bluuebunny/crossref_metadata_2025 huggingface dataset:
The Analysis of Posterior Soft Tissue Repair Durability after Total Hip Arthroplasty in Primary Osteoarthritis Patients
Authors: Loiba Valdemar , Stucinskas Justinas , Robertsson Otto , Wingstrand Hans , Tarasevicius Sarunas
Published: May 2015

Background and purpose

The posterior soft tissue repair is 1 of the preventing factors for dislocation after total hip arthroplasty (THA). The aim of our study was to analyse THA patients with posterior soft tissue repair in terms of suture durability, time of suture failure and correlate the changes in leg length and offset postoperatively to suture durability.

Methods

A total of 37 consecutive THA patients operated for osteoarthritis were included in the study. The posterior repair included reattaching the piriformis, conjoined tendons and posterior capsule to the greater trochanter through 2, 2 mm drill holes with 2 grasping stitches. A metal indicator wire was stitched into the piriformis tendon at distance of 1 cm from the greater trochanter after the prosthesis had been implanted and the joint reduced. Anteroposterior radiographs were taken immediately after the patients returned from the operating theatre to the intensive care unit, the next day after mobilisation, and at the 5th day of stay and at 3 months postoperatively.

Results

Out of 37 THA hips, 6 (16%) had failed immediately after surgery, 25 (68%) at the 1st postoperative day after mobilisation, 2 (5%) at the 5th postoperative day, and 1 (3%) repairs had failed at 3 months after THA. In the remaining 3 hips no failure occurred.

Interpretation

We conclude that posterior soft tissue repair in THA often fails and suggest that new posterior soft tissue repair methods be developed.
Vascularised Iliac Bone Grafting in the Treatment of Femoral Neck Nonunion in Young Adults: A Retrospective Study
Authors: Wang Yeming , Zhang Jianguo , Wei Wanfu
Published: May 2015

Introduction

Revision internal fixation for femoral neck nonunion in young patients can pose a surgical challenge. Hip salvage protocols include osteotomy and osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularised or nonvascularised fibular graft). The purpose of this study was to evaluate the clinical outcomes of vascularised iliac grafting for femoral neck nonunion in patients younger than 50 years.

Materials and methods

A total of 22 patients underwent vascularised iliac grafting and internal fixations for femoral neck nonunion were retrospectively analysed. Their mean age was 36.6 years. The cases were evaluated radiographically and clinically.

Results

All the patients were followed-up for an average of 64.6 months. The mean time to union for all patients was 5.4 months. The mean Harris Hip Score had increased from 55.3 preoperatively to 85.2 at the latest follow-up. The average neck-shaft angle had changed from 127.4° preoperatively to 128.3° postoperatively. Postoperative progression of osteonecrosis of the femoral head was seen in 3 patients, 2 patients were pain free and 1 patient required total hip arthroplasty 9 years after the revision procedure. There was no further progression in 3 patients with preoperative radiological evidence of the femoral head osteonecrosis.

Conclusions

This study indicates that vascularised iliac grafting is a viable option in treatment of femoral neck nonunion in the young adult.
Correlation between the Level of Physical Activity as Measured by Accelerometer and the Harris Hip Score
Authors: Alvarez Alejandro , Domenech Julio , Valverde-Mordt Carlos , Lison Juan F.
Published: May 2015

Background

The most widely used method to assess the outcome of total hip arthroplasty (THA) is the Harris Hip Score (HHS). Patients’ expectations about the benefits of hip arthroplasty are increasing and are no longer limited to pain reduction. Patients believe they will be able to do recreational activity and sport after surgery. It is also essential to assess the level of physical activity after arthroplasty insofar as it is associated with early failure of the components. The purpose of this study is to explore correlation of the HHS with physical activity in patients with THA.

Methods

This is a cross-sectional study on 47 patients with THA. Correlation of HHS with the results of physical activity obtained objectively using accelerometer worn for a week and subjectively using the IPAQ questionnaire and the UCLA scale.

Finding

There was no correlation between the HHS and the activity measured using accelerometers, or with the IPAQ activity questionnaire. The HHS reported moderately significant correlations with the UCLA scale.

Conclusions

The HHS may not be as discriminatory as other instruments at assessing patient activity levels after THA.
High Early Migration of the Revised Acetabular Component is a Predictor of Late cup Loosening: 312 cup Revisions followed with Radiostereometric Analysis for 2-20 Years
Authors: Klerken Tina , Mohaddes Maziar , Nemes Szilard , Kärrholm Johan
Published: May 2015

Introduction

Radiostereometric analysis (RSA) is an accurate and precise measurement tool of migration and rotation of implants. We investigated if early migration measured with RSA can be used to predict the risk of later aseptic loosening in acetabular revision surgery.

Patients and methods

A total of 312 patients who underwent acetabular revision surgery were followed by RSA measurements for 2 to 20 years. The endpoint was either re-revision due to aseptic loosening or loosening on last available radiographic examination. Cox regression model was used to evaluate the predictive value of early migration.

Results

A total of 16 acetabular cups were re-revised due to aseptic loosening and 7 unrevised cups were radiographically loose. Every mm of proximal migration 2 years postoperatively increased the risk of aseptic loosening by 37% (hazard ratio (HR) 1.37, 95% confidence interval (CI) 1.18-1.58). Adjusting for differences in base line demographics, bone defects and surgical techniques in a Cox regression model, risk of aseptic loosening with every mm of proximal migration was even higher (HR 1.94, 95% CI 1.34-2.82, p<0.001).

