bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment outcomes of metastatic nonclear cell renal cell carcinoma: A single institution retrospective analysis
Authors: Agarwala Vivek , Ramaswamy Anant , Joshi Amit , Patil Vijay Maruti , Noronha Vanita , Menon Santosh , Popat B. Palak , Nilesh Sable , Prabhash Kumar 
Published: October 2018

Abstract
Introduction: Nonclear cell (NCC) metastatic renal cell carcinoma (mRCC) is a biologically heterogeneous entity. We report the outcomes of NCC mRCC treated with first-line vascular endothelial growth factor (VEGF) inhibitors or mammalian target of rapamycin (mTOR) inhibitors at our institute. This is first such report from India. Methods: This is a retrospective analysis of the 40 consecutive patients of NCC mRCC treated between January 2013 and June 2015 in routine clinical practice at our institute. The primary endpoint analyzed was overall survival (OS) with respect to the type of first-line treatment and tumor histology. Results: The most common histological subtype was papillary in 25 patients (62.5%) followed by sarcomatoid in six (15%), chromophobe in 5 (12.5%), translocation-associated in one patient, and other nonspecified in three patients. First-line treatment was sorafenib in 14 (35%), sunitinib in 9 (22.5%), pazopanib in 8 (20%), everolimus in seven (17.5%), and best-supportive care (BSC) in two (5%) patients. Partial response, stable disease, and progression was observed in six (15%), 13 (32.5%), and nine (22.5%) cases, respectively, as the best response to first-line treatment. The median OS was 11.7 months and median event-free survival was 6.1 months in the whole cohort. The median OS in months for different first-line treatments were as follows: sorafenib (16.2), sunitinib (11.7), pazopanib (not reached, mean-23.9 ± 6.0), everolimus (4.1) and BSC (0.6) and for different histological subtypes were as follows: papillary (9.8), chromophobe (not reached, mean-30.3 ± 8.4), sarcomatoid (4.1), and others (7.9). Conclusions: Chromophobe histology has a better outcome compared to other histological subtypes, and anti-VEGF tyrosine kinase inhibitors are preferable first-line agents compared to mTOR inhibitors.
Clinical and endoscopic response to high dose rate endobronchial brachytherapy in malignant lung tumors: A single centre experience
Authors: Dhillon Sneha , Bansal Saurabh , Sindhwani Girish , Gupta Meenu , Nautiyal Vipul , Saini Sunil , Ahmad Mushtaq 
Published: October 2018

Abstract
Purpose: The aim of the study was to evaluate the short-term clinical, endoscopic response, and acute toxicities in endobronchial cancer treated with high-dose-rate endobronchial brachytherapy (HDR-EB). Materials and Methods: Thirty patients of advanced endobronchial cancers were treated with HDR-EB. Brachytherapy was delivered at a depth of 1 cm from the source axis at weeks 1, 2, and 3 with 7 Gy per fraction. All patients were evaluated before treatment and at 1 month after completion of therapy. Using Speiser's scoring criteria, the severity of symptoms (dyspnea, cough, hemoptysis, and postobstructive pneumonia) and degree of obstruction were graded. Results: Symptomatic response for cough, dyspnea, and hemoptysis was seen in 88%, 75%, and 96%, respectively, with a significant P value (<0.05). Obstructive pneumonia was resolved in 94% of patients. Endoscopic response in terms of degree of obstruction was seen in 84% of patients. Acute toxicities in the form of radiation bronchitis were seen in 32% of patients, whereas 8% of patients experienced esophagitis. Bronchospasm was seen in one patient during treatment. Conclusion: HDR brachytherapy is a highly effective, safe, convenient therapy in alleviating symptoms of endobronchial obstruction with endoscopic response in the majority of cases. Thus, HDR-BT is a promising treatment for palliation of patients presenting with symptoms of endobronchial obstruction with an acceptable rate of complications.
Changes in sea-surface temperature and atmospheric circulation patterns associated with reductions in Arctic sea ice cover in recent decades
Authors: Yu Lejiang , Zhong Shiyuan 
Published: October 2018

