bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of health insurance reform on the number of cataract surgeries in Chongqing, China
Authors: Chen Xiaofan , Chen Chunlin , Zhang Yao , Yuan Rongdi , YE Jian
Published: April 2011

Background

Cataracts are the leading cause of blindness in China, and poverty is a major barrier to having cataract surgery. In 2003, the Chinese government began a series of new national health insurance reforms, including the New Cooperative Medical Scheme (NCMS) and the Urban Resident Basic Health Insurance scheme (URBMI). These two programs, combined with the previously existing Urban Employee Basic Health Insurance (UEBMI) program, aimed to make it easier for individuals to receive medical treatment. This study reports cataract surgery numbers in rural and urban populations and the proportion of these who had health insurance in Chongqing, China from 2003 to 2008.

Methods

The medical records of a consecutive case series, including 14,700 eyes of 13,262 patients who underwent age-related cataract surgery in eight hospitals in Chongqing from January 1, 2003, to December 31, 2008, were analysed retrospectively via multi-stage cluster sampling.

Results

In the past six years, the total number of cataract surgeries had increased each year as had the number of patients with insurance. Both the number of surgeries and the number of insured patients were much higher in the urban group than in the rural group. The rate of increase in the rural group however was much higher than in the urban group, especially in 2007 and 2008. The odds ratios of having health insurance for urban vs. rural individuals were relatively stable from 2003 to 2006, but it decreased in 2007 and was significantly lower in 2008.

Conclusions

Health insurance appears to be an important factor associated with increased cataract surgery in Chongqing, China. With the implementation of health insurance, the number of Chongqing's cataract surgeries was increased year by year.
Comparative analysis of remotely-sensed data products via ecological niche modeling of avian influenza case occurrences in Middle Eastern poultry
Authors: Bodbyl-Roels Sarah , Peterson ATownsend , Xiao Xiangming
Published: April 2011

Background

Ecological niche modeling integrates known sites of occurrence of species or phenomena with data on environmental variation across landscapes to infer environmental spaces potentially inhabited (i.e., the ecological niche) to generate predictive maps of potential distributions in geographic space. Key inputs to this process include raster data layers characterizing spatial variation in environmental parameters, such as vegetation indices from remotely sensed satellite imagery. The extent to which ecological niche models reflect real-world distributions depends on a number of factors, but an obvious concern is the quality and content of the environmental data layers.

Methods

We assessed ecological niche model predictions of H5N1 avian flu presence quantitatively within and among four geographic regions, based on models incorporating two means of summarizing three vegetation indices derived from the MODIS satellite. We evaluated our models for predictive ability using partial ROC analysis and GLM ANOVA to compare performance among indices and regions.

Results

We found correlations between vegetation indices to be high, such that they contain information that overlaps broadly. Neither the type of vegetation index used nor method of summary affected model performance significantly. However, the degree to which model predictions had to be transferred (i.e., projected onto landscapes and conditions not represented on the landscape of training) impacted predictive strength greatly (within-region model predictions far out-performed models projected among regions).

Conclusion

Our results provide the first quantitative tests of most appropriate uses of different remotely sensed data sets in ecological niche modeling applications. While our testing did not result in a decisive "best" index product or means of summarizing indices, it emphasizes the need for careful evaluation of products used in modeling (e.g. matching temporal dimensions and spatial resolution) for optimum performance, instead of simple reliance on large numbers of data layers.
Evidence of fibrinogen as a target of citrullination in IgM rheumatoid factor-positive polyarticular juvenile idiopathic arthritis
Authors: Gilliam Brooke E , Reed Melinda R , Chauhan Anil K , Dehlendorf Amanda B , Moore Terry L
Published: April 2011

Background

Several studies have noted the significance of measuring anti-cyclic citrullinated peptide (CCP) antibodies in juvenile idiopathic arthritis (JIA) as an important indicator for destructive disease, as is the case in rheumatoid arthritis (RA). While the role of anti-CCP antibodies in RA and JIA has become better understood, the identity of the target proteins of this modification has remained elusive. In this study, we evaluated serum from patients with various subtypes of JIA to investigate the presence of anti-deiminated (citrullinated) fibrinogen and anti-citrullinated α-enolase antibodies, and their association with RF and anti-CCP antibody isotypes.

Methods

Sera were obtained from 96 JIA patients, 19 systemic lupus erythematosus (SLE) patients, and 10 healthy children. All sera were measured for antibodies against citrullinated and native fibrinogen and α-enolase by an enzyme linked immunosorbent assay (ELISA). In addition, all sera were assayed for anti-CCP antibody isotypes and rheumatoid factor (RF) isotypes by ELISA. The relationship between anti-citrullinated fibrinogen and anti-α-enolase antibodies and disease activity and joint damage were also investigated. All results were correlated with clinical and laboratory parameters using Spearman's rho correlation coefficient. Multiple logistic regression analysis was utilized to identify which variables were associated with joint erosions and diagnosis of JIA.

Results

Thirty-one JIA patients (32%) demonstrated reactivity to citrullinated fibrinogen and 9 (9%) to citrullinated α-enolase. Reactivity to citrullinated fibrinogen and α-enolase was predominantly found in IgM RF-positive polyarthritis patients. Fourteen JIA patients reacted with native α-enolase and a higher percentage of SLE patients reacted with citrullinated α-enolase when compared to JIA patients. Anti-citrullinated fibrinogen antibodies correlated with the presence of IgG anti-CCP antibodies and IgA and IgM RF. The presence of anti-citrullinated α-enolase antibodies correlated with IgA anti-CCP antibodies. IgG anti-CCP antibodies were significantly associated with joint damage and anti-citrullinated fibrinogen antibodies were strongly associated with JIA when compared to control groups. Anti-citrullinated fibrinogen antibodies demonstrated high sensitivity (81%) for IgM RF-positive polyarticular JIA. IgG anti-CCP antibodies had the highest specificity (95%) for JIA, with anti-citrullinated fibrinogen antibodies, IgA anti-CCP antibodies and IgA RF all following at 84%.

