bluuebunny/crossref_metadata_2025_split huggingface dataset:
Importance of non‐regional lymph nodes in assigning risk in primary metastatic prostate cancer
Authors: Ali Adnan , Hoyle Alex , Mistry Hitesh , Clarke Noel W. 
Published: May 2018

ObjectiveTo determine the prognostic relevance of non‐regional lymph node (NRLN) metastases presenting synchronously with bone metastases in metastatic prostate cancer (mPCa) for guiding treatment decisions based on oligometastatic definitions.Patients and MethodsPatients diagnosed with mPCa between 2004 and 2013 were identified from the Surveillance, Epidemiology and End Results database and were grouped by metastatic sites into only NRLN, only bone, bone + NRLN and other sites ± bone/NRLN metastases. Multivariate Cox and competing risk regression analyses were performed to compare the risks of all‐cause mortality (ACM) and prostate cancer‐specific mortality (PCSM) associated with bone + NRLN metastases before and after propensity‐score matching to patients with only bone metastases. This was complemented with landmark and supplementary analyses.ResultsOf 17 167 patients with mPCa identified, 63.1% presented with only bone metastases, while bone and NRLN metastases co‐occurred in 8.9% of the cohort. On multivariate analyses, after adjusting for potential confounders (clinical and sociodemographic), patients with bone + NRLN metastases had a significantly higher risk of ACM (hazard ratio [HR] 1.161, 95% confidence interval [CI] 1.084–1.243; P < 0.001) and PCSM (subdistribution HR 1.149, 95% CI 1.067–1.237; P < 0.001) compared with patients with only bone metastases. Landmark analyses limited to survivors of ≥6 and ≥12 months again showed a significantly increased risk of ACM for patients presenting with bone + NRLN metastases compared with patients with only bone metastases. In a subsequent 1:1 propensity‐score‐matched cohort of patients with bone + NRLN metastases and only bone metastases, the bone + NRLN group had higher multivariate‐adjusted hazard rates for ACM (HR 1.202, 95% CI 1.102–1.311; P < 0.001) and PCSM (subdistribution HR 1.146, 95% CI 1.044–1.259; P = 0.004).ConclusionsPatients with concomitant NRLN and bone metastases have a higher risk of death, NRLN and bone metastases therefore representing a high‐risk feature, when compared with patients with bone metastases alone. The current therapeutic stratification of ‘low‐’ vs ‘high‐volume’ disease does not account for this phenomenon, and patients requiring aggressive combination therapy may not receive maximum therapeutic benefit as a consequence.
Simulation in urology to train non‐technical skills in ward rounds
Authors: Somasundram Khevan , Spence Heather , Colquhoun Alexandra J. , Mcilhenny Craig , Biyani Chandra S. , Jain Sunjay 
Published: May 2018

ObjectiveTo report our experience of an exercise designed to train newly appointed urology trainees in non‐technical skills on ward rounds as a part of a simulation ‘boot camp’, through a qualitative analysis of participant feedback on the utility of this method of training.Patients and MethodsThe simulations took place in a high‐fidelity simulated ward bay. Forty‐eight doctors with formal urology training ranging between 2 and 60 months (mean 19.1 ± 11.6 months) took part. Thirty‐one participants were on a formal urology specialty training pathway. The remaining participants were core (pre‐specialty) surgical trainees. The entry requirement was that participants must be junior‐level urologists, ideally at the beginning of specialty training. Participants individually led a simulated ward round, which was devised using actors to play patients and a simulated ‘switchboard’ for telephone conversations. Distractions were introduced deliberately for participants to manage an emergent urology‐related scenario. ‘Freeze‐frames’ were used to ‘pause’ the ward round, whereby observing consultants provided feedback on performance. After the simulated exercises, a whole‐group structured debriefing took place. Non‐Technical Skills for Surgeons (NOTSS) scores were generated for participants by seven consultant urologists. Participants completed a two‐part feedback form. Part one involved nine questions scored on a Likert scale, and part two required free‐text responses.ResultsThe mean (±sd) itemized NOTSS scores for situational awareness, decision‐making, communication and teamwork, and leadership were 3.01 (±0.15), 2.95 (±0.16), 3.05 (±0.19), and 2.98 (±0.15), respectively. From the thematic analysis, participants commented positively on the number of scenarios per participant, the use of actors as patients and real staff, and the use of freeze‐frames for immediate feedback. Residents also provided suggestions for distractions to be considered in the future.ConclusionsThis simulated ward round was generally well received by participants, and the obtained feedback provides an insight into how this can be adapted to maximize the benefits for new specialty residents. The mean NOTSS scores indicated that non‐technical skills performances could be improved. This supports our rationale to train non‐technical skills in a safe environment to bolster career transition into positions of greater decision‐making autonomy.
The serotonin (5‐hydroxytryptamine) 5‐HT7 receptor is up‐regulated in Onuf's nucleus in rats with chronic spinal cord injury
Authors: Ni Jianshu , Cao Nailong , Wang Xiaohu , Zhan Changsheng , Si Jiemin , Gu Baojun , Andersson Karl‐Erik 
Published: May 2018

