bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a novel Surgicric® cricothyroidotomy device for emergency tracheal access in a porcine model
Authors: King W. , Teare J. , Vandrevala T. , Cartwright S. , Mohammed K. B. , Patel B. 
Published: November 2015

SummaryA can't intubate, can't ventilate scenario can result in morbidity and death. Although a rare occurrence (1:50 000 general anaesthetics), it is crucial that anaesthetists maintain the skills necessary to perform cricothyroidotomy, and are well‐equipped with appropriate tools. We undertook a bench study comparing a new device, Surgicric®, with two established techniques; the Melker Emergency Cricothyroidotomy, and a surgical technique. Twenty‐five anaesthetists performed simulated emergency cricothyroidotomy on a porcine model, with the primary outcome measure being insertion time. Secondary outcomes included success rate, tracheal