xiaoli , Liu Shaohong , Li Xiaodong , Sun Xudong , Sakka Yoshio
Published: December 2011

To suppress the thermal decomposition and stabilize the crystal structure of Gd3Al5O12 (GdAG) garnet, GdAG was doped with significantly smaller Lu3+ to form (Gd,Lu)AG solid solutions. The precursors for (Gd1−xLux)3AG (x = 0–0.5), with a general formula of (NH4)xLn3Al5(OH)y(CO3)z·nH2O (Ln = Gd and Lu), were synthesized via carbonate co‐precipitation from the mixed solutions of aluminum, lutetium, and gadolinium nitrates using ammonium hydrogen carbonate as the precipitant. The results showed that 10 at.% of Lu3+ (x = 0.1) has been able to stabilize GdAG against its thermal decomposition to a mixture of GdAlO3 (GdAP) and Al2O3 phases at temperatures above 1300°C and that Lu3+ doping effectively lowers the temperature for garnet crystallization. The precursors of x ≥ 0.3 convert to pure LnAG at a low temperature of ~1000°C via the intermediates of Ln4Al2O9 (LnAM) and LnAP. The carbonate precursors are loosely agglomerated and the resultant LnAG powders show good dispersion and a fairly uniform particle morphology. The (Gd,Lu)AG solid solutions exhibit decreasing lattice parameters and increasing optical bandgaps along with more Lu3+ incorporation.
Ice‐Templating of Alumina Suspensions: Effect of Supercooling and Crystal Growth During the Initial Freezing Regime
Authors: Lasalle Audrey , Guizard Christian , Leloup Jérôme , Deville Sylvain , Maire Eric , Bogner Agnès , Gauthier Catherine , Adrien Jérôme , Courtois Loïc
Published: December 2011

We investigate the ice‐templating behavior of alumina suspensions by in situ X‐ray radiography and tomography. We focus herein on the formation and structure of the transitional zone, occurring during the initial instants of freezing. For many applications, this zone is undesirable as the resulting porosity is heterogeneous in size, morphology, and orientation. We investigate the influence of the composition of alumina suspensions on the formation of the transitional zone. Alumina particles are dispersed by three different dispersants, in various quantities, or by hydrochloric acid. We show that the dimensions and the morphology of the transitional zone are determined by the growth of large dendritic ice‐crystals growing in a supercooled state much faster than the cellular freezing front. When the freezing temperature decreases, the degree of supercooling increases. This results in an initial faster freezing front velocity and increase in the dimensions of the transitional zone. It is therefore possible to adjust the dimensions of the transitional zone by changing the composition of alumina suspensions. The counter‐ion Na+ has the most dramatic effect on the freezing temperature of suspensions, yielding a predominance of cellular ice crystals instead of the usual lamellar crystals.
Determination of the Solubility of Tin in Indium Oxide Using In Situ and Ex Situ X‐Ray Diffraction
Authors: González G. B. , Mason T. O. , Okasinski J. S. , Buslaps T. , Honkimäki V.
Published: December 2011

A novel approach to determine the thermodynamic solubility of tin in indium oxide via the exsolution from tin overdoped nano‐ITO powders is presented. High‐energy, in situ and ex situ synchrotron X‐ray diffraction was utilized to study the solubility limit at temperatures ranging from 900°C to 1375°C. The tin exsolution from overdoped nanopowders and the formation of In4Sn3O12 were observed in situ during the first 4–48 h of high‐temperature treatment. Samples annealed between 900°C and 1175°C were also studied ex situ with heat treatments for up to 2060 h. Structural results obtained from Rietveld analysis include compositional phase analysis, atomic positions, and lattice parameters. The tin solubility in In2O3 was determined using the phase analysis compositions from X‐ray diffraction and the elemental compositions obtained from X‐ray fluorescence. Experimental complications that can lead to incorrect tin solubility values in the literature are discussed.
Independent but Additive Effects of Fluorine and Nitrogen Substitution on Properties of a Calcium Aluminosilicate Glass
Authors: Hanifi Amir Reza , Genson Annäik , Pomeroy Michael J. , Hampshire Stuart
Published: December 2011