ObjectivesTo examine the effect of intrathecal (i.t.) serotonin (5‐hydroxytryptamine) 5‐HT7 agonist administration on voiding function in the urethane‐anesthetised rat, and the change in 5‐HT7 receptor (5‐HT7R) expression in the lumbosacral cord Onuf's nucleus after spinal cord injury (SCI).Materials and methodsIn all, 32 female Sprague–Dawley (SD) rats were equally divided into a spinally intact (SI) group and SCI group (n = 16 each). At 8 weeks after transection, half of the rats underwent continuous cystometry under urethane anaesthesia, and the 5‐HT7R‐selective agonist LP44 was given (i.t.). The remaining rats were used for pseudorabies (PRV) retrograde tracing, immunofluorescence, and Western Blot.ResultsLP44 administered i.t. had no effect in the SI rats. In SCI rats, LP44 (1–30 μg/kg) induced significant dose‐dependent increases in micturition volume, voiding efficiency, number of high‐frequency oscillations per micturition; and decreases in residual volume, bladder capacity, peak bladder pressure, threshold pressure and non‐voiding contractions. The 5‐HT7R antagonist, SB‐269970 (10 μg/kg), partially reversed LP44‐induced changes. Using PRV retrograde tracing and immunofluorescence, 5‐HT7Rs were found in the L6–S1 spinal cord Onuf's nucleus in both SI and SCI rats, but the expression was significantly greater in the SCI rats. Western blot showed significantly more 5‐HT7Rs in the ventral L6–S1 spinal cord in SCI rats.ConclusionA 5‐HT7R agonist, given i.t., improved voiding efficiency in urethane‐anesthetised SCI rats, and the 5‐HT7R was significantly up‐regulated in the lumbosacral cord Onuf's nucleus. If valid for humans, these findings suggest that the 5‐HT7R could be a target for therapeutic interventions.
A narrative approach to helping an adult with a mild learning disability to confront “the gremlin”
Authors: Lewis Vicky , Rose David 
Published: May 2018

Accessible summary

Sometimes people with a learning disability find things hard which changes how they think, feel and what they do. The psychology team supports people with feelings, thoughts, relationships and behaviours.

Narrative therapy is a way of helping people to understand things in a different way.

Narrative therapy assumes that people have many skills and are good at lots of things which can help them to reduce the impact of what they find hard.

This is the story of how I helped a woman with a learning disability using narrative therapy. It is important to share this story so that narrative therapy can be used to help other people.

AbstractBackgroundThe main assumption of narrative therapy is that people are the “experts” on their own lives. When working with people with a learning disability, it can often be the case that the client’s voice is not the primary voice. This is due to the fact that others “hold” the story for the client. When the story is, therefore, told, it is done so from the perspective of that person. Narrative therapy has been found to provide an opportunity to access the perspective and experience of those whose voice may otherwise be excluded.Materials and MethodsThis paper details a case study which explains how a woman with a mild learning disability was helped to confront overwhelming anxiety which she referred to as “the gremlin.” The client described how “the gremlin” was having an influence over her ability to manage in stressful situations and cope with change. A narrative approach was utilised which focussed on reducing the influence of “the gremlin.”ResultsThe client’s evaluation of the therapy using self‐report and scaling measures showed that it had been a success. The client identified times where stories other than the dominant were lived and she became the primary author of preferred stories of her life, reducing the influence of “the gremlin.”ConclusionsThis study described how narrative therapy helped a woman with a learning disability and provides an example for use with other clients in the future.
“Something was wrong”: A narrative inquiry of becoming a father of a child with an intellectual disability in Ireland
Authors: Marsh Lynne , Warren Patricia‐Leahy , Savage Eileen 
Published: May 2018

Accessible summary

Ten fathers were asked to tell their story of being told that their child was diagnosed with an intellectual disability.