Conclusions

We found a strong relationship between early migration measured by RSA and risk of late aseptic loosening in acetabular revision surgery. Monitoring proximal migration with RSA should be considered as an essential step in quality assessment when new implants and novel techniques are introduced in acetabular revision surgery.
The Anatomy and Function of the Obturator Externus
Authors: Gudena Ravindra , Alzahrani Abdullah , Railton Pamela , Powell James , Ganz Reinhold
Published: May 2015

There is limited knowledge regarding the anatomic relationships and functional anatomy of the Obturator Externus muscle (OE). It is described as a muscle which originates from the external bony margin of the obturator foramen with a cylindrical tendon which passes like a sling under the femoral neck and inserts in the trochanteric fossa. The primary aim of this study is to describe the OE morphology and its anatomic relationship to the acetabulum. A secondary aim is to postulate its action. Eighteen fresh human cadaveric hips were dissected to investigate the anatomy of the OE. A plastic model of the pelvis and femur was used to create a string model based on a technique previously described by Beck et al. The plastic model was used to determine the function of the OE.

We conclude that the Obturator externus muscle helps to stabilise the head of the femur in the socket. The mechanical model demonstrated that the primary action of the obturator externus muscle was to externally rotate the femur when the hip was in neutral position and flexed at 90°. Its secondary function was as an adductor when the hip was in flexion.
Aseptic Loosening of Cobalt Chromium Monoblock Sockets after Hip Resurfacing
Authors: Amstutz Harlan C. , Le Duff Michel J.
Published: May 2015

Introduction

Acetabular component loosening is a leading cause for revision after metal-on-metal hip resurfacing arthroplasty (MMHRA). We aimed to identify potential risk factors and determine radiographic signs associated with this mode of failure.

Methods

From a series of 1375 hips treated with MMHRA, 21 (20 patients) underwent revision surgery secondary to aseptic loosening of the acetabular component and 6 patients had a radiographically loose acetabular component. A control group of 27 hips (26 patients) was selected among the patients that did not have a revision, and was matched for age, gender, component size and diagnosis.

Results

Mean time to revision in the loosening group was 103.0 months and the mean time of follow-up in the control group was 161.4 months. We found greater activity levels, range of motion scores, and cup abduction angles in the loosening group. The centre-edge (CE) angle of Wiberg was 10° lower in the loosening group compared with the control group. In addition, 11 of the hips from the study group presented a sclerotic halo superior to the cup on the last radiograph vs. none in the control group. There was no difference in the prevalence of postoperative reaming gaps or radiographic signs of neck-cup impingement between the 2 groups.

Discussion

Risk factors for acetabular loosening included hip dysplasia with low CE angle, and a large cup abduction angle. The patient's level of activity influences the appearance of symptoms and the time to revision. We recommend selecting patients with a sufficient CE angle and properly orienting the cup.
Time Evolution of in Vivo Articular Cartilage Repair Induced by Bone Marrow Stimulation and Scaffold Implantation in Rabbits
Authors: Sancho-Tello María , Forriol Francisco , Gastaldi Pablo , Ruiz-Saurí Amparo , Martín de Llano José J. , Novella-Maestre Edurne , Antolinos-Turpín Carmen M. , Gómez-Tejedor José A. , Ribelles José L Gómez , Carda Carmen
Published: May 2015

Purpose

Tissue engineering techniques were used to study cartilage repair over a 12-month period in a rabbit model.

Methods

A full-depth chondral defect along with subchondral bone injury were originated in the knee joint, where a biostable porous scaffold was implanted, synthesized of poly(ethyl acrylate-co-hydroxyethyl acrylate) copolymer. Morphological evolution of cartilage repair was studied 1 and 2 weeks, and 1, 3, and 12 months after implantation by histological techniques. The 3-month group was chosen to compare cartilage repair to an additional group where scaffolds were preseeded with allogeneic chondrocytes before implantation, and also to controls, who underwent the same surgery procedure, with no scaffold implantation.

Results

Neotissue growth was first observed in the deepest scaffold pores 1 week after implantation, which spread thereafter; 3 months later scaffold pores were filled mostly with cartilaginous tissue in superficial and middle zones, and with bone tissue adjacent to subchondral bone. Simultaneously, native chondrocytes at the edges of the defect started to proliferate 1 week after implantation; within a month those edges had grown centripetally and seemed to embed the scaffold, and after 3 months, hyaline-like cartilage was observed on the condylar surface. Preseeded scaffolds slightly improved tissue growth, although the quality of repair tissue was similar to non-preseeded scaffolds. Controls showed that fibrous cartilage was mainly filling the repair area 3 months after surgery. In the 12-month group, articular cartilage resembled the untreated surface.

Conclusions

Scaffolds guided cartilaginous tissue growth in vivo, suggesting their importance in stress transmission to the cells for cartilage repair.
Alpha-methylacyl-CoA Racemase and Hepsin as Urinary Prostate Cancer Markers
Authors: Sroka Wiktor Dariusz , Adamowski Marek , Słupski Piotr , Siódmiak Joanna , Jarzemski Piotr , Odrowąż-Sypniewska Grażyna , Marszałł Michał Piotr
Published: May 2015

Background

Because of the numerous limitations of prostate-specific antigen (PSA), α-methylacyl-CoA racemase (AMACR) and hepsin have recently been suggested as potential biomarkers in prostate cancer (PC). This report presents a comparison study of the presence of AMACR and hepsin in urine collected before and after digital rectal examination (DRE) as a previously suggested diagnostic marker for PC.