Conclusions

JIA patient sera exhibited strong reactivity to anti-citrullinated fibrinogen antibodies and demonstrated high sensitivity and specificity for JIA, primarily in IgM RF-positive polyarthritis patients. Fibrinogen is one of several protein targets for citrullination in JIA.
Round-robin test on thermal conductivity measurement of ZnO nanofluids and comparison of experimental results with theoretical bounds
Authors: Lee Wook-Hyun , Rhee Chang-Kyu , Koo Junemo , Lee Jaekeun , Jang Seok Pil , Choi Stephen US , Lee Ki-Woong , Bae Hwa-Young , Lee Gyoung-Ja , Kim Chang-Kyu , Hong Sung Wook , Kwon Younghwan , Kim Doohyun , Kim Soo Hyung , Hwang Kyo Sik , Kim Hyun Jin , Ha Hyo Jun , Lee Seung-Hyun , Choi Chul Jin , Lee Ji-Hwan
Published: April 2011

Ethylene glycol (EG)-based zinc oxide (ZnO) nanofluids containing no surfactant have been manufactured by one-step pulsed wire evaporation (PWE) method. Round-robin tests on thermal conductivity measurements of three samples of EG-based ZnO nanofluids have been conducted by five participating labs, four using accurate measurement apparatuses developed in house and one using a commercial device. The results have been compared with several theoretical bounds on the effective thermal conductivity of heterogeneous systems. This study convincingly demonstrates that the large enhancements in the thermal conductivities of EG-based ZnO nanofluids tested are beyond the lower and upper bounds calculated using the models of the Maxwell and Nan et al. with and without the interfacial thermal resistance.
Gold-ionic liquid nanofluids with preferably tribological properties and thermal conductivity
Authors: Wang Baogang , Wang Xiaobo , Lou Wenjing , Hao Jingcheng
Published: April 2011

Gold/1-butyl-3-methylimidazolium hexafluorophosphate (Au/[Bmim][PF6]) nanofluids containing different stabilizing agents were fabricated by a facile one-step chemical reduction method, of which the nanofluids stabilized by cetyltrimethylammonium bromide (CTABr) exhibited ultrahighly thermodynamic stability. The transmission electron microscopy, UV-visible absorption, Fourier transform infrared, and X-ray photoelectron characterizations were conducted to reveal the stable mechanism. Then, the tribological properties of these ionic liquid (IL)-based gold nanofluids were first investigated in more detail. In comparison with pure [Bmim][PF6] and the nanofluids possessing poor stability, the nanofluids with high stability exhibited much better friction-reduction and anti-wear properties. For instance, the friction coefficient and wear volume lubricated by the nanofluid with rather low volumetric concentration (1.02 × 10-3%) stabilized by CTABr under 800 N are 13.8 and 45.4% lower than that of pure [Bmim][PF6], confirming that soft Au nanoparticles (Au NPs) also can be excellent additives for high performance lubricants especially under high loads. Moreover, the thermal conductivity (TC) of the stable nanofluids with three volumetric fraction (2.55 × 10-4, 5.1 × 10-4, and 1.02 × 10-3%) was also measured by a transient hot wire method as a function of temperature (33 to 81°C). The results indicate that the TC of the nanofluid (1.02 × 10-3%) is 13.1% higher than that of [Bmim][PF6] at 81°C but no obvious variation at 33°C. The conspicuously temperature-dependent and greatly enhanced TC of Au/[Bmim][PF6] nanofluids stabilized by CTABr could be attributed to micro-convection caused by the Brownian motion of Au NPs. Our results should open new avenues to utilize Au NPs and ILs in tribology and the high-temperature heat transfer field.
Gallium hydride vapor phase epitaxy of GaN nanowires
Authors: Zervos Matthew , Othonos Andreas
Published: April 2011

Straight GaN nanowires (NWs) with diameters of 50 nm, lengths up to 10 μm and a hexagonal wurtzite crystal structure have been grown at 900°C on 0.5 nm Au/Si(001) via the reaction of Ga with NH3 and N2:H2, where the H2 content was varied between 10 and 100%. The growth of high-quality GaN NWs depends critically on the thickness of Au and Ga vapor pressure while no deposition occurs on plain Si(001). Increasing the H2 content leads to an increase in the growth rate, a reduction in the areal density of the GaN NWs and a suppression of the underlying amorphous (α)-like GaN layer which occurs without H2. The increase in growth rate with H2 content is a direct consequence of the reaction of Ga with H2 which leads to the formation of Ga hydride that reacts efficiently with NH3 at the top of the GaN NWs. Moreover, the reduction in the areal density of the GaN NWs and suppression of the α-like GaN layer is attributed to the reaction of H2 with Ga in the immediate vicinity of the Au NPs. Finally, the incorporation of H2 leads to a significant improvement in the near band edge photoluminescence through a suppression of the non-radiative recombination via surface states which become passivated not only via H2, but also via a reduction of O2-related defects.
Fabrication and evolution of multilayer silver nanofilms for surface-enhanced Raman scattering sensing of arsenate
Authors: Hao Jumin , Han Mei-Juan , Xu Zhonghou , Li Jinwei , Meng Xiaoguang
Published: April 2011