They said that initially they were shocked, disappointed, in denial and blamed themselves when the diagnosis was certain.

All fathers remembered when they were told and by whom they were told about their child’s diagnosis.

Becoming a father was a reason to be happy.

AbstractBackgroundIn recent years, there has been a growth of research on men’s experiences of becoming fathers, most of which relates to a typically developing child without intellectual disabilities. While some studies have specifically explored the experiences of becoming a father of a child with an intellectual disability, there are few studies from an Irish context.AimThe aim of this study was to present Irish fathers’ narratives within the context of leading up to the diagnosis and the actual diagnosis of a child’s intellectual disability.MethodA qualitative narrative inquiry design was used with ten fathers aged 31–48 years through semi‐structured interviews.ResultsThis study is part of a larger study focusing on becoming a father of a child with an intellectual disability in Ireland. The findings related to finding out “something was wrong” with the child are presented.ConclusionFathers are emotionally affected by the diagnosis of a child’s intellectual disability. Therefore, healthcare professionals need to be cognisant of the emotional upheaval that such a diagnosis can have on fathers and be sensitive to their needs in supporting them through this process.
MicroRNA‐493 is a prognostic factor in triple‐negative breast cancer
Authors: Yao Ling , Liu Yirong , Cao Zhigang , Li Junjing , Huang Yanni , Hu Xin , Shao Zhiming 
Published: May 2018

Breast cancer is one of the most common malignant diseases in women. Triple‐negative breast cancer (TNBC) shows higher aggressiveness and recurrence rates than other subtypes, and there are no effective targets or tailored treatments for TNBC patients. Thus, finding effective prognostic markers for TNBC could help clinicians in their ability to care for their patients. We used tissue microarrays (TMAs) to detect microRNA‐493 (miR‐493) expression in breast cancer samples. A miRCURY LNA detection probe specific for miR‐493 was used in in situ hybridization assays. Staining results were reviewed by two independent pathologists and classified as high or low expression of miR‐493. Kaplan–Meier survival plots and multivariate Cox analysis were carried out to clarify the relationship between miR‐493 and survival. In the Kaplan–Meier analysis, patients with high miR‐493 expression had better disease‐free survival than patients with low miR‐493 expression. After adjusting for common clinicopathological factors in breast cancer, the expression level of miR‐493 was still a significant prognostic factor in breast cancer. Further subtype analysis revealed that miR‐493 expression levels were only significantly prognostic in TNBC patients. These results were validated in the Molecular Taxonomy of Breast Cancer International Consortium database for overall survival. We proved the prognostic role of miR‐493 in TNBC by using one of the largest breast cancer TMAs available and validated it in a large public RNA sequencing database.
Improving metabolic stability with deuterium: The discovery of HWL‐066, a potent and long‐acting free fatty acid receptor 1 agonists
Authors: Liu Chunxia , Li Zheng , Shi Wei , Li Huilan , Wang Nasi , Dai Yuxuan , Liao Chen , Huang Wenlong , Qian Hai 
Published: May 2018

The free fatty acid receptor 1 (FFA1) is a potential target due to its function in enhancing of glucose‐stimulated insulin secretion. The FFA1 agonist GW9508 has great potential for the treatment of type 2 diabetes mellitus, but it has been suffering from high plasma clearance probably because the phenylpropanoic acid is vulnerable to β‐oxidation. To identify orally available analog without influence on the unique pharmacological mechanism of GW9508, we tried to interdict the metabolically labile group by incorporating two deuterium atoms at the α‐position of phenylpropionic acid affording compound 4 (HWL‐066). As expected, HWL‐066 revealed a lower clearance (CL = 0.23 L−1 hr−1 kg−1), higher maximum concentration (Cmax = 5907.47 μg/L), and longer half‐life (T1/2 = 3.50 hr), resulting in a 2.8‐fold higher exposure than GW9508. Moreover, the glucose‐lowering effect of HWL‐066 was far better than that of GW9508 and comparable with TAK‐875. Different from glibenclamide, no side‐effect of hypoglycemia was observed in mice after oral administrating HWL‐066 (80 mg/kg).
The Intersection of Race and Gender Among Black American Adolescents
Authors: Seaton Eleanor K. , Tyson Karolyn 
Published: May 2018