Abstract. In recent decades, the Arctic sea ice has been declining at a rapid pace as the Arctic warms at a rate of twice the global average. The underlying physical mechanisms for the Arctic warming and accelerated sea ice retreat are not fully understood. In this study, we apply a relatively novel statistical method called self-organizing maps (SOM) along with composite analysis to examine the trend and variability of autumn Arctic sea ice in the past three decades and their relationships to large-scale atmospheric circulation changes. Our statistical results show that the anomalous autumn Arctic dipole (AD) (Node 1) and the Arctic Oscillation (AO) (Node 9) could explain in a statistical sense as much as 50 % of autumn sea ice decline between 1979 and 2016. The Arctic atmospheric circulation anomalies associated with anomalous sea-surface temperature (SST) patterns over the North Pacific and North Atlantic influence Arctic sea ice primarily through anomalous temperature and water vapor advection and associated radiative feedback.
Multisatellite observations of the magnetosphere response to changes in the solar wind and interplanetary magnetic field
Authors: Korotova Galina , Sibeck David , Thaller Scott , Wygant John , Spence Harlan , Kletzing Craig , Angelopoulos Vassilis , Redmon Robert 
Published: October 2018

Abstract. We employ multipoint observations of the Van Allen Probes, THEMIS, GOES and
Cluster to present case and statistical studies of the electromagnetic field,
plasma and particle response to interplanetary (IP) shocks observed by the Wind satellite. On 27 February 2014 the
initial encounter of an IP shock with the magnetopause occurred on the
postnoon magnetosphere, consistent with the observed alignment of the shock
with the spiral IMF. The dayside equatorial magnetosphere exhibited a
dusk–dawn oscillatory electrical field with a period of ∼330 s and
peak-to-peak amplitudes of ∼15 mV m−1 for a period of 30 min.
The intensity of electrons in the energy range from 31.5 to 342 KeV
responded with periods corresponding to the shock-induced ULF (ultralow frequency) electric
field waves. We then perform a statistical study of Ey variations of the
electric field and associated plasma drift flow velocities for 60
magnetospheric events during the passage of interplanetary shocks. The Ey
perturbations are negative (dusk-to-dawn) in the dayside magnetosphere
(followed by positive or oscillatory perturbations) and dominantly positive (dawn-to-dusk direction) in the nightside magnetosphere,
particularly near the Sun–Earth line within an L-shell range from 2.5 to 5.
The typical observed amplitudes range from 0.2 to 6 mV m−1 but can
reach 12 mV during strong magnetic storms. We show that electric field
perturbations increase with solar wind pressure, and the changes are
especially marked in the dayside magnetosphere. The direction of the Vx
component of plasma flow is in agreement with the direction of the Ey
component and is antisunward at all local times except the nightside
magnetosphere, where it is sunward near the Sun–Earth line. The flow
velocities Vx range from 0. 2 to 40 km s−1 and are a factor of 5 to
10 times stronger near noon as they correspond to greater variations of the
electric field in this region. We demonstrate that the shock-induced electric
field signatures can be classified into four different groups according to
the initial Ey electric field response and these signatures are dependent
on local time. Negative and bipolar pulses predominate on the dayside while
positive pulses occur on the nightside. The ULF electric field pulsations of
Pc and Pi types produced by IP shocks are observed at all local times and in
the range of periods from several tens of seconds to several minutes. We
believe that most electric field pulsations of the Pc5 type in the dayside
magnetosphere at L<6 are produced by field line resonances. We
show that the direction of the shock normal determines the direction of the
propagation of the shock-induced magnetic and plasma disturbances. The
observed directions of velocity Vy predominately agree with those expected
for the given spiral or orthospiral shock normal orientation.
The Prohibitions against Homosexual Sex in Leviticus 18:22 and 20:13: Are They Relevant Today?
Authors: Sklar Jay 
Published: October 2018