Surface-enhanced Raman scattering (SERS) has recently been investigated extensively for chemical and biomolecular sensing. Multilayer silver (Ag) nanofilms deposited on glass slides by a simple electroless deposition process have been fabricated as active substrates (Ag/GL substrates) for arsenate SERS sensing. The nanostructures and layer characteristics of the multilayer Ag films could be tuned by varying the concentrations of reactants (AgNO3/BuNH2) and reaction time. A Ag nanoparticles (AgNPs) double-layer was formed by directly reducing Ag+ ions on the glass surfaces, while a top layer (3rd-layer) of Ag dendrites was deposited on the double-layer by self-assembling AgNPs or AgNPs aggregates which had already formed in the suspension. The SERS spectra of arsenate showed that characteristic SERS bands of arsenate appear at approximately 780 and 420 cm-1, and the former possesses higher SERS intensity. By comparing the peak heights of the approximately 780 cm-1 band of the SERS spectra, the optimal Ag/GL substrate has been obtained for the most sensitive SERS sensing of arsenate. Using this optimal substrate, the limit of detection (LOD) of arsenate was determined to be approximately 5 μg·l-1.
Investigation of electrical and magnetic properties of ferro-nanofluid on transformers
Authors: Tsai Tsung-Han , Chen Ping-Hei , Lee Da-Sheng , Yang Chin-Ting
Published: April 2011

This study investigated a simple model of transformers that have liquid magnetic cores with different concentrations of ferro-nanofluids. The simple model was built on a capillary by enamel-insulated wires and with ferro-nanofluid loaded in the capillary. The ferro-nanofluid was fabricated by a chemical co-precipitation method. The performances of the transformers with either air core or ferro-nanofluid at different concentrations of nanoparticles of 0.25, 0.5, 0.75, and 1 M were measured and simulated at frequencies ranging from 100 kHz to 100 MHz. The experimental results indicated that the inductance and coupling coefficient of coils grew with the increment of the ferro-nanofluid concentration. The presence of ferro-nanofluid increased resistance, yielding to the decrement of the quality factor, owing to the phase lag between the external magnetic field and the magnetization of the material.
Nuclear envelope structural defects cause chromosomal numerical instability and aneuploidy in ovarian cancer
Authors: Capo-chichi Callinice D , Cai Kathy Q , Simpkins Fiona , Ganjei-Azar Parvin , Godwin Andrew K , Xu Xiang-Xi
Published: April 2011

Background

Despite our substantial understanding of molecular mechanisms and gene mutations involved in cancer, the technical approaches for diagnosis and prognosis of cancer are limited. In routine clinical diagnosis of cancer, the procedure is very basic: nuclear morphology is used as a common assessment of the degree of malignancy, and hence acts as a prognostic and predictive indicator of the disease. Furthermore, though the atypical nuclear morphology of cancer cells is believed to be a consequence of oncogenic signaling, the molecular basis remains unclear. Another common characteristic of human cancer is aneuploidy, but the causes and its role in carcinogenesis are not well established.

Methods

We investigated the expression of the nuclear envelope proteins lamin A/C in ovarian cancer by immunohistochemistry and studied the consequence of lamin A/C suppression using siRNA in primary human ovarian surface epithelial cells in culture. We used immunofluorescence microscopy to analyze nuclear morphology, flow cytometry to analyze cellular DNA content, and fluorescence in situ hybridization to examine cell ploidy of the lamin A/C-suppressed cells.

Results

We found that nuclear lamina proteins lamin A/C are often absent (47%) in ovarian cancer cells and tissues. Even in lamin A/C-positive ovarian cancer, the expression is heterogeneous within the population of tumor cells. In most cancer cell lines, a significant fraction of the lamin A/C-negative population was observed to intermix with the lamin A/C-positive cells. Down regulation of lamin A/C in non-cancerous primary ovarian surface epithelial cells led to morphological deformation and development of aneuploidy. The aneuploid cells became growth retarded due to a p53-dependent induction of the cell cycle inhibitor p21.

Conclusions

We conclude that the loss of nuclear envelope structural proteins, such as lamin A/C, may underlie two of the hallmarks of cancer - aberrations in nuclear morphology and aneuploidy.
Rapid detection of anti-Vaccinia virus neutralizing antibodies
Authors: Kramski Marit , Drozd Anna , Lichtfuss Gregor F , Dabrowski Piotr W , Ellerbrok Heinz
Published: April 2011

Increasing infections with Monkeypox and Cowpox viruses pose a continuous and growing threat to human health. The standard method for detecting poxvirus neutralizing antibodies is the plaque-reduction neutralization test that is specific but also time-consuming and laborious. Therefore, a rapid and reliable method was developed to determine neutralizing antibody titers within twelve hours. The new assay measures viral mRNA transcription as a marker for actively replicating virus after incomplete neutralization using real-time PCR.
Pandemic (H1N1) 2009 influenza virus induces weaker host immune responses in vitro: a possible mechanism of high transmissibility
Authors: Mukherjee Sanjay , Vipat Veena C , Mishra Akhilesh C , Pawar Shailesh D , Chakrabarti Alok K
Published: April 2011

Background

The world has recently overcome the first influenza pandemic of the 21st century caused by a novel H1N1 virus (pH1N1) which is a triple reassortant comprising genes derived from avian, human, and swine influenza viruses and antigenically quite different from seasonal H1N1 strains. Although the case fatality rates have decreased in many developed countries, the situation is still alarming in many developing countries including India where considerable numbers of new cases are appearing everyday. There is still a high morbidity and mortality of susceptible adult as well as young population without having underlying health issues due to the influenza infection.