The effects of fluorine and nitrogen substitution for oxygen in a calcium aluminosilicate glass have been examined. Twelve glasses in the Ca–Si–Al–O–N–F system, with constant cation ratio, have been prepared and characterized with respect to density, molar volume (MV), fractional glass compactness (C), Young's modulus (E), microhardness (μHv), and glass transition temperature (Tg). Linear regression analysis of the property data with respect to nitrogen and fluorine substitution for oxygen strongly indicates that each affects property values independent of each other. Nitrogen substitution decreases MV and increases C, E, μHv, and Tg values due to the greater network connectivity associated with tri‐coordinated nitrogen. Fluorine substitution, which reduces network connectivity, decreases Tg values as might be expected. However, MV, C, E, and μHv are little affected by increases in fluorine content. The vastly different effects of nitrogen and fluorine on E and μHv are due to the manner in which their substitution for oxygen affects glass free volume and thus fractional glass compactness (i.e. atomic packing density). Differences in the effects of N and F substitution on Tg reflect their different effects on glass crosslink density. A method for calculating crosslink density is presented here, and the need for this method to take into account the ratio of network forming to network modifying aluminum is discussed.
Esthetic evaluation of single‐tooth implants in the anterior maxilla following autologous bone augmentation
Authors: Hof M. , Pommer B. , Strbac G. D. , Sütö D. , Watzek G. , Zechner W.
Published: December 2011

Objectives

Autologous bone augmentation to rebuild compromised alveolar ridge contour prior to implant placement allows for favorable three‐dimensional implant positioning to achieve optimum implant esthetics. The aim of the present study was to evaluate peri‐implant soft tissue conditions around single‐tooth implants following bone grafts in the esthetic zone of the maxilla.

Materials and methods

Sixty patients underwent autologous bone augmentation of deficient maxillary sites prior to placement of 85 implants in the esthetic zone. In case of multiple implants per patient, one implant was randomly selected. Objective evaluation of 60 single‐tooth implants was performed using the Pink‐Esthetic‐Score (PES) and Papilla Index (PI) and supplemented by subjective patient evaluation, as well as clinical and radiologic examination.

Results

Objective ratings of implant esthetics were satisfactory (median PES: 11, median PI: 2) and significantly correlated with high patient satisfaction (mean VAS score: 80%). Both esthetic indices demonstrated respectable levels of inter‐ as well as intra‐observer agreement. Poor implant esthetics (low PES and PI ratings) were significantly associated with increased anatomic crown height, while no influence of horizontal implant‐tooth distance could be found.

Conclusions

The present investigation indicates that favorable esthetic results may be achieved in the augmented anterior maxilla. However, bony reconstruction of compromised alveolar ridges does not guarantee optimum implant esthetics.
Periapical tissue reactions to calcium hydroxide and MTA after external root resorption as a sequela of delayed tooth replantation
Authors: Marão Heloisa Fonseca , Panzarini Sônia Regina , Aranega Alessandra Marcondes , Sonoda Celso Koogi , Poi Wilson Roberto , Esteves Jônatas Caldeiras , Silva Pedro Ivo Santos
Published: December 2011

Abstract –  Clinical experience has shown that most avulsed teeth are replanted after a long extra‐alveolar time and dry or inadequate wet storage, causing necrosis of periodontal ligament cells. This condition invariably leads to development of external root resorption, leaving the filling material in contact with the periapical connective tissues. In this study, the periapical tissue reactions to calcium hydroxide (CH) and mineral trioxide aggregate (MTA) were evaluated after occurrence of external root resorption as an expected sequela of delayed tooth replantation. Twenty male Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. Then, the dental papilla, enamel organ, pulp tissue, and periodontal ligament were removed, and the teeth were immersed in a 2% acidulated phosphate sodium fluoride solution, pH 5.5, for 10 min. The teeth were randomly assigned into two groups (n = 10), in which the canals were filled with either a CH and saline paste (CH group) or MTA (MTA group). The sockets were irrigated with saline, and the teeth were replanted. After 80 days, it was possible to observe large areas of replacement root resorption and some areas of inflammatory root resorption in both groups. More severe inflammatory tissue reaction was observed in contact with calcium hydroxide compared with the mineral trioxide aggregate. New bone formation was more intense at the bottom of the socket in the MTA group. In conclusion, as far as periapical tissue compatibility is concerned, intracanal MTA can be considered as a viable option for root canal filling in delayed tooth replantation, in which external root resorption is an expected sequela.
A method to maintain the thickness of the mouthguard after the vacuum forming process: changes of the holding conditions of the mouthguard sheet
Authors: Mizuhashi Fumi , Koide Kaoru , Takahashi Mutsumi , Mizuhashi Ryo
Published: December 2011