This study employed an exploratory sequential mixed‐methods design to examine the intersection of race and gender among Black American adolescents, aged 11–19. The quantitative component (n = 344) used survey data to examine gender differences in peer‐perpetrated and adult‐perpetrated racial discrimination experiences, and no gender differences were evident. Qualitative data (n = 42) probed how males and females interpret discrimination experiences given the intersection of race and gender. Although the majority of participants believed that Black males and females have similar experiences, some believed that Black males face more racial discrimination. However, analyses revealed social disadvantages for Black females given that they report inappropriate comments and unwelcome hair touching and limited opportunities for interracial dating compared with Black males.
Allergy in the elderly: A case note review of referrals to an adult allergy clinic
Authors: Gray N. J. , Redshaw E. L. , Isaacs D. , Tarzi M. D. , Smith H. E. , Frew A. J. 
Published: May 2018

SummaryThe UK population is ageing and we can expect more referrals to allergy clinics for this age group. 16% of patients to our clinic are aged >60. Compared to younger patients, 3 times as many referrals were for angioedema. Overall, allergy was excluded in 79% of cases. 15% were diagnosed with previously unrecognised allergies, while allergic disease was confirmed in 6%, enabling optimised management. While the differential diagnosis of allergic conditions is wider in older people, assessment in the allergy clinic is helpful and adds value.
Natural history of Rathke's cleft cysts: A retrospective analysis of a two centres experience
Authors: Sala Elisa , Moore Justin M. , Amorin Alvaro , Carosi Giulia , Martinez Hector , Harsh Griffith R. , Arosio Maura , Mantovani Giovanna , Katznelson Laurence 
Published: May 2018

SummaryObjectiveRathke's cleft cyst (RCC) is a common sellar lesion which may cause visual impairment, hypopituitarism and headaches from mass effect. The natural history of these lesions is currently unclear. We investigated the natural history of RCCs and compared surgically treated patients with those treated conservatively.MethodsWe performed a retrospective cohort study of patients diagnosed with a RCC between 1996 and 2016 at Stanford University and Ospedale Maggiore Policlinico di Milano.ResultsPatients were divided into 2 cohorts: Group A, 72 subjects who underwent surgical resection of a symptomatic RCC, and Group B, 62 subjects managed conservatively. Compared to Group B, Group A subjects had larger RCCs (79% vs 22% had a largest diameter >10 mm, P < .001) and were more likely (41.5% vs 16%, P < .001) to present with hypopituitarism and diabetes insipidus (DI) (18% vs 1.6%, P = .002). In Group A, after a mean follow‐up of 53.7 months, 12.5% of patients had recurrence and a second surgery. After surgery, 35% of patients recovered pituitary function. Hyperprolactinemia (26.6%) and hypogonadism (66.6%) resolved more commonly that did DI (20.1%). New pituitary deficits appeared in 16.6% of patients after surgery. In Group B, with a mean follow‐up of 41 months, only 6.4% had cyst enlargement, none underwent surgery, and none developed a pituitary deficit.ConclusionOur data offer guidance in decision‐making regarding the management of RCC patients and confirm the safety of conservative treatment in asymptomatic patients.
Influence of different drilling preparation on cortical bone: A biomechanical, histological, and micro‐CT study on sheep
Authors: Stocchero Michele , Toia Marco , Jinno Yohei , Cecchinato Francesca , Becktor Jonas P. , Naito Yoshihito , Halldin Anders , Jimbo Ryo 
Published: May 2018