Results

To achieve a better understanding of the risk posed by the pH1N1 and to understand its pathogenicity, we studied the host gene expression response to Indian isolate of pH1N1 infection and compared it with seasonal H1N1 infection. The response was studied at four different time points (4, 8, 16 and 24 h) post infection (hpi) in A549 cells using microarray platform. We found that pH1N1 induces immune response earlier than seasonal H1N1 viruses, but at the later stages of infection there is a suppression of host immune responses. The infection with pH1N1 resulted in considerable decrease in the expression of cytokine and other immune genes namely IL8, STAT1, B2 M and IL4 compared to seasonal H1N1.

Conclusion

We propose that the inability to induce strong innate immune response could be a reason for the high transmissibility, pathogenicity and mortality caused by pH1N1 virus.
In vitro evaluation of antiviral and virucidal activity of a high molecular weight hyaluronic acid
Authors: Cermelli Claudio , Cuoghi Alessandro , Scuri Monica , Bettua Clotilde , Neglia Rachele G , Ardizzoni Andrea , Blasi Elisabetta , Iannitti Tommaso , Palmieri Beniamino
Published: April 2011

Background

hyaluronic acid (HA), a non-sulphated glycosaminoglycan, is present in synovial fluid, vitreous humour serum and many connective tissues. Pharmaceutical preparations of HA are used in clinical practice for wound healing, joint pain, kerato-conjunctivitis, asthma, mouth care, oesophageal-reflux, and gastritis. Moreover, it is used as a filler to counteract ageing and facial lipoatrophy. Our study aims at investigating the in vitro antiviral activity of a high molecular weight HA.

Methods

the MTT test was used to rule out the potential toxic effects of HA on the different cell lines used in the antiviral assays. The antiviral activity of HA against Coxsackievirus B5, Herpes Simplex Virus-1, Mumps Virus, Adenovirus-5, Influenza Virus A/H1N1, Human Herpesvirus-6, Porcine Parvovirus, Porcine Reproductive and Respiratory Syndrome Virus was assessed by virus yield assays.

Results

the most effective inhibition was observed against Coxsackievirus B5, with 3Log reduction of the virus yield at 4 mg/ml, and a reduction of 3.5Log and 2Log, at 2 mg/ml and 1 mg/ml, respectively: the selectivity index was 16. Mumps virus was highly inhibited too showing a reduction of 1.7Log at 1 mg/ml and 1Log at 4 mg/ml and 2 mg/ml (selectivity index = 12). The selectivity index for Influenza Virus was 12 with the highest inhibition (1Log) observed at 4 mg/ml. Herpes Simplex Virus-1 and Porcine Parvovirus were mildly inhibited, whereas no antiviral activity was observed with respect to Adenovirus-5, Human Herpesvirus-6, Porcine Reproductive and Respiratory Syndrome Virus. No HA virucidal activity was ever observed against any of the viruses tested. Kinetic experiments showed that both Coxsackievirus B5 and Herpes simplex virus-1 replication were consistently inhibited, not influenced by the time of HA addition, during the virus replication cycle.

Conclusions

the spectrum of the antiviral activity exhibited by HA against both RNA and DNA viruses, known to have different structures (with or without envelope) and replication strategies, suggests a non specific mechanism of action, probably involving cell membrane-virus interaction steps. The results of the kinetic experiments support this hypothesis.
Complete genome sequence of the lytic Pseudomonas fluorescens phage ϕIBB-PF7A
Authors: Sillankorva Sanna , Kluskens Leon D , Lingohr Erika J , Kropinski Andrew M , Neubauer Peter , Azeredo Joana
Published: April 2011

Background

Phage ϕIBB-PF7A is a T7-like bacteriophage capable of infecting severalPseudomonas fluorescensdairy isolates and is extremely efficient in lysing this bacterium even when growing in biofilms attached to surfaces. This work describes the complete genome sequence of this phage.

Results

The genome consists of a linear double-stranded DNA of 40,973 bp, with 985 bp long direct terminal repeats and a GC content of approximately 56%. There are 52 open reading frames which occupy 94.6% of the genome ranging from 137 to 3995 nucleotides. Twenty eight (46.7%) of the proteins encoded by this virus exhibit sequence similarity to coliphage T7 proteins while 34 (81.0%) are similar to proteins ofPseudomonasphage gh-1.

Conclusions

That this phage is closely related toPseudomonas putidaphage gh-1 and coliphage T7 places it in the "T7-like viruses" genus of the subfamilyAutographivirinaewithin the familyPodoviridae. Compared to the genome of gh-1, the sequence of ϕIBB-PF7A is longer and contains more genes with unassigned function and lacks a few potentially essential and non-essential T7 genes, such as gene1.1, 3.8, and 7.
Onion peel extracts ameliorate hyperglycemia and insulin resistance in high fat diet/streptozotocin-induced diabetic rats
Authors: Jung Ji Young , Lim Yeni , Moon Min Sun , Kim Ji Yeon , Kwon Oran
Published: April 2011

Background

Quercetin derivatives in onions have been regarded as the most important flavonoids to improve diabetic status in cells and animal models. The present study was aimed to examine the hypoglycemic and insulin-sensitizing capacity of onion peel extract (OPE) containing high quercetin in high fat diet/streptozotocin-induced diabetic rats and to elucidate the mechanism of its insulin-sensitizing effect.