Abstract
This article explores whether the prohibitions against homosexual sex in Lev 18:22 and 20:13 have ongoing relevance today. It begins by noting that the use of the term abomination in these verses does not settle the question and then turns to consider three different types of responses to the question: (1) the prohibitions do not apply today because Leviticus does not apply today; (2) the prohibitions do not apply today because the reason this activity was prohibited in Leviticus no longer applies today; and (3) the prohibitions do apply today because the reason the activity was prohibited in Leviticus still applies today. The conclusion notes that multiple moral rationales may be at work behind a single command and considers why this is significant when discussing whether these particular verses have ongoing relevance.
Prólogo
Authors: Hooker Blandford Alta Suzzane 
Published: October 2018

La Revista Ciencia e Interculturalidad de la Universidad de las Regiones Autónomas de la Costa Caribe Nicaragüense (URACCAN), divulga artículos inéditos de investigación, artículos de revisión bibliográfica y ensayos investigativos que contribuyen a promover las diversas temáticas relacionadas a la ciudadanía intercultural de género. Está dirigida a investigadores, profesores, estudiantes y profesionales vinculados a áreas sensibles como: Educación y Salud Intercultural, Territorialidad, Recursos Naturales y Medio Ambiente, Género e Identidad, Derechos Humanos, en especial los vinculantes a los tratados y convenios internacionales de los pueblos indígenas y afrodescendientes. Para fines de organización, la cobertura temática de la revista contempla las siguientes sec- ciones: Revitalización Lingüística y Cultural, Educación, Educación Intercultural, Género e Identidad, Ciencias Sociales, Recursos Naturales y Medio Ambiente, Agropecuaria, Cultura Indígena y Afrodescendiente, Autonomía Regional, Educación Superior en el Caribe, Humanidades, Salud Intercultural, Ingeniería y Tecnología. Este volumen No. 22, presenta una compilación estructurada en 5 secciones, las cuales comprenden 10 artículos; dos en las áreas de Educación, dos en Cultura indígena y afrodescendiente, uno en Autonomía de la Costa Caribe nicaragüense, tres en Género e interculturalidad y tres en Ciencias Sociales. Los resultados de estas investigaciones aportan significativamente a la praxis innova- dora de la comunidad universitaria, y constituyen un medio educativo y de comunicación para compartir con la comunidad de profesores, investigadores y estudiantes del mundo académico, en una expresión crítica, autónoma y de emancipación en un ambiente de ciudadanías interculturales de género.
AS MUITAS FACES DA PROSTITUIÇÃO: UMA ABORDAGEM HISTÓRICA SOBRE O CONTROLE DA SEXUALIDADE A PARTIR DE FOUCAULT
Authors: Silva Gabriela Natalia 
Published: October 2018

O objetivo deste artigo é abordar a representação social da prostituta, descrevendo com ela tem sido categorizada e enunciada ao longo da história da humanidade, bem como evidenciar os efeitos da estigmatização do sujeito e da sua atividade na sociedade contemporânea. O debate é realizado com base nos pressupostos ideológicos de Michel Foucault, no que tange ao conceito de poder e controle dasexualidade. Conclui-se como sendo necessário e urgente a desconstrução da identidade da prostituta a partir da visão masculina, que permanece silenciando e estigmatizando essa categoria. O papel da história deveria ser o de descortinar essa posição hegemônica para dar espaço à leitura feminina desse fenômeno.Palavras-chave: Prostituição Feminina; Análise do Discurso; Michel Foucault.
Effect of Obesity on Perioperative Complications, Hospital Costs, and Length of Stay in Patients With Open Ankle Fractures
Authors: Gil Joseph A. , Durand Wesley , Johnson Joseph P. , Goodman Avi D. , Daniels Alan H. 
Published: October 2018

Introduction:
The objective of this study was to examine the effect of obesity on perioperative complications and the cost of surgical management of open ankle fractures.