Methods

Seventy-six urine samples (38 before and 38 after prostate massage) from patients with benign prostate hyperplasia (BPH) and 66 urine samples (33 before and 33 after prostate massage) from patients with PC were analyzed. PC was confirmed by prostate biopsy. Urinary levels of AMACR and hepsin were determined by ELISA and related to the tumor stage, Gleason score and PSA level.

Results

AMACR and hepsin levels in urine collected after prostate massage were higher only in the PC group. There were no correlations between AMACR levels, hepsin levels, tumor stage and Gleason score. AMACR and hepsin did not differentiate between BPH and PC with better true positive and false negative rates than serum PSA.

Conclusions

AMACR and hepsin were unable to diagnose PC with better true positive and false negative rates than PSA. An additional procedure combined with other markers should be applied for the reliable diagnosis of PC.
Germ Cell Tumors Overexpress the Candidate Therapeutic target Cyclin B1 Independently of p53 function
Authors: De Giorgi Ugo , Yuan Juping , Moroni Mauro , Veronese Silvio , Sartore-Bianchi Andrea , Broggini Massimo , Rosti Giovanni , Strebhardt Klaus , Ruffini Pier Adelchi
Published: May 2015

Germ cell tumors (GCTs) generally express wild-type p53 protein. Rare p53 mutations may be associated with cisplatin resistance. There is growing interest in the role of cyclins as targets for GCTs. Cyclin B1 is involved in G2/M transition and its overexpression has been reported in tumors carrying nonfunctional p53. Conversely, cyclin B1-specific small interfering RNAs have been shown to dramatically reduce tumor proliferation. We investigated whether a subset of chemotherapy-resistant GCTs overexpressed cyclin B1 as a result of nonfunctional p53, as this would make cyclin B1 a potential therapeutic target. Our data showed that GCTs consistently overexpressed cyclin B1 independently of their responsiveness to chemotherapy or the presence of p53 mutations. Cyclin B1 was overexpressed by GCT cell lines carrying functional p53. Cyclin B1-specific small interfering RNAs only slightly reduced the proliferation of JAR and JEG-3 placental choriocarcinoma cells. Further research into targeting cyclin B1 could provide a novel intervention for GCTs.
Evaluation of PICC Complications in Orthopedic Inpatients with Bone Infection for Long-Term Intravenous Antibiotics Therapy
Authors: Schneider Laura Valbousquet , Duron Sandrine , Arnaud François-Xavier , Bousquet Aurore , Kervella Yann , Bouzad Caroline , Baccialone Jacques , A'Teriitehau Christophe , Potet Julien
Published: May 2015

Purpose

The purpose of this study is to evaluate the complications of peripherally inserted central catheters (PICCs) in orthopedic patients with chronic bone orthopedic infection.

Materials and methods

The institutional review board approved this retrospective study and informed consent was waived. Records of 180 consecutives PICCs placed in patients hospitalized in the orthopedic surgery department were reviewed. All patients had bones infections necessitating a long-term intravenous antibiotics therapy. All PICC complications were recorded during the patient hospitalization: infection [catheter-related bloodstream infection (CRBSI), central line associated bloodstream infection (CLABSI), exit-site infection, septic phlebitis], thrombosis, occlusion, mechanical complication (accidental withdrawal, malposition, median nerve irritation).

Results

One hundred and eighty PICCs were placed in 136 patients. Mean duration of catheterization was 21 days (total 3911 PICC-days). Thirty-six PICCs (20%) were removed due to complications (9.2 complications per 1000 PICC-days): 14 (8%) infections (one CRBSI ( Pseudomonas aeruginosa), one septic phlebitis ( P. aeruginosa), two exit-site infections and 10 CLABSIs), 11 (6%) occlusions, and 12 (7%) mechanical complications (10 accidental withdrawals, one malposition, one median nerve irritation). One patient had two complications simultaneously. After multivariate analysis, two risk factors were significantly associated with the overall occurrence of complications: age more than 70 years [OR = 2.89 (1.06-7.89], p = 0.04] and number of lumen at least two [OR = 2.64 (1.03-6.75), p = 0.04].

Conclusions

Even in orthopedic patients with chronic orthopedic bone infection, PICCs have a low rate of complication. The increasing lumen number of the PICC is a potential risk factor in our series.
Primary Mucosal Malignant Melanoma of the Cervix: Case Report and Review of the Literature
Authors: Cetinkaya Kadir , Benzer Emine , Dervisoglu Haluk
Published: May 2015

The incidence of primary mucosal malignant melanoma (PMMM) is 1.3% among all malignant melanomas (MM). Cervical involvement is very rare; the number of cases of cervical PMMM reported so far is around 80. In our patient, a dark color, 2-cm diameter, nonulcerated tumor formation was observed upon examination of the cervix. Tumoral tissue consisted of atypical melanocytic cells containing numerous mitotic figures. In immunochemical studies, S-100, Melan-A, and HMB-45 positivity were observed. The tumor was 20 mm in invasion depth, Breslow IV, and FIGO stage IB1. Radical surgery was followed by adjuvant radiotherapy, and subsequently interferon treatment was applied. Examination and scans 20 months after surgery were free from tumor.
Smoking in Italy 2013-2014, with a Focus on the Young
Authors: Lugo Alessandra , Asciutto Rosario , Pacifici Roberta , Colombo Paolo , La Vecchia Carlo , Gallus Silvano
Published: May 2015

Aims

To update smoking prevalence trends in Italy among adult and young populations; to determine the recent spread, particularly among young smokers, of roll-your-own (RYO) cigarettes (which cost approximately half the price of manufactured cigarettes); and to evaluate the effects of 2013 legislation increasing the minimum tobacco purchasing age from 16 to 18 years in Italy.