Methods

Male Sprague-Dawley rats were fed the AIN-93G diet modified to contain 41.2% fat and intraperitoneally injected with a single dose of streptozotocin (40 mg/kg body weight). One week after injection, the rats with fasting blood glucose levels above 126 mg/dL were randomly divided into 4 groups to treat with high fat diet containing 0 (diabetic control), 0.5, or 1% of OPE or 0.1% quercetin (quercetin equivalent to 1% of OPE) for 8 weeks. To investigate the mechanism for the effects of OPE, we examined biochemical parameters (insulin sensitivity and oxidative stresses) and protein and gene expressions (pro-inflammatory cytokines and receptors).

Results

Compared to the diabetic control, hypoglycemic and insulin-sensitizing capability of 1% OPE were demonstrated by significant improvement of glucose tolerance as expressed in incremental area under the curve (P= 0.0148). The insulin-sensitizing effect of OPE was further supported by increased glycogen levels in liver and skeletal muscle (P< 0.0001 andP= 0.0089, respectively). Quantitative RT-PCR analysis showed increased expression of insulin receptor (P= 0.0408) and GLUT4 (P= 0.0346) in muscle tissues. The oxidative stress, as assessed by superoxide dismutase activity and malondialdehyde formation, plasma free fatty acids, and hepatic protein expressions of IL-6 were significantly reduced by 1% OPE administration (P= 0.0393, 0.0237, 0.0148 and 0.0025, respectively).

Conclusion

OPE might improve glucose response and insulin resistance associated with type 2 diabetes by alleviating metabolic dysregulation of free fatty acids, suppressing oxidative stress, up-regulating glucose uptake at peripheral tissues, and/or down-regulating inflammatory gene expression in liver. Moreover, in most cases, OPE showed greater potency than pure quercetin equivalent. These findings provide a basis for the use of onion peel to improve insulin insensitivity in type 2 diabetes.
Statistical analysis of IMRT dosimetry quality assurance measurements for local delivery guideline
Authors: Chung Jin Beom , Kim Jae Sung , Ha Sung Whan , Ye Sung-Joon
Published: April 2011

Purpose

To establish our institutional guideline for IMRT delivery, we statistically evaluated the results of dosimetry quality assurance (DQA) measurements and derived local confidence limits using the concept confidence limit of |mean|+1.96σ.

Materials and methods

From June 2006 to March 2009, 206 patients with head and neck cancer, prostate cancer, liver cancer, or brain tumor were treated using LINAC-based IMRT technique. In order to determine site specific DQA tolerances at a later stage, a hybrid plan with the same fluence maps as in the treatment plan was generated on CT images of a cylindrical phantom of acryl. Points of measurement using a 0.125 cm3 ion-chamber were typically located in the region of high and uniform doses. The planar dose distributions perpendicular to the central axis were measured by using a diode array in solid water with all fields delivered, and assessed using gamma criteria of 3%/3 mm. The mean values and standard deviations were used to develop the local confidence and tolerance limits. The dose differences and gamma pass rates for the different treatment sites were also evaluated in terms of total monitor uints (MU), MU/cGy, and the number of PTV's pieces.

Results

The mean values and standard deviations of ion-chamber dosimetry differences between calculated and measured doses were -1.6 ± 1.2% for H&N cancer, -0.4 ± 1.2% for prostate and abdominal cancer, and -0.6 ± 1.5% for brain tumor. Most of measured doses (92.2%) agreed with the calculated doses within a tolerance limit of ±3% recommended in the literature. However, we found some systematic under-dosage for all treatment sites. The percentage of points passing the gamma criteria, averaged over all treatment sites was 97.3 ± 3.7%. The gamma pass rate and the agreement of ion-chamber dosimetry generally decreased with increasing the number of PTV's pieces, the degree of modulation (MU/cGy), and the total MU beyond 700. Our local confidence limits were comparable to those of AAPM TG 119 and ESTRO guidelines that were provided as a practical baseline for center-to-center commissioning comparison. Thus, our institutional confidence and action limits for IMRT delivery were set into the same levels of those guidelines.

Discussion and Conclusions

The systematic under-dosage were corrected by tuning up the MLC-related factors (dosimetric gap and transmission) in treatment planning system (TPS) and further by incorporating the tongue-and groove effect into TPS. Institutions that have performed IMRT DQA measurements over a certain period of time need to analyze their accrued DQA data. We confirmed the overall integrity of our IMRT system and established the IMRT delivery guideline during this procedure. Dosimetric corrections for the treatment plans outside of the action level can be suggested only with such rigorous DQA and statistical analysis.
A meta-analysis of gemcitabine containing chemotherapy for locally advanced and metastatic pancreatic adenocarcinoma
Authors: Hu Jing , Zhao Gang , Wang Hong-Xia , Tang Lei , Xu Ying-Chun , Ma Yue , Zhang Feng-Chun
Published: April 2011

Background

The objectives of the present study are to investigate the efficacy and safety profile of gemcitabine-based combinations in the treatment of locally advanced and metastatic pancreatic adenocarcinoma (LA/MPC).

Methods

We performed a computerized search using combinations of the following keywords: "chemotherapy", "gemcitabine", "trial", and "pancreatic cancer".