Abstract –  The aim of this study was to investigate differences in the thickness of the mouthguard sheet according to the holding conditions during heating. The material used in this study was Sports Mouthguard (3.8 mm thickness), and two holding conditions of the sheet were undertaken: one was the condition that the sheet was held all around the periphery and the other was that the sheet was held at only four points. The sheets were formed using a vacuum former when the sheets were heated until they hung 2.0 cm from the baseline. We measured the thickness of each part of the mouthguard and calculated the ratio of changes in the thickness. The difference in the thickness by the holding conditions at the area of the sheet that fitted over the anterior teeth, palate, and posterior teeth was analyzed by the paired t‐test. The results showed that the thickness of the sheet differed statistically and significantly at the regions of the sheet that fitted over the anterior teeth and posterior teeth (P < 0.01) and the palate (P < 0.05) according to the holding conditions of the sheet. The thickness of the condition that the sheet was held all around the periphery was thinner than that of the condition that the sheet was held at only four points. These results suggested that the thickness of the sheet was maintained by holding the sheet only at four points, and this new method could be an effective way to maintain the thickness of the mouthguard in clinical use.
Akt1 deficiency modulates reward learning and reward prediction error in mice
Authors: Chen Y.‐C. , Chen Y.‐W. , Hsu Y.‐F. , Chang W.‐T. , Hsiao C. K. , Min M.‐Y. , Lai W.‐S.
Published: December 2011

In contemporary reinforcement learning models, reward prediction error (RPE), the difference between the expected and actual reward, is thought to guide action value learning through the firing activity of dopaminergic neurons. Given the importance of dopamine in reward learning and the involvement of Akt1 in dopamine‐dependent behaviors, the aim of this study was to investigate whether Akt1 deficiency modulates reward learning and the magnitude of RPE using Akt1 mutant mice as a model. In comparison to wild‐type littermate controls, the expression of Akt1 proteins in mouse brains occurred in a gene‐dosage‐dependent manner and Akt1 heterozygous (HET) mice exhibited impaired striatal Akt1 activity under methamphetamine challenge. No genotypic difference was found in the basal levels of dopamine and its metabolites. In a series of reward‐related learning tasks, HET mice displayed a relatively efficient method of updating reward information from the environment during the acquisition phase of the two natural reward tasks and in the reverse section of the dynamic foraging T‐maze but not in methamphetamine‐induced or aversive‐related reward learning. The implementation of a standard reinforcement learning model and the Bayesian hierarchical parameter estimation show that HET mice have higher RPE magnitudes and that their action values are updated more rapidly among all three test sections in T‐maze. These results indicate that Akt1 deficiency modulates natural reward learning and RPE. This study showed a promising avenue for investigating RPE in mutant mice and provided evidence for the potential link from genetic deficiency, to neurobiological abnormalities, to impairment in higher‐order cognitive functioning.
Changes in care and short‐term outcome for very preterm infants in Estonia
Authors: Toome Liis , Ringmets Inge , Andresson Pille , Ilmoja Mari‐Liis , Saik Pille , Varendi Heili
Published: December 2011

Aim:  To identify recent changes in short‐term outcome and care for very preterm infants in Estonia.

Methods:  Comparison of two population‐based cohorts of very preterm infants born alive at 22–31 gestational weeks. In 2007–2008, data were recorded prospectively in a neonatal register. For the cohort born in 2002–2003, the same variables were extracted retrospectively from the hospital records. Infants were followed up to discharge or death.

Results:  The cohort of 2007−2008 contained a higher proportion of infants born by caesarean section and of infants who received antenatal corticosteroids, maternal antibiotics, or surfactant therapy than the earlier cohort. A higher proportion of infants was admitted for care in 2007–2008 (98% vs. 94%; p = 0.013). During the study period, survival until discharge increased (85% vs. 78%; p = 0.041), although the length of hospital stay was unchanged. The use of mechanical ventilation, inotropes, and postnatal antibiotics decreased. Neonatal morbidity remained unchanged, except for a decrease in severe periventricular/intraventricular hemorrhage.