Methods:
This study examined data from the National Inpatient Sample. The primary outcome variables assessed were occurrence of any complication, complication subtype, length of stay, and total hospital costs.

Results:
Patients with obesity accounted for 10.1% (n = 8.972) of the total cohort. After adjusting for patient and hospital characteristics, patients with obesity exhibited higher odds of any complication, as well as longer length of stay and higher total costs.

Conclusion:
As our understanding of the association between complications and cost of managing open ankle fractures in patients with obesity improves, future research should strive to improve patient outcomes and decrease cost of care through efforts made to prevent complications in patients with obesity.
Laparoscopy-assisted vaginal hysterectomy: Cost analysis and review of initial experience in a community hospital
Authors: Messina Michael J. , Garavaglia Mary M. , Walsh Robert T. , Turke Geron D. , PharmD Richard E. Amenta 
Published: October 2018

Abstract
During the past 2 years, an increasing number of gynecologic surgeons have performed laparoscopy-assisted vaginal hysterectomy (LAVH) and laparoscopic hysterectomy (LH). Although these procedures have become more common, they are still considered controversial. Many gynecologists question their cost, safety, efficacy, and indications. We reviewed and analyzed the perioperative and postoperative course of ten patients as well as the total cost. The patients who underwent these procedures were compared with ten matched patients who underwent abdominal hysterectomy for similar indications. Compared with control subjects, patients in the laparoscopic group had a shorter hospitalization stay (2.2 days vs 4.2 days), shorter recovery (2 weeks vs 5 weeks), and 28% fewer complications. Although the LAVH took significantly longer than TAH (3.28 hours vs 1.75 hours), the total hospital costs and charges for both procedures were similar. As technology advances and techniques are modified, the laparoscopic approach should reduce hospital costs and charges significantly. The current results suggest that LAVH may eventually be preferred to the TAH approach by physicians and their patients.
Sickle cell disease: The clinical manifestations
Authors: Childs Julianne Wilkens 
Published: October 2018

Abstract
In the United States, sickle cell disease primarily affects people of Mrican descent, and the multisystemic complications caused by the resultant vasoocclusive state create a multitude of diagnostic considerations. In the musculoskeletal system, likelihood is high for avascular necrosis of the femoral humeral head, as a consequence of skeletal infarcts, and also for leg ulceration and osteomyelitis; in the eyes, the incidence of proliferative retinopathy is high; in the urinary tract, dehydration is common, and causes for renal failure are many; in the pulmonary system, pneumonia is of prime concern, as are sickle cell chest syndrome (from occlusion within the microvasculature of the lung) and the deadly sickle cell chronic lung disease, for which pulmonary function tests are important in early asymptomatic stages. Cholelithiasis occurs in 40% of young adult patients with sickle cell disease and can be confused with sickle cell hepatopathy, and rheumatologic and immunologic diseases can occur concomitantly with sickle cell disease, with similar symptoms. The chance for stroke in patients with sickle cell disease is 25%, and early recurrence is common, although the pathogenesis has been more clearly elucidated through computed tomography and magnetic resonance imaging. Infection with Streptococcus pneumoniae has high mortality because of the asplenia associated with sickle cell disease.
Residents' performance before and after night call as evaluated by an indicator of creative thought
Authors: Nelson Craig S. , Dell’Angela Kim , Jellish Scott W. , Brown Irwin E. , Skaredoff Michael 
Published: October 2018

Abstract
The effects of sleep deprivation on medical personnel have received much attention. This study evaluates the effects of sleep loss on divergent-thinking (creative or innovative) processes as measured by the Torrance Test of Creative Thinking (TTCT). Anesthesia residents who had approximately 30 minutes sleep while being on-call were evaluated. These physicians had similar caffeine and nicotine consumption before and after the test. The results reported here demonstrate that postcall residents had TTCT scores that were appreciably below those scores of rested residents. Postcall verbal fluency was less among the on-call group than among the rested group (94.0 ± 9.7 vs 101.8 ± 9.8) as was figural originality (89.9 ± 22.1 vs 113.3 ± 20.3). These study results suggest that sleep deprivation affects divergent, or creative, thinking. Divergent-thinking processes are usually innovative and are used during complex problem-solving tasks. Further studies are needed on the effects of sleep deprivation. This information can then be used to help improve residents' working conditions and patient care.
Efficacy of combination therapy with insulin and oral hypoglycemic agents in patients with type II diabetes during a 1-year period
Authors: Mozersky Robert P. , Bahl Vijay K. , Patel Hitendra , Bahl Sachin , Mook William 
Published: October 2018