Results

Thirty-five trials were included in the present analysis, with a total of 9,979 patients accrued. The analysis showed that the gemcitabine-based combination therapy was associated with significantly better overall survival (OS) (ORs, 1.15; p = 0.011), progression-free survival (PFS) (ORs, 1.27; p < 0.001), and overall response rate (ORR) (ORs, 1.58; p < 0.001) than gemcitabine monotherapy. Similar results were obtained when the gemcitabine-fluoropyrimidine combination was compared with gemcitabine, with the OS (ORs, 1.33; p = 0.007), PFS (ORs, 1.53; p < 0.001), and ORR (ORs 1.47, p = 0.03) being better in the case of the former. The OS (ORs, 1.33; p = 0.019), PFS (ORs, 1.38; p = 0.011), and one-year survival (ORs, 1.40; p = 0.04) achieved with the gemcitabine-oxaliplatin combination were significantly greater than those achieved with gemcitabine alone. However, no survival benefit (OS: ORs, 1.01, p = 0.93; PFS: ORs, 1.19, p = 0.17) was noted when the gemcitabine-cisplatin combination was compared to gemcitabine monotherapy. The combinations of gemcitabine and other cytotoxic agents also afforded disappointing results. Our analysis indicated that the ORR improved when patients were treated with the gemcitabine-camptothecin combination rather than gemcitabine alone (ORs, 2.03; p = 0.003); however, there were no differences in the OS (ORs, 1.03; p = 0.82) and PFS (ORs, 0.97; p = 0.78) in this case.

Conclusions

Gemcitabine in combination with capecitabine or oxaliplatin was associated with enhanced OS and ORR as compared with gemcitabine in monotherapy, which are likely to become the preferred standard first-line treatment of LA/MPC.
Expression of Ets-1, Ang-2 and maspin in ovarian cancer and their role in tumor angiogenesis
Authors: Lin Zijing , Liu Yu , Sun Yuhui , He Xiuping
Published: April 2011

Background

Various angiogenic regulators are involved in angiogenesis cascade. Transcription factor Ets-1 plays important role in angiogenesis, remodeling of extracellular matrix, and tumor metastasis. Ets-1 target genes involved in various stages of new blood vessel formation include angiopoietin, matrix metalloproteinases (MMPs) and the protease inhibitor maspin.

Methods

We used immunohistochemistry (IHC) to detect the expression of Ets-1, angiopoietin-2 (Ang-2) and maspin in ovarian tumor and analyzed the relationship between the expression of these proteins and the clinical manifestation of ovarian cancer.

Results

Ets-1 expression was much stronger in ovarian cancer compared to benign tumors, but had no significant correlation with other pathological parameters of ovarian cancer. However, Ang-2 and maspin expression had no obvious correlation with pathological parameters of ovarian cancer. Ets-1 had a positive correlation with Ang-2 which showed their close relationship in angiogenesis. Although microvessel density (MVD) value had no significant correlation with the expression of Ets-1, Ang-2 or maspin, strong nuclear expression of maspin appeared to be correlated with high grade and MVD.

Conclusions

The expression of Ets-1, Ang2 and maspin showed close relationship with angiogenesis in ovarian cancer and expression of maspin appeared to be correlated with high grade and MVD. The mechanisms underlying the cross-talk of the three factors need further investigations.
High efficacy of lopinavir/r‐based second‐line antiretroviral treatment after 24 months of follow up at ESTHER/Calmette Hospital in Phnom Penh, Cambodia
Authors: Ferradini Laurent , Ouk Vara , Segeral Olivier , Nouhin Janin , Dulioust Anne , Hak Chanroeurn , Fournier Isabelle , Lerolle Nathalie , Ngin Sopheak , Mean Chhi Vun , Delfraissy Jean‐François , Nerrienet Eric
Published: April 2011

Background

The number of patients on second‐line highly active antiretroviral therapy (HAART) regimens is increasing in resource‐limited settings. We describe the outcomes after 24 months for patients on LPV/r‐based second‐line regimens followed up by the ESTHER programme in Phnom Penh, Cambodia.

Methods

Seventy patients who initiated second‐line HAART regimens more than 24 months earlier were included, and immuno‐virological data analyzed. HIV RNA viral load was determined by real‐time RT‐PCR. HIV‐1 drug resistance was interpreted according to the ANRS algorithm.

Results

Of the 70 patients, two were lost to follow up, three died and 65 (92.8%) remained on second‐line treatment after 24 months of follow up (median duration of treatment: 27.4 months). At switch to second‐line, the median CD4 T cell count was 106 cells/mm3 and the median viral load was 4.7 Log10. Second‐line regimens prescribed were ddI/3TC/LPV/r (65.7%), ddI/TDF/LPV/r (10.0%), ddI/AZT/LPV/r (8.6%) and TDF/3TC/LPV/r (7.1%). The median CD4 T cell gain was +258 cells/mm3 at 24 months (n = 63). After 24 months of follow up, 92.3% (60/65) of the patients presented undetectable viral loads, giving an overall treatment success rate of 85.7% (CI: 75.6‐ 92.0) in intent‐to‐treat analysis.

Conclusions

These data suggest that a LPV/r‐based second‐line regimen is associated with a high rate of virological suppression and immune reconstitution after 24 months of follow up in Cambodia.
Screening recurrence and lymph node metastases in head and neck cancer: the role of computer tomography in follow-up
Authors: Rivelli Valentina , Luebbers Heinz T , Weber Franz E , Cordella Claudia , Grätz Klaus W , Kruse Astrid L
Published: April 2011

Introduction

Follow-up of patients with oral cancer is being questioned with regard to financial costs and effectiveness. Therefore, the aim of the present study was to evaluate whether local recurrence and cervical lymph node metastases were first discovered clinically or by routine computer tomography.