Conclusion:  The outcome for very preterm infants in Estonia has improved since 2002. With proactive perinatal management and less invasive neonatal care, survival until discharge increased without concomitant increases in neonatal morbidity and the length of hospital stay.
Clinical and Microbiological Evaluation of Travel-Associated Respiratory Tract Infections in Travelers Returning From Countries Affected by Pandemic A(H1N1) 2009 Influenza
Authors: Jauréguiberry Stéphane , Boutolleau David , Grandsire Eric , Kofman Tomek , Deback Claire , AÏt-Arkoub ZaÏna , Bricaire François , Agut Henri , Caumes Eric
Published: December 2011

Background

Although acute respiratory tract infections (RTI) have been recognized as a significant cause of illness in returning travelers, few studies have specifically evaluated the etiologies of RTI in this population.

Methods

This prospective investigation evaluated travelers returning from countries with endemic influenza A(H1N1) 2009, and who were seen in our department at the onset of the outbreak (April–July 2009). Patients were included if they presented with signs of RTI that occurred during travel or less than 7 days after return from overseas travel. Patients were evaluated for microbial agents with RespiFinder plus assay, and throat culture according to clinical presentation.

Results

A total of 113 travelers (M/F ratio 1.2:1; mean age 39 y) were included. They were mainly tourists (n = 50; 44.2%) mostly returning from North America (n = 65; 58%) and Mexico (n = 21; 18.5%). The median duration of travel was 23 days (range 2–540 d). The median lag time between return and onset of illness was 0.2 days (range 10 d prior to 7 d after). The main clinical presentation of RTI was influenza-like illness (n = 76; 67.3%). Among the 99 microbiologically evaluated patients, a pathogen was found by polymerase chain reaction (PCR) or throat culture in 65 patients (65.6%). The main etiological agents were influenza A(H1N1) 2009 (18%), influenza viruses (14%), and rhinovirus (20%). A univariate analysis was unable to show variables associated with influenza A(H1N1) 2009, whereas rhinorrhea was associated with viruses other than influenza (p = 0.04).

Conclusion

Despite the A(H1N1) 2009 influenza pandemic, rhinovirus and other influenza viruses were also frequent causes of RTI in overseas travelers. Real-time reverse transcription-PCR and nasopharyngeal swab cultures are useful diagnostic tools for evaluating travelers with RTI.
Transgenic chimera quail production by microinjecting lentiviral vector into the blood vessel of the early embryo
Authors: SUN Peng , ZHANG Zifu , WU Guojin , YAN Li , YUAN Fang , ZHANG Wenxin , GAO Junshuang , JIN Wenjing , LI Zandong
Published: December 2011

In the past, several strategies have been used to generate transgenic birds. The most successful method has proven to be injection of lentiviral vector into the subgerminal cavity of the newly laid egg. In this study, we directly injected lentiviral vector into the blood vessel of HH13–15 quail embryos to produce transgenic chimeras. In the manipulated, hatched birds, the green fluorescent protein (GFP) gene driven by a cytomegalovirus (CMV) promoter was extensively expressed. All tissues analyzed were GFP‐positive, and gonad cells from some of the manipulated embryos expressed GFP. The semen genome of 21.4% of mature male birds was determined to be GFP‐positive by PCR, indicating these male birds were transgenic chimeras.
eviQ cancer treatments online: How does the web‐based protocol system fare in a comprehensive quality assessment?
Authors: LANGTON Julia M , PEARSON Sallie‐Anne
Published: December 2011

Aims:  There have been few evaluations of the quality of computerized decision support tools in medical oncology despite their widespread use in clinical practice. In this article, we provide an in‐depth quality assessment of eviQ, an Australian web‐based protocol system.

Methods:  We used the Appraisal of Guidelines for Research and Evaluation (AGREE‐II) instrument to examine the quality of eviQ chemotherapy protocols across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence and overall quality rating. Domain scores were categorized as high quality (scores of >70%), moderate quality (30–70%), and low quality (<30%).

Results:  eviQ was rated highly with respect to articulating its scope and purpose, clarity of presentation, applicability and on the overall rating item (scores of 72–80%). Domains addressing the involvement of stakeholders in the development process and the rigor with which protocols were developed were of moderate quality (scores of 34–37%) and the management of editorial independence and conflict of interest issues were rated in the low quality range (22%).