Abstract
In this retrospective study, the authors assess the efficacy of combined insulin and oral hypoglycemic agents (OHAs) in controlling glycemic levels, as well as lipid levels and insulin requirements, in 48 patients with type IT diabetes mellitus during a I-year period. Thirty-two of these patients had secondary failure to an OHA (group 1). Sixteen patients (group 2) were taking high doses of insulin alone. Overall, 64.6% of all the patients responded to the combination therapy and insulin at 6 months. Response was defined as a decrease in hemoglobin Ale of more than 0.5%. At 12 months, 500/0 of these patients continued to respond to this regimen. No significant differences were seen in the patients' total cholesterol and triglyceride levels between responders and nonresponders in each group. After 1 year of combination OHA and insulin therapy, 500/0 of the patients showed a 21.4% reduction in their daily insulin dose.
Radiation-induced sarcoma of the breast
Authors: Caleel Richard T. , Mason Richard W. , Einspanier Glennon R. 
Published: October 2018

Abstract
A small but growing number of radiation-induced sarcomas after breast-conserving surgery for carcinoma have been reported. Because breast-conserving surgery followed by irradiation is becoming increasingly popular, the potential for the emergence of these sarcomas is growing. Unfortunately, because of postirradiation changes in the affected breast, detection of a new lesion can be difficult, resulting in a delay in diagnosis. This case history describes a 48-year-old woman in whom a malignant fibrous histiocytoma was discovered 5 years after she had had a lumpectomy followed by radiation therapy for infiltrating ductal carcinoma. Although the exact mechanism of radiation-induced carcinogenesis is unclear, one theory is discussed. Also discussed are the histologic composition of the malignant fibrous histiocytoma, its latency period, and the best treatment modality for radiation-induced sarcomas.
Acute diplopia and a solitary lung mass: A unique presentation of light-chain myeloma
Authors: Foresman Brian H. , Friess Gregory , Brown Andrew , McIntosh William 
Published: October 2018

Abstract
The patient described, a 51-yearold woman, had diplopia and cephalgia of two weeks' duration. On admission, the radiologic evaluation revealed a mass in the sphenoid sinus, multiple lesions in the calvarium and a solitary lung mass. Biopsy of the lung mass revealed an atypical plasmacytic infiltration. Laboratory findings confirmed the diagnosis of light-chain myeloma presenting with a pulmonary plasmacytoma and cranial nerve involvement.
Churg-Strauss syndrome
Authors: Simpson David A. , Gargulinski Richard B. , Wishnow Robin , Rentz Louis E. , Jones Margaret Z. 
Published: October 2018

Abstract
The neurologic manifestations of systemic necrotizing vasculitis are heterogeneous and often complex. Late onset asthma, systemic vasculitis manifest by mononeuritis multiplex, and peripheral eosinophilia-the triad of which is consistent with Churg-Strauss syndrome-developed in a 59-year-old woman. Electromyography and nerve conduction studies showed both myelinating and axonal neuropathy involving multiple nerves. Muscle and nerve biopsy showed neurogenic atrophy, demyelination, and axonal changes involving the sural nerve and inflammatory necrotizing small and medium vessel arterial changes. The patient was treated with high-dose prednisone and improved rapidly. Unusual in this case was the lack of multisystemic involvement. Churg-Strauss syndrome is a disease that is being recognized with increased clinical frequency and responds quickly to methylprednisolone treatment.