Materials and methods

The records of all 317 patients that were treated for an oral cancer between 1998 and 2008 were systematically reviewed. Criteria for inclusion were tumor histology with a squamous cell carcinoma of the head and neck, and regular follow-up examinations with a minimum follow-up time of 12 months, including clinical and radiological (CT) controls. All patients had the first CT after 6 months, followed by yearly CT controls.

Results

Out of 315 patients with an oral squamous cell carcinoma, 294 were evaluated. Those experiencing neither recurrence of the tumor nor lymph node metastases constituted 62%. Local recurrence was seen in 36 (12%), lymph node metastases in 32 (11%), and both in 16 (6%). Of the 32 patients with lymph node metastases, 25 were recognized first clinically, and 7 were detected by routine CT scans; concerning local recurrence, 32 appeared clinically, and 4 were detected by routine CT scans.

Conclusion

Routine CT for follow-up is still indicated for detecting lymph node metastases as well as local recurrence.
Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit
Authors: Lone Nazir I , Walsh Timothy S
Published: April 2011

Introduction

The number of patients requiring prolonged mechanical ventilation (PMV) is likely to increase. Transferring patients to specialised weaning units may improve outcomes and reduce costs. The aim of this study was to establish the incidence and outcomes of PMV in a UK administrative health care region without a dedicated weaning unit, and model the potential impact of establishing a dedicated weaning unit.

Methods

A retrospective cohort study was undertaken using a database of admissions to three intensive care units (ICU) in a UK region from 2002 to 2006. Using a 21 day cut-off to define PMV, incidence was calculated using all ICU admissions and ventilated ICU admissions as denominators. Outcomes for the PMV cohort (mortality and hospital resource use) were compared with the non-PMV cohort. Length of ICU stay beyond 21 days was used to model the effect of establishing a weaning unit in terms of unit occupancy rates, admission refusal rates, and healthcare costs.

Results

Out of 8290 ICU admission episodes, 7848 were included in the analysis. Mechanical ventilation was required during 5552 admission episodes, of which 349 required PMV. The incidence of PMV was 4.4 per 100 ICU admissions, and 6.3 per 100 ventilated ICU admissions. PMV patients used 29.1% of all general ICU bed days, spent longer in hospital after ICU discharge than non-PMV patients (median 17 vs 7 days, P < 0.001) and had higher hospital mortality (40.3% vs 33.8%, P = 0.02). For the region, in which about 70 PMV patients were treated each year, a weaning unit with a capacity of three beds appeared most cost efficient, resulting in an occupancy rate of 73%, admission refusal rate at 21 days of 36%, and potential cost saving of £344,000 (€418,000) using UK healthcare tariffs.

Conclusions

One in every sixteen ventilated patients requires PMV in our region and this group use a substantial amount of health care resource. Establishing a weaning unit would potentially reduce acute bed occupancy by 8-10% and could reduce overall treatment costs. Restructuring the current configuration of critical care services to introduce weaning units should be considered if the expected increase in PMV incidence occurs.
Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study
Authors: Amrein Karin , Sourij Harald , Wagner Gerit , Holl Alexander , Pieber Thomas R , Smolle Karl Heinz , Stojakovic Tatjana , Schnedl Christian , Dobnig Harald
Published: April 2011

Introduction

Vitamin D deficiency is encountered frequently in critically ill patients and might be harmful. Current nutrition guidelines recommend very low vitamin D doses. The objective of this trial was to evaluate the safety and efficacy of a single oral high-dose vitamin D3 supplementation in an intensive care setting over a one-week observation period.

Methods

This was a randomized, double-blind, placebo-controlled pilot study in a medical ICU at a tertiary care university center in Graz, Austria. Twenty-five patients (mean age 62 ± 16yrs) with vitamin D deficiency [25-hydroxyvitamin D (25(OH)D) ≤20 ng/ml] and an expected stay in the ICU >48 hours were included and randomly received either 540,000 IU (corresponding to 13.5 mg) of cholecalciferol (VITD) dissolved in 45 ml herbal oil or matched placebo (PBO) orally or via feeding tube.

Results

The mean serum 25(OH)D increase in the intervention group was 25 ng/ml (range 1-47 ng/ml). The highest 25(OH)D level reached was 64 ng/ml, while two patients showed a small (7 ng/ml) or no response (1 ng/ml). Hypercalcemia or hypercalciuria did not occur in any patient. From day 0 to day 7, total serum calcium levels increased by 0.10 (PBO) and 0.15 mmol/L (VITD; P < 0.05 for both), while ionized calcium levels increased by 0.11 (PBO) and 0.05 mmol/L (VITD; P < 0.05 for both). Parathyroid hormone levels decreased by 19 and 28 pg/ml (PBO and VITD, ns) over the seven days, while 1,25(OH)D showed a transient significant increase in the VITD group only.

Conclusions

This pilot study shows that a single oral ultra-high dose of cholecalciferol corrects vitamin D deficiency within 2 days in most patients without causing adverse effects like hypercalcemia or hypercalciuria. Further research is needed to confirm our results and establish whether vitamin D supplementation can affect the clinical outcome of vitamin D deficient critically ill patients.