Conclusion:  Our evaluation demonstrated the eviQ protocol system is generally of high quality. However, we identified a number of areas in which eviQ could improve either its development processes or the means by which these processes are communicated to end‐users. This research represents the first comprehensive evaluation of oncology protocols and paves the way for continued quality assurance research to ensure that these tools meet their objective of facilitating evidence‐based medicine, standardizing treatment and, ultimately, improving patient outcomes.
The adverse implications of the transition from film to digital mammography for performing surveillance in patients with a history of breast cancer or significant risk factors for the disease
Authors: WARD Rachel L , SPEAKMAN David , HENDERSON Michael A
Published: December 2011

Aim:  The transition from screen‐film to digital mammography at Peter MacCallum Cancer Centre was investigated, considering the impact on patient management and resource utilization.

Methods:  A retrospective comparison of the imaging outcomes of the last year of screen‐film and the first year of digital mammography was performed. The study group of 692 patients, all with a history or a significant risk factor of breast cancer, underwent a surveillance mammogram in both periods, enabling serial comparison of imaging outcomes on the same patient.

Results:  Overall 92 patients required a total of 125 further investigations after their film mammogram due to a mammographic abnormality while 130 underwent a total of 202 additional investigations after their digital mammogram. This is a significant increase in the number of patients further investigated (Fisher's exact test P = 0.005). However, the positive predictive value of further investigation finding a tumor after digital mammography was not significantly higher than that of film mammography (7.4 vs 6.5%, Fisher's exact test P = 0.57). There was a 44% increase in the cost of additional investigations during the first year of digital mammography compared to the previous year and an associated increase in hospital visits for patients.

Conclusion:  For patients undergoing annual surveillance mammography at Peter MacCallum Cancer Centre, the transition from film to digital mammography was found to be associated with an increase in both the number of additional investigations performed and in the number of hospital visits. The findings of this study should be considered when conversions from film to digital mammography are planned, specifically in terms of cost allocations and the burden on patient services in radiology and outpatient departments.
Cost‐effectiveness analysis of cisplatin plus etoposide and carboplatin plus paclitaxel in a phase III randomized trial for non‐small cell lung cancer
Authors: THONGPRASERT Sumitra , PERMSUWAN Unchalee , RUENGORN Chidchanok , CHAROENTUM Chaiyut , CHEWASKULYONG Busyamas
Published: December 2011

Aim:  Carboplatin plus paclitaxel is a more costly chemotherapy regimen than cisplatin plus etoposide; however there have been reports of higher efficacy and less toxicity of this regimen. Thus, this study aimed to assess the cost‐effectiveness of these two chemotherapy regimens in advanced non‐small cell lung cancer (NSCLC).

Methods:  Using the perspective of Maharaj Nakorn Chiang Mai Hospital, Thailand, direct medical costs, including chemotherapy, drugs, medical service charges, costs of adverse events, concomitant medication and survival time were directly gathered from 65 patients enrolled from August 2005 to November 2008. A one‐way sensitivity analysis was performed. An incremental cost‐effectiveness ratio (ICER) was also calculated.

Results:  Of these 65 patients, 30 received cisplatin plus etoposide (Arm I) and 35 received carboplatin plus paclitaxel (Arm II). The median survival time was not statistically significant (8.23 months vs 8.80 months in Arm I and II, respectively; P = 0.99). The total cost per patient in Arm II was about three times that in Arm I (95,548 Baht vs 29,692 Baht) while quality‐adjusted life‐years (QALY) in Arm II were slightly above those in Arm I (0.587 vs 0.412). The ICER was equal to 375,958 Baht per QALY.

Conclusion:  With a cost‐effectiveness threshold of 100,000 Baht in Thailand, carboplatin plus paclitaxel was still not cost‐effective. While the selection of a suitable regimen for individual patients should not rely on drug and hospital costs alone, the overall cost, including the burden on patients, should be taken into consideration.
Management of tumor lysis syndrome with a single fixed dose of rasburicase in Asian lymphoma patients: A case series and literature review
Authors: CHIANG Joen , CHAN Alexandre , LIAN Tracy , TAY Kevin , QUEK Richard , TAO Miriam , LIM Soon Thye
Published: December 2011

Aim:  Recently, a number of studies have demonstrated the effectiveness of a single reduced dose of rasburicase for the management of tumor lysis syndrome (TLS) in adults. Whether Asian lymphoma patients similarly respond to a single dose of rasburicase is currently unknown. We aim to assess the efficacy of a single dose rasburicase in preventing TLS in Asian lymphoma patients.