AbstractObjectiveThe aim of this study was to investigate the extent of cortical bone remodeling between two different drilling protocols by means of histomorphometric, µ‐CT, and biomechanical analyses.Material and methodsA total of 48 implants were inserted into the mandible of six sheep following two drilling protocols: Group A (Test, n = 24), undersized preparation; Group B (Control, n = 24), non‐undersized preparation. The animals were euthanatized to obtain 5 and 10 weeks of implantation time. Removal torque (RTQ) was measured on 12 implants of each group and the peri‐implant bone was µ‐CT scanned. Bone volume density (BV/TV) was calculated in pre‐determined cylindrical volumes, up to 1.5 mm from implant surface. Non‐decalcified histology was prepared on the remaining 12 implants from each group, where total bone‐to‐implant contact (totBIC) and newly‐formed BIC (newBIC) was measured. Bone Area Fraction Occupancy (BAFO) was determined in pre‐determined areas up to 1.5 mm from implant surface. Paired sample t test or Wilcoxon signed‐rank test was used to investigate differences between the groups.ResultsGroup A presented significantly increased RTQ value at 5 weeks, while no difference was observed at 10 weeks. Group B presented increased BV/TV value at 5 weeks. Both groups showed comparable values for totBIC at both time‐points. However, Group A presented significantly lower newBIC at 5 weeks. Higher BAFO was observed in Group B at 5 weeks.ConclusionsImplants inserted into undersized sites has an increased biomechanical performance, but provoked major remodeling of the cortical bone during the early healing period compared to non‐undersized preparations. After 10 weeks, no difference was observed.
Seagrass meadows support global fisheries production
Authors: Unsworth Richard K.F. , Nordlund Lina Mtwana , Cullen‐Unsworth Leanne C. 
Published: May 2018

AbstractThe significant role seagrass meadows play in supporting fisheries productivity and food security across the globe is not adequately reflected in the decisions made by authorities with statutory responsibility for their management. We provide a unique global analysis of three data sources to present the case for why seagrass meadows need targeted policy to recognize and protect their role in supporting fisheries production and food security. (1) Seagrass meadows provide valuable nursery habitat to over 1/5th of the world's largest 25 fisheries, including Walleye Pollock, the most landed species on the planet. (2) In complex small‐scale fisheries from around the world (poorly represented in fisheries statistics), we present evidence that many of those in proximity to seagrass are supported to a large degree by these habitats. (3) We reveal how intertidal fishing activity in seagrass is a global phenomenon, often directly supporting human livelihoods. Our study demonstrates that seagrasses should be recognized and managed to maintain and maximize their role in global fisheries production. The chasm that exists between coastal habitat conservation and fisheries management needs to be filled to maximize the chances of seagrass meadows supporting fisheries, so that they can continue to support human wellbeing.
Comparable outcomes in intestinal retransplantation: Single‐center cohort study
Authors: Ekser Burcin , Kubal Chandrashekhar A. , Fridell Jonathan A. , Mangus Richard S. 
Published: May 2018

AbstractBackgroundGraft loss in intestinal transplantation (ITx) is close to 25% in the first year and 50% at 5‐year post‐transplantation. Although technically and immunologically challenging, intestinal retransplantation is now the 4th most common indication for ITx.MethodsThe aim of this study was to review and compare the outcomes of intestinal retransplantation with primary ITx, which included isolated ITx, modified multivisceral transplantation (mMVTx), and full MVTx, between 2003 and 2014 at Indiana University.ResultsOf 218 ITx, 18 (8.3%) were retransplantation. Causes of graft loss were rejection(78%), pancreatitis (11%), and severe intestine dismotility (11%). MVTx (16/18, 89%) was the preferred retransplantation option. In 7 (39%) patients, graftectomy was performed between primary and intestinal retransplantation. Median interval between primary ITx and retransplantation was 421 days. Although patient and graft survival rates at 1 year, 3 years, and 5 years were comparable between primary and retransplants, the number of retransplants was limited in the follow‐up after post‐transplant year 3.ConclusionsWe identified that timing of retransplantation, graftectomy prior to retransplant allowing an immunosuppression free state, inclusion of the liver, and preserved renal function are important factors in the consideration of intestinal retransplantation. Immunological aspects remain challenging in the decision making and for short‐ and long‐term outcomes.