Methods

Two surveys on smoking were conducted in 2013 and 2014 in Italy, on a total sample of 6052 individuals, representative each year of the national population aged ≥15 years, where we collected data on type of tobacco most frequently smoked and on the perception of the enforcement of the tobacco sales-to-minors legislation.

Results

A total of 21.1% of the population surveyed were smokers (25.5% of men and 17.0% of women). Prevalence of current smoking among young participants (15-24 years) was 19.9% (21.7% of male participants and 18.0% of female participants). Overall, 6.9% of smokers, and 13.3% of young smokers, reported RYO cigarettes as the most frequently smoked tobacco product. More than 80% of Italian adults had never seen a tobacco retailer refuse to sell cigarettes to minors (i.e., aged <18 years) or request their identification or age.

Conclusions

Although adult and young smoking prevalence rates substantially decreased over the last few decades, neither of them have significantly changed since 2007. Use of RYO cigarettes is increasing, particularly among the young. Our study highlights the need to equalize the costs of different types of tobacco products and to improve the enforcement of the current tobacco sales-to-minors legislation.
ANXA1 Silencing Increases the Sensitivity of Cancer Cells to Low-concentration Arsenic Trioxide Treatment by Inhibiting ERK MAPK Activation
Authors: Zhang Xueyan , Li Xiaodong , Li Xiaolin , Zheng Lei , Lei Lei
Published: May 2015

Aims and background

Arsenic trioxide (ATO), an antitumor agent, is widely used for treating acute promyelocytic leukemia (APL), in which it induces apoptosis. In most solid tumors, ATO disturbs the cell cycle instead of inducing apoptosis. We aimed to determine the exact mechanism underlying the different response of APL to ATO compared with the response of solid tumors.

Methods

A proteomics-based screening was used to identify the ATO-associated proteins in the human esophageal squamous cell carcinoma cell line, Eca109. The expression levels of Annexin A1 (ANXA1) in 4 different types of cancer cells were determined by quantitative reverse transcription polymerase chain reaction and Western blotting. Human esophageal squamous cell carcinoma cell line Eca109 and pancreatic carcinoma cell line BxPC3 cells were transfected with siRNAs targeting ANXA1 and scrambled control siRNA. Cell proliferation was evaluated by methyl thiazolyl tetrazolium assay.

Results

After verification of the mRNA and protein levels in 4 cancer cell lines, ANXA1 and lamin A/B were validated to have increased expression levels after low-concentration ATO treatment. Lower concentrations of ATO, which has no effect on proliferation of cancer cells, induced apoptosis after ANXA1 silencing. Furthermore, over-expression of ANXA1 induced by ATO resulted in activation of extracellular signal-regulated kinase (ERK) mitogenactivated protein kinases (MAPKs), rendering cancer cells resistant to the agent. In addition, PD98059, a specific ERK inhibitor, increased the sensitivity of cancer cells to a lower concentration of ATO treatment.

Conclusions

Taken together, these data indicate that overexpression of ANXA1 induced by low-concentration ATO makes cancer cells more resistant to the agent via activated ERK MAPKs. Specific silencing of ANXA1 increased the sensitivity of cancer cells to ATO treatment.
Primary TKI Resistance in Advanced Non-small Cell Lung Cancer with EGFR Mutation: An Open Question
Authors: Giuliani Jacopo , Martelli Salvatore , Remo Andrea , Bonetti Andrea
Published: May 2015

The malignant behavior of non-small cell lung cancer (NSCLC) is caused by different driver mutations, which may include alterations in the epidermal growth factor receptor (EGFR) signaling pathway. Activating mutations in exons 19 or 21 of EGFR in NSCLC are associated with increased sensitivity to EGFR tyrosine kinase inhibitors (TKIs) such as gefitinib and erlotinib. However, approximately 10% of NSCLC patients show primary resistance to TKIs, and the resistance mechanism is poorly understood. We report the case of a 72-year-old nonsmoking Caucasian woman who underwent pulmonary segmentectomy for right peripheral T1N0M0 NSCLC. The tumor was an adenocarcinoma, with a point mutation in exon 21 of EGFR and with negative ALK gene rearrangement. Postoperative CT scan revealed right pleural effusion and abundant ascites without metastases to parenchymal organs. After paracentesis with positive cytology for adenocarcinoma, the patient started therapy with oral gefitinib 250 mg/day. CT scan after 2 months revealed disease progression with an increase in the pleural effusion (right and left) and ascites, as well as the appearance of solid tissue involving the right main bronchus and bronchus intermedius. Gefitinib was stopped and the patient died 1 month later of progressive NSCLC. The peculiarities of our case are the site of the metastatic disease and the complete lack of a response to gefitinib in a patient with an activating mutation in EGFR exon 21.
Evaluation of Transforming Growth Factor-β2 for Radiation-induced Diarrhea after Pelvic Radiotherapy
Authors: Demiral Selcuk , Beyzadeoglu Murat , Sager Omer , Dincoglan Ferrat , Uysal Bora , Gamsiz Hakan , Akin Mustafa , Turker Turker
Published: May 2015

Aims and background

Radiotherapy (RT) plays a central role in the management of cancers located in the abdomen and pelvis. However, radiation-induced toxicity remains a major concern for patients receiving RT to the abdominopelvic region. In this context, our study aims to evaluate the use of transforming growth factor (TGF)-β2-enriched formula for amelioration of radiation-induced diarrhea for patients undergoing pelvic RT.