Methods:  This was a single‐center case series of adult lymphoma patients at high risk of TLS who received a single fixed dose of rasburicase. Patients had to have their uric acid, serum creatinine, lactate dehydrogenase and electrolytes monitored for at least 24–48 h post‐administration.

Results:  Eleven patients were identified. Majority were Chinese (91%), male (64%) and with a median age of 61 years (range 41–84). All had at least two risk factors for developing TLS. Ten patients received a 6‐mg dose and one received 4.5 mg. Prior to rasburicase administration, the mean uric acid level was 835 µmol/L (range 318–1237 µmol/L) and the level 24‐h post‐administration was 186 µmol/L (range 30–653 µmol/L) (P < 0.001). Eight patients (73%) experienced an improvement of renal function 72‐h post‐rasburicase. Normalization of serum electrolytes was achieved within 96 h.

Conclusion:  Among Asian lymphoma patients who manifested at least two risk factors for developing TLS, a single fixed dose of rasburicase at 6 mg is deemed to be effective for rapidly lowering uric acid levels as well as sustaining reduced levels for up to 72 h.
Cancer in Australia: Actual incidence and mortality data from 1982 to 2007 and projections to 2010
Authors:   Australian Institute of Health and Welfare
Published: December 2011

Background:  The Australian Institute of Health and Welfare and the Australasian Association of Cancer Registries collaborate every year to provide updated information on cancer occurrences and trends in Australia.

Method:  Actual number of cases and deaths is presented together with age‐standardised rates for all cancers combined and selected cancer sites from 1982 to 2007, with projections to 2010. Differences in incidence and mortality rates according to age, Indigenous status and remoteness areas are also provided. In addition, change over time in 5‐year relative survival estimates for those diagnosed with cancer is presented, as is information on the participation in Australia's national screening programs for breast, cervical and bowel cancer. The term ‘cancer’ is used to refer to primary tumours which are invasive.

Results:  In 2007, a total of 108,368 new cases of cancer (excluding basal and squamous cell carcinoma of the skin) and 39,884 deaths from cancer occurred in Australia. Prostate cancer was the most commonly diagnosed cancer in males, while breast cancer was the most commonly diagnosed cancer in females. Lung cancer was by far the most common cause of cancer death in both males and females. In the last decade, cancer incidence rates increased in males and stabilised in females, while mortality rates decreased steadily. The overall incidence rate of cancer for Indigenous Australians was lower than that for non‐indigenous Australians, while the overall mortality rate from cancer was higher. Furthermore, the 5‐year relative survival for many cancers improved markedly from 1982–1986 to 1998–2004.
The Application of Ecohydrological Groundwater Indicators to Hydrogeological Conceptual Models
Authors: Lewis Jeff
Published: December 2011

This article reviews the application of ecohydrological indicators to hydrogeological conceptual models for earth‐scientists with little or no botanical training. Ecohydrological indicators are plants whose presence or morphology can provide data about the hydrogeological setting. By examining the literature from the fields of ecohydrology, hydrogeology, geobotany, and ecology, this article summarizes what is known about groundwater indicator plants, their potential for providing information about the aquifer, and how this data can be a cost‐effective addition to hydrogeological conceptual models. We conclude that the distribution and morphology of ecohydrological groundwater indicator plants can be useful to hydrogeologists in certain circumstances. They are easiest to evaluate in arid and semiarid climates. Ecohydrological groundwater indicators can provide information about the absolute depth to the water table, patterns of groundwater fluctuation, and the mineralization of the aquifer. It is shown that an understanding of the meteorological conditions of a region is often necessary to accurately interpret groundwater indicator plants and that useful data is usually obtained by observing patterns of vegetation behavior rather than interpreting individual plants. The most serious limitations to applying this source of information to hydrogeological conceptual models are the limited data in the literature and the regional nature of many indicator plants. The physical and physiological indications of the plants exist, but little effort has been made to interpret them. This article concludes by outlining several potential lines of research that could further the usefulness of ecohydrological groundwater indicators to the hydrogeological community.
Trends in the Hospitalization of Ischemic Stroke in the United States, 1998–2007
Authors: Lee Leslie K. , Bateman Brian T. , Wang Shuang , Schumacher H. Christian , Pile-Spellman John , Saposnik Gustavo
Published: December 2011

Background

The late 1990s/early 2000s was a time of change in both the prevention and acute care of ischemic stroke, with primary prevention driven by increased utilization of antihypertensive, antiplatelet, anticoagulation, and lipid-lowering agents.