EudraCT Number

2009-012080-34

German Clinical Trials Register (DRKS)

DRKS00000750
ISsaga is an ensemble of web-based methods for high throughput identification and semi-automatic annotation of insertion sequences in prokaryotic genomes
Authors: Varani Alessandro M , Siguier Patricia , Gourbeyre Edith , Charneau Vincent , Chandler Mick
Published: April 2011

Insertion sequences (ISs) play a key role in prokaryotic genome evolution but are seldom well annotated. We describe a web application pipeline, ISsaga (http://issaga.biotoul.fr/ISsaga/issaga_index.php), that provides computational tools and methods for high-quality IS annotation. It uses established ISfinder annotation standards and permits rapid processing of single or multiple prokaryote genomes. ISsaga provides general prediction and annotation tools, information on genome context of individual ISs and a graphical overview of IS distribution around the genome of interest.
Implementation of case management in long-term conditions in England: Survey and case studies
Authors: Challis David , Hughes Jane , Berzins Kathryn , Reilly Siobhan , Abell Jessica , Stewart Karen , Bowns Ian
Published: April 2011

Objectives

Our aim was to describe the current provision of case management arrangements in primary care for people with long-term conditions in England and identify the extent and nature of self-care support services within it.

Methods

Cross-sectional survey of primary care trusts (PCTs) in England and four case studies using semi-structured interviews and focus groups.

Results

Services were predominantly nurse-led, typically by community matrons, and delivered on a geographical basis. Often multiple arrangements existed within a PCT but integration of services with local authority adult social care was not widespread. A range of self-care support services were utilized and often tuition was provided by case managers to patients in their own homes. Assessment, care coordination and direct support to patients were the principal tasks. Often care plans were limited to primary care services and did not include service costings. Links with nurse-led services within PCTs were evident but operational links with adult social care were poorly developed. This is consistent with previous research relating to the introduction of care management in social services in England which also resulted in a plethora of organizational arrangements.

Conclusions

Case management for patients with long-term conditions is at an early stage of development. Effective links with a range of local services are required if care plans are going to be comprehensive.
Governance for health and wellbeing in the English NHS
Authors: Marks Linda , Cave Sally , Hunter David , Mason James , Peckham Stephen , Wallace Andrew
Published: April 2011

Objectives

Shifting the focus of health-care systems towards prevention has proved difficult to achieve. Governance structures are complex, incentives may conflict and there are many competing priorities. We explored the influence of governance and incentive arrangements on commissioning for health and well-being in the English National Health Service (NHS) and the governance paradoxes which emerge.

Methods

Qualitative and quantitative methods were employed. We carried out one national and two regional focus groups; a national online survey of primary care trusts (PCTs); and 99 semi-structured interviews in 10 purposively selected case study sites across England. Interviewees included decision-makers in PCTs, practice-based commissioners, Chairs of Local Involvement Networks (LINks) and of Overview and Scrutiny committees (OSCs) and Voluntary and Community Sector (VCS) members of local health and wellbeing partnerships.

Results

Case study sites differed in the extent to which they reflected a public health ethos throughout the commissioning cycle, incentivized preventive services through contractual flexibilities or prioritized investment in health and wellbeing. Practice-based commissioners were tangentially involved in the commissioning cycle, public health partnerships or local health needs assessment. While commissioning for health and wellbeing involves working through partnerships, performance management regimes favoured single organizational success. Preventive services were considered at increased risk in times of financial stringency.

Conclusions

As the NHS in England undergoes further reorganization, it is important to ensure that a systematic, strategic and population-based approach to commissioning is not lost. Governance and incentive arrangements should be critically assessed for their impact on population health and wellbeing.
The association between presenteeism and engagement of National Health Service staff
Authors: Admasachew Lul , Dawson Jeremy
Published: April 2011

Objective

Although several studies have demonstrated a relationship between staff engagement and health and wellbeing, none has analysed the association with presenteeism in the National Health Service (NHS) context. Our aim is to determine whether there is a relationship between presenteeism and staff engagement.

Methods

A hierarchical logistic multilevel modelling of cross-sectional data from the NHS staff survey (2009) was conducted. We controlled for a range of demographic and socioeconomic background variables, including ethnic group, gender, age and occupational group. The sample was 156,951 respondents across all 390 English NHS trusts, each providing a random sample of employees. Engagement was measured using three facets: motivation, advocacy and involvement, which were also used in a composite score.

Results

There was a low-to-moderate negative correlation between presenteeism and staff engagement: odds ratio 0.42 (95% confidence interval [CI] 0.42-0.43) for overall staff engagement and 0.53 (95% CI 0.52-0.54) for staff advocacy of the trust; 0.53 (95% CI 0.52-0.54) for motivation and 0.50 (95% CI 0.49-0.51) for involvement.

Conclusions

Putting pressure on health-care staff to come to work when unwell is associated with poorer staff engagement with their jobs.
Organizing and delivering diabetes education and self-care support: Findings of scoping project
Authors: Forbes Angus , While Alison , Griffiths Peter , Ismail Khalida , Heller Simon
Published: April 2011

Objective

To provide an overview of current research and development on the organization and delivery of diabetes education and self-care support, incorporating stakeholder perspectives.

Method

Four methods were used: literature review (159 papers and 52 grey literature items); patient participation event (n 5 38); online survey of professionals (n 5 423) and patients (n5 495); and, a conference.

Results

The literature review identified themes relating to the organization and delivery of diabetes and self-care support: structure and flexibility in models of education; accessibility; patient choice; integrating self-care within the overall care system; quality improvement; peer educators; health literacy; efficiency in delivery; telecare models; feedback technologies; care planning; psychological intervention; and self-care outcome measures. This generated four models to provide a framework to help shape the development of diabetes self-care: a diabetes education pathway; integrating self-care and clinical care; choice as a method of optimizing care; and an integrated framework for delivering diabetes self-care.

Conclusion

The clinical benefit of the identified models need to be evaluated.