Methods and Study Design

Between September 2013 and September 2014, 86 malnourished patients undergoing RT for pelvic cancers who received oral nutritional supplementation with or without TGF-β2-enriched formula were assessed retrospectively in 3 groups. Oral diphenoxylate-atropine tablets were used at onset of diarrhea in all groups. Kruskal-Wallis and chi-square tests were used in the comparison of continuous and categorical variables, respectively.

Results

Patients receiving nutritional supplemention with TGF-β2-enriched formula (groups I and II) experienced a significantly lower median number of diarrhea episodes compared to patients receiving nutritional supplementation with other products (group III), which was statistically significant (p<0.05). Also, number of patients experiencing grade 2 and grade 3 diarrhea was significantly lower in groups I and II compared to group III (p<0.05).

Conclusions

Nutritional supplemention with TGF-β2-enriched formula offers amelioration of radiation-induced diarrhea for patients receiving pelvic RT. Since this is the first study assessing the use of nutritional supplementation with TGF-β2-enriched formula for patients undergoing pelvic RT, future prospective studies are needed to confirm the results.
A Breast Cancer Clinical Registry in An Italian Comprehensive Cancer Center: An Instrument for Descriptive, Clinical, and Experimental Research
Authors: Baili Paolo , Torresani Michele , Agresti Roberto , Rosito Giuseppe , Daidone Maria Grazia , Veneroni Silvia , Cavallo Ilaria , Funaro Francesco , Giunco Marco , Turco Alberto , Amash Hade , Scavo Antonio , Minicozzi Pamela , Bella Francesca , Meneghini Elisabetta , Sant Milena
Published: May 2015

In clinical research, many potentially useful variables are available via the routine activity of cancer center-based clinical registries (CCCR). We present the experience of the breast cancer clinical registry at Fondazione IRCCS “Istituto Nazionale dei Tumori” to give an example of how a CCCR can be planned, implemented, and used. Five criteria were taken into consideration while planning our CCCR: (a) available clinical and administrative databases ought to be exploited to the maximum extent; (b) open source software should be used; (c) a Web-based interface must be designed; (d) CCCR data must be compatible with population-based cancer registry data; (e) CCCR must be an open system, able to be connected with other data repositories. The amount of work needed for the implementation of a CCCR is inversely linked with the amount of available coded data: the fewer data are available in the input databases as coded variables, the more work will be necessary, for information technology staff, text mining analysis, and registrars (for collecting data from clinical records). A cancer registry in a comprehensive cancer center can be used for several research aspects, such as estimate of the number of cases needed for clinical studies, assessment of biobank specimens with specific characteristics, evaluation of clinical practice and adhesion to clinical guidelines, comparative studies between clinical and population sets of patients, studies on cancer prognosis, and studies on cancer survivorship.
Diffusion Tensor Imaging Study on Radiation-induced Brain Injury in Nasopharyngeal Carcinoma during and after Radiotherapy
Authors: Chen Wangsheng , Qiu Shijun , Li Jianjun , Hong Lan , Wang Fen , Xing Zengbao , Li Changqing
Published: May 2015

Aims and background

The aim of this study was to monitor the mircostructure change of temporal lobe during the acute and subacute stage of radiation-induced brain injury using magnetic resonance diffusion tensor imaging (DTI) in nasopharyngeal carcinoma patients.

Methods and Study Design

Eighty patients diagnosed with nasopharyngeal carcinoma and treated with the first radiotherapy from July 2010 to May 2012 were enrolled. Routine brain magnetic resonance imaging (MRI) and DTI were conducted in all patients before and during radiotherapy (radiation dose was 20, 40, and 60 Gy, respectively). The MRI and DTI were also performed in the 1st, 2nd, and 3rd month after radiotherapy in 47 cases of 80 patients. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of DTI during different stages were dynamically observed and analyzed.

Results

The ADC values were increased and the FA values were decreased with the increase of radiation dose (20, 40, and 60 Gy) during the radiotherapy, but there was no significant difference in ADC value or FA value between before and during radiotherapy (p>0.05). Compared with before radiotherapy, the ADC values were significantly increased and the FA values were significantly decreased at the 1st month, 2nd month, and 3rd month after radiotherapy (all p<0.05).

Conclusions

Diffusion tensor imaging reflects the microstructure change of radiation-induced brain injury in the acute and subacute stage, which provides an objective basis for early intervention of potential irreversible brain injury in the late delayed stage, and has important significance for improving the overall efficacy of radiotherapy.
Very Elderly (>80 Years), Frail Patients with Muscle-invasive Bladder Cancer and Comorbidities: Is Curative Irradiation Feasible?
Authors: Santacaterina Anna , Platania Angelo , Palazzolo Carmela , Spatola Corrado , Acquaviva Grazia , Crispi Manuela , Privitera Giuseppe , Settineri Nicola , Pergolizzi Stefano
Published: May 2015

Purpose

To evaluate clinical results in elderly and frail patients with bladder cancer treated with curative conformal irradiation alone.

Methods

The records of ambulatory frail elderly patients, age >80 years, Charlson Comorbidity Index (CCI) >5, with invasive bladder cancer, were retrospectively analyzed. The patients were irradiated with curative intent. Acute and late toxicities were evaluated.