Aim

To examine whether ischemic stroke hospitalization rates and outcomes in the United States have changed.

Method

We retrospectively identified 894 169 hospitalizations with a primary diagnosis of ischemic stroke from 1 January 1998 through to 31 December 2007 in the Nationwide Inpatient Sample, the largest all-payer healthcare database in the United States. Annual, national case estimates were combined with US Census data to derive age-adjusted and age-specific population hospitalization rates. Temporal trends were tested using linear regression.

Results

From 1998 through 2007, there were an estimated 4 382 336 ischemic stroke hospitalizations in the United States. Overall, the age-adjusted rate of ischemic stroke hospitalization decreased from 184 to 128 per 100 000 ( P #< 0.0001). Age-specific rates decreased among those 55+ years old ( P #< 0.0001), but increased among those 25–34 and 35–44 years old ( P #< 0.001 and P #< 0.0001, respectively). Rates among those <25 and 45–54 years old were unchanged. In-hospital mortality decreased from 7.0% (standard error 0.1) to 5.4% (standard error 0.1) ( P #< 0.0001). Case proportion at the highest quintile of hospitals by annual caseload increased from 54.0% (standard error 2.1) to 61.8% (standard error 2.0) ( P #< 0.0001). Mean adjusted hospitalization costs increased from $9273 (standard deviation 199) to $10 524 (standard deviation 77) ( P #< 0.0001).

Conclusion

In 1998 through to 2007, the overall rate of ischemic stroke hospitalization in the United States decreased. However, rates among young adults increased. In-hospital mortality rates decreased over the study period.
MRI in Patients with Acute Basilar Artery Occlusion – DWI Lesion Scoring is an Independent Predictor of Outcome
Authors: Nagel Simon , Herweh Christian , Köhrmann Martin , Huttner Hagen B. , Poli Sven , Hartmann Marius , Hähnel Stefan , Steiner Thorsten , Ringleb Peter , Hacke Werner
Published: December 2011

Aims

We analyzed early diffusion-weighted magnetic resonance imaging of patients with acute basilar artery occlusion by applying different lesion scoring systems and determined their predictive value for favorable outcome.

Methods

Between 1998 and 2010, patients with confirmed basilar artery occlusion were entered in a local database. magnetic resonance imaging angiography was performed for diagnosis of basilar artery occlusion and/or during initiated recanalization therapy. We analyzed the patients’ clinical and radiological baseline data, recanalization, and favorable outcome modified Rankin Scale 0–2 after three-months. Diffusion weighted imaging findings were categorized into lesions in vascular territories as well as by two previously published scores for ischemic damage in the posterior circulation, the Renard score and posterior circulation Acute Stroke Prognosis Early computed tomography Score.

Results

Fifty patients with basilar artery occlusion received an early MRI, and in 30 of those, a follow-up MRI was performed. Median time to baseline MRI was 5·5 h (one-hour to 24 h). Median baseline Renard score and posterior circulation Acute Stroke Prognosis Early CT Score were 2·75 (0–10) and 7 (0–10), respectively. Of the patients, 82% received an acute recanalization therapy and in 78% of those, the basilar artery recanalized. Median time to therapy was five-hours (1·25–20 h). 24% of all patients had a favorable outcome (mRS 0–2). Patients with a favorable outcome had a lower Renard score and higher pcASPECTS, a lower rate of complete basilar artery occlusion, a higher Glasgow coma scale on admission, and a higher rate of successful recanalization (all P < 0·05). After logistic regression, the only independent predictor for favorable outcome was a posterior circulation Acute Stroke Prognosis Early CT Score of 8 or more points (odds ratio 3·9, 95% confidence interval 1·4–11·7, P < 0·05).