Results

A total of 27 ambulatory patients were treated. Median age was 84.5 years and a median CCI of 6.5 was recorded. Median delivered radiation dose was 64 Gy. All patients completed the planned treatment. Grade 1-2 gastrointestinal (GI) and genitourinary (GU) toxicities were observed in 55.5% of patients (15/27). At the last follow-up, no late G3+ toxicities have been observed, with G1-2 toxicities reported in 11.1% of patients (3/27). Higher values of CCI were associated with higher acute GU/GI toxicities; there was a correlation between CCI and acute GU toxicity ( r = 0.43, p = 0.027). The mean survival time was 23.5 months (95% confidence interval 20.9-26.1) and no median was reached. Locoregional disease-free events and metastasis-free survival showed a 2-year actuarial rate of 90% and 87%, respectively, with an actuarial 2-year overall survival of 84.5%.

Conclusions

Our results demonstrate safety and feasibility of curative radiation therapy in very elderly and frail patients with bladder cancer using 3D conformal radiation therapy.
Pattern of blood donor deferral in a tertiary hospital, South-south, Nigeria: A three-year study review
Authors: Amos Ekwere Timothy , Ino-Ekanem Mabel , Oluseyi Motilewa Olugbemi , Augustine Ibanga Iquo
Published: May 2015

Aims: Provision of safe and adequate supply of blood and blood products is a major public health issue globally. Safe blood is ensured through proper donor selection and testing of donated blood. However, a large number of apparently healthy donors are unable to donate blood for various reasons. To determine the proportions and reasons for donor deferral in University of Uyo Teaching Hospital (UUTH) Blood Bank.
Methods: A three-year retrospective review of records of blood donors from January 2009 to December 2012 was analyzed to determine the proportions and reasons for donor deferral in University of Uyo Teaching Hospital blood bank.
Results: There were 5,636 donors of which 902 donors representing 16% of the entire donor population were deferred for various reasons. Large proportions (89.1%) of the donors were family replacement donors. Female donors constitute 16% of the entire donor population and were more frequently deferred than male donors 34.4% versus 12.4%, respectively. Transfusion transmissible infections (TTIs) positivity and anemia were the major reasons for permanent (50.4%) and temporary (39%) deferral of donors. The TTIs rates were higher among male donors than female donors. Conversely, more female donors were anemic (25.6%) compared to male (12.7%). Other reasons identified for donor deferral were underage (6.8%), underweight (2.4%), and hypertension (3.1%).
Conclusion: A donor deferral rate of 16% in this study is similar to that reported in other studies. However, the reasons for deferral differ reflecting differences in donor selection criteria.
Interações medicamentosas potencias em unidades de terapia intensiva de um hospital do Sul do Brasil
Authors: Oliveira-Paula Gustavo Henrique , Pereira Francieli , Paccola Mayara Ticianelli , Martins-Junior Airton da Cunha , Dalla-Costa Ester Massae Okamoto
Published: May 2015

As interações medicamentosas são importantes causas de reações adversas em unidades de saúde. O elevado consumo de medicamentos em unidades de terapia intensiva predispõe os pacientes a um risco potencial de ocorrência de interações medicamentosas. Este estudo objetivou determinar a frequência e as características das interações medicamentosas potenciais em unidades de terapia intensiva do Hospital Universitário da Universidade Estadual de Londrina. Foram analisadas as prescrições de pacientes maiores de 18 anos internados no período de janeiro a maio de 2010, com permanência de pelo menos quatro dias. A análise das interações medicamentosas foi realizada utilizando-se o sistema Micromedex Drug-Reax®. As interações foram classificadas por gravidade, tempo necessário para o início dos efeitos adversos, mecanismo de ação e qualidade da evidência científica. Além disso, foram analisados os possíveis eventos adversos relacionados às interações, bem como as estratégias de manejo e monitoramento recomendadas. Ao todo foram identificadas 198 diferentes interações medicamentosas potenciais com a ocorrência de 1242 episódios. Destes, 43% foram caracterizados por interações de gravidade moderada, 35% graves, 16% leves e 6% contra-indicadas. A ineficácia terapêutica foi o possível evento adverso mais frequente (18%) e a principal estratégia de manejo recomendada foi o ajuste de dose (35,6%). As interações mais frequentes foram: fentanil + midazolam (8,6%), fenitoína + ranitidina (5,5%) e midazolam + ranitidina (4,8%). Os resultados identificados demonstram a importância das interações medicamentosas como evento adverso significativo em unidades de terapia intensiva e, portanto, medidas preventivas são necessárias para minimizar este problema.
The function of ultra-large von Willebrand factor multimers in high shear flow controlled by ADAMTS13
Authors: Reininger A. J.
Published: May 2015

The paradigm that platelet aggregation, which contributes to bleeding arrest and also to thrombovascular disorders, initiates after signaling-induced platelet activation has been refuted in past recent years. Platelets can form aggregates independently of activation when soluble von Willebrand factor (VWF) is present and the shear rate exceeds a certain threshold where active A1 domains become exposed in soluble VWF multimers and can bind to platelet glycoprotein Ib. Subsequently – fostering each other – VWF can self-assemble into large nets combining with platelets into large conglomerates, which are entirely reversible when they enter a flow region with shear rates below the threshold. In addition the threshold changes from approximately 20 000 s-1 in wall parallel flow to approximately 10 000 s-1 in stagnation point flow. VWF containing ultra-large multimers – as when just released from endothelial storage sites – has been shown to have the highest binding potential to platelets and to each other, thus facilitating rapid platelet accrual to sites of vessel injury and exposed subendothelial structures, i.e. collagen. The VWF nets as well as the platelet-VWF conglomerates are controlled by the cleaving protease ADAMTS13 within minutes under high shear flow. Therewith the hemostatic potential is delivered where needed and the thrombogenic potential is highly controlled twofold: by flow and enzymatic proteolytic cleavage.
Care in Family Relations
Authors: Burri Susanne
Published: May 2015

Care in Family Relations: The Case of Surrogacy Leave

The advance of reproductive technologies, like surrogacy arrangements, confronts courts with new demands and dilemmas. This contribution analyses the potential of EU law towards a better and more balanced reconciliation of work, private and family life when no national law applies. In two recent cases of the Court of Justice of the EU on leave for surrogacy mothers, the Advocates General Kokott and Wahl published diverging opinions on similar prejudicial questions of national courts. These opinions illustrate some difficulties in applying the EU concept of equality and interpreting the scope of relevant EU law on leaves. The Court followed a cautious approach, which is not surprising given the lack of consensus on surrogacy arrangements in the member states and their legal implications. Developments in society and technologies in relation to motherhood, fatherhood and parenthood give rise to new legal questions. However, the existing EU legal instruments in this field were not designed to address questions such as for example surrogacy leave for commissioning mothers and fathers. A modernisation of the EU instruments in the light of societal, technological and legal developments in the member states would provide an opportunity to remedy some gaps in the existing EU legal framework on reconciliation issues. In a society where participation in the labour market of both women and men is increasing and getting more balanced, the need to address care of children, older people and disabled people becomes more urgent.
The Minor in Divorce-Related Judicial Proceedings in the Netherlands and Germany
Authors: Strutz Maximilian , Verhagen Evelien
Published: May 2015

The Minor in Divorce-Related Judicial Proceedings in the Netherlands and Germany: Rights to a Special Representative and to Be Heard in Person

This contribution examines the extent to which a minor is involved in divorce-related judicial proceedings in the Netherlands and Germany. The discussion will concentrate exclusively on the rights of the minor to a special representative and to be heard in person. The purpose of this contribution is to identify the uncertainties and bottlenecks that arise in both legal systems.
Consolidating Family Law in Kenya
Authors: Murungi Lucyline Nkatha
Published: May 2015

Consolidating Family Law in Kenya: An Appraisal of Recent Marriage and Matrimonial Property Law Reforms

Following the adoption of a new Constitution in 2010, Kenya embarked on an extensive process of law reform in order to give effect to the provisions of the Constitution. Accordingly, in 2014, two main statutes were adopted in the area of family law: the Matrimonial Property Act and the Marriage Act. In addition, parliamentary discussion of a Bill on domestic violence was underway as of March 2015. The main outcome of the Marriage Act is the consolidation of family laws that were previously covered in multiple statutes, customary law, and common law in one Act. The Matrimonial Property Act is the first Kenyan legislation on the subject, and is therefore a critical development in Kenya’s family law. The new family laws embrace a number of significant developments at the national and international levels in relation to matrimonial relations. However, the new laws also raise concerns in a number of areas of family law including; the equality of men and women in marriage, the capacity of persons with disabilities to consent to marriage, the rights of spouses to matrimonial property, kinds of marriage, and registration of marriages. This article discusses the approach of these laws to selected issues in marriage and matrimonial property, and highlights areas of concern in this regard.
Spanish Matrimonial Property Regimes and CEFL Principles Regarding Property Relations between Spouses
Authors: Quinzá Redondo Pablo
Published: May 2015

Spanish Matrimonial Property Regimes and CEFL Principles Regarding Property Relations between Spouses: Common Core and Better Law

This article compares the CEFL principles to Spanish civil law regarding the general rights and duties of spouses, matrimonial property agreements and matrimonial property rights, i.e., property relations between spouses, by detecting where the latter follows the common core or better law approach solution selected by the former.
Identifying the Impetus behind the Europeanization of the Private International Law Rules on Family Matters and Succession
Authors: Gray Jacqueline
Published: May 2015

Identifying the Impetus behind the Europeanization of the Private International Law Rules on Family Matters and Succession

The EU is currently in the midst of unifying the private international law rules on family matters and succession. This article seeks to explain this expansion into essentially non-economic territory. In order to do so, it presents the ideological, problem-based, and legal considerations that appear to lie at the heart of legislative action in these fields. However, as will become apparent, it is the role of the Member States that is crucial in guiding this process.
Politie in tweevoud: centraal en decentraal
Authors: Terpstra J. , van Stokkom B.
Published: May 2015

Dutch policing in duplicate: central and municipal. Some backgrounds and tensions

The advent of the Dutch National Police in 2012 is the culmination of a much longer process of centralization and scaling up of the regular police organization. Partly as a result of this process of increased scale, municipalities have introduced their own surveillance officers to patrol the streets. Thus, the contours of a dual police system have arisen. This raises various questions, and in this article we focus on two of them. First, which background factors have contributed to the emergence of new municipal enforcement organizations and to what extent developments within the police have contributed to this development? Second, what are the consequences of this dual police system and what problems and risks are involved?
Epidurinis skausmo malšinimas akušerijoje: gimdyvių savijauta, informacijos šaltiniai ir noras kito gimdymo metu keisti analgezijos būdą
Authors: Bašarinaitė Anastasija , Bučaitė Aušra , Kontrimavičiūtė Eglė , Šipylaitė Jūratė , Ramašauskaitė Diana
Published: May 2015