Conclusion

In patients with acute basilar artery occlusion, posterior circulation Acute Stroke Prognosis Early CT Score of 8 or more points on early diffusion weighted imaging is an independent predictor for favorable outcome.
Comparison of Cardiovascular Risk Factors and Survival in Patients with Ischemic or Hemorrhagic Stroke
Authors: Henriksson Karin M. , Farahmand Bahman , Åsberg Signild , Edvardsson Nils , Terént Andreas
Published: December 2011

Background

Differences in risk factor profiles between patients with ischemic and hemorrhagic stroke may have an impact on subsequent mortality.

Aim

To explore cardiovascular disease risk factors, including the CHADS2 score, with survival after ischemic or hemorrhagic stroke.

Methods

Between 2001 and 2005, 87 111 (83%) ischemic stroke, 12 497 (12%) hemorrhagic stroke, and 5435 (5%) patients with unspecified stroke were identified in the Swedish Stroke Register. Data on gender, age, and cardiovascular disease risk factors were linked to the Swedish Hospital Discharge and Cause of Death Registers. Adjusted odds and hazard ratios and 95% confidence interval were calculated using logistic and Cox proportional hazard regression models.

Results

Hemorrhagic stroke patients were younger than ischemic stroke patients. All cardiovascular disease risk factors studied, alone or combined in the CHADS2 score, were associated with higher odds ratios for ischemic stroke vs. hemorrhagic stroke. Higher CHADS2 scores and all studied risk factors except hypertension were associated with higher odds ratio for death by ischemic stroke than hemorrhagic stroke. Ischemic stroke was associated with lower early mortality (within 30 days) vs. hemorrhagic stroke (hazard ratio = 0·28, confidence interval 0·27 to 0·29).

Conclusions

Patients with hemorrhagic stroke had a higher risk of dying within the first 30 days after stroke, but the risk of death was similar in the two groups after one-month. Hypertension was the only cardiovascular disease risk factor associated with an increased mortality rate for hemorrhagic stroke as compared to ischemic stroke.
Low Bone Mineral Density is Associated with Poor Clinical Outcome in Acute Ischemic Stroke
Authors: Lee Sang-Bong , Cho A-Hyun , Butcher Ken S. , Kim Tae-Woo , Ryu Seon-Young , Kim Yeong-In
Published: December 2011

Background

Chronic low bone mineral density is associated with an increased risk of stroke. However, little is known about the influence of bone mineral density at the time of stroke on clinical outcome. We investigated the association between bone mineral density and functional disability at three-months in patients with acute ischemic stroke.

Methods

We retrospectively examined consecutive acute ischemic stroke patients who underwent bone densitometry tests within seven-days of stroke symptom onset. Patient demographics, risk factors, and initial National Institute of Health Stroke Scale scores were assessed. Bone mineral density was measured at the lumbar spine and bilateral femoral necks. Osteoporosis was defined as bone mineral density ≤−2·5 T-scores at each site. The primary outcome was modified Rankin Scale at 90 days poststroke. A favorable outcome was defined as modified Rankin Scale 0–1 and poor outcome as modified Rankin Scale 2–6.

Results

Of the 191 patients included, 61 (31·9%) were men. Mean age (±standard deviation) was 69·8 ± 11·1 years. Patients with osteoporosis of the right femoral neck were more likely to have poor outcome (25/82; 30·5%) than those without (12/109; 11·0%, P = 0·001). After adjustment for age, sex, and initial National Institute of Health Stroke Scale score, osteoporosis of the right femoral neck was significantly associated with poor outcome (odds ratio, 2·97; 95% confidence interval 1·21 to 7·32, P = 0·018).

Conclusions

Low bone mineral density of the right femur in the acute poststroke period is associated with poor outcome at three-months. Assessment of bone mineral density in acute stroke patients may be a useful prognosticator and facilitate early intervention.
Autophagy in Brain Tumors: A New Target for Therapeutic Intervention
Authors: Kaza Niroop , Kohli Latika , Roth Kevin A.
Published: December 2011

The role of autophagy, traditionally considered a cellular homeostatic and recycling mechanism, has expanded dramatically to include an involvement in discrete stages of tumor initiation and development. Gliomas are the most aggressive and also the most common brain malignancies. Current treatment modalities have only a modest effect on patient outcomes. Resistance to apoptosis, a hallmark of most cancers, has driven the search for novel targets in cancer therapy. The autophagy lysosomal pathway is one such target that is being explored in multiple cancers including gliomas and is a promising avenue for further therapeutic development. This review summarizes our current understanding of the autophagic process and its potential utility as a target for glioma therapy.