Darbo tikslas. Išsiaiškinti epidurinės nejautros įtaką moterų savijautai per gimdymą ir pirmosiomis dienomis po gimdymo, ištirti, kiek moterų baimės jausmas ir informuotumas lemia jų pasirinkimą dėl skausmo malšinimo gimdymo metu. Įvertinti moterų atsiliepimus apie ligoninę.
Darbo metodika. Atlikta anketinė apklausa moterų, gimdžiusių 2013 12–2014 03 VULSK Akušerijos ir ginekologijos skyriuje. Apklausta 100 gimdyvių: 41 taikyta epidurinė nejautra (I grupė – tiriamoji), o 59 – intraveninis skausmo malšinimas fentaniliu (II grupė – kontrolinė). Atrinktos moterys, gimdžiusios be Cezario pjūvio operacijos, sutikusios dalyvauti tyrime. Surinkti duomenys: apie gimdyvių amžių; gyvenamąją vietą; gimdymų skaičių; baimės jausmo stiprumą prieš gimdymą; moterų apsisprendimą dėl skausmo malšinimo, norą gauti epidurinį skausmo malšinimą; skausmo intensyvumą gimdymo metu; savijautą po gimdymo; nepageidaujamus poveikius; gimdymo skausmo malšinimo informacijos šaltinius; norą keisti analgezijos būdą kito gimdymo metu; atsiliepimai apie gimdymo procesą ir skausmo malšinimą.
Rezultatai. Respondenčių amžius – 17–41 metai (vidurkis 29 ± 4,4). I grupės 37 (90,24 %) gimdyvės gyvena mieste, 4 (9,76 %) kaimo vietovėje, II – 30 (51 %) mieste, 29 (49 %) kaimo vietovėje. Pirmą kartą gimdančių moterų I grupėse buvo 56 %, II – 37,3 %, p = 0,049. Gauti statistiškai reikšmingi skirtumai tarp skausmo intensyvumo vidurkių I ir II grupėse – 6,71 ± 2,61 ir 8,83 ± 1,45 (p = 0,0001); savijautos po gimdymo I grupės moterų vidurkiai: 8,39 ± 1,99 balų, II – 7,05 ± 2,34 (p = 0,0001). Statistiškai reikšmingai skiriasi baimės jausmas prieš gimdymą: I ir II grupių vidurkiai – 6,46 ± 3,87 ir 4,30 ± 3,75 (p = 0,0093). I grupėje 65,88 %, o II grupėje 67,81 % moterų nepasireiš­kė nepageidaujamų poveikių. 60,8 % I grupės moterų buvo
apsisprendusios rinktis epidurinę nejautrą. Iš II grupės 62,7 % nebuvo apsisprendu­sios. 90,24 % I grupėje domėjosi skausmo malšinimo būdais, II grupėje – 61,02 % moterų nesidomėjo. Pagrindinis informacijos šaltinis – internetas (51,1 % I grupėje ir 22,04 % II grupėje). 35 (85,36 %) I grupės ir 37 (62,71 %) II grupės moterys kito gimdymo metu nekeistų skausmo malšinimo būdo (p = 0,0005).
Išvados. Taikant epidurinį skausmo malšinimą gimdymo metu statistiškai reikšmingai sumažėja gimdymo skausmas, pagerėja moterų savijauta po gimdymo, palyginti su skausmo malšinimu fentaniliu. Nepageidaujamų poveikių pasireiškimo skirtumas statistiškai nereikšmingas. Epidurinę nejautrą dažniau renkasi gimdymo skausmo labai bijančios, pirmą kartą gimdančios, mieste gyvenančios gimdyvės, jos dažniausiai ir buvo apsisprendusios dėl epidurinio skausmo malšinimo. Dauguma pasirinkusiųjų epidurinę nejautrą apie skausmo malšinimą informacijos ieškojo internete ir analgezijos būdo nekeistų. Moterys, gimdžiusios su epidurine nejautra, yra labiau patenkintos gimdymu ir visu aptarnaujančiu personalu.
Reta liga: vyrų krūties vėžys
Authors: Liutkutė Jūratė , Lachej Nadežda , Steponavičienė Laura , Pipirienė Želvienė Teresė , Aleknavičius Eduardas
Published: May 2015

Įvadas. Vyrų krūties vėžys – reta onkologinė liga. Pasaulyje vyrai sudaro apie 1  % visų sergančiųjų krūties vėžiu. Lietuvos vėžio registro duomenimis, kasmet Lietuvoje nustatoma 10–14 naujų vyrų krūties vėžio atvejų.
Medžiaga ir metodika. Pagrindinis informacijos šaltinis, ieškant duomenų, buvo PubMed ir Medscape duomenų bazės.
Rezultatai. Straipsnyje apžvelgiami pagrindiniai vyrų krūties vėžio rizikos veiksniai, paplitimas, histopatologiniai ypatumai, klinika ir diagnostika. Gana plačiai pateiktos kompleksinio gydymo galimybės (chirurginis gydymas, spindulinė terapija, chemoterapija, hormonoterapija, biologinė terapija), trumpai supažindinama su metastazavusio krūties vėžio gydymo galimybėmis.
Išvados. Svarbu nepamiršti, kad norint laiku diagnozuoti ligą ir suteikti optimalų gydymą pacientams svarbu šviesti visuomenę, nuolat priminti šeimos gydytojams ir kitiems specialistams apie šią retą ligą, nes bendras išgyvenamumas tiesiogiai koreliuoja su ligos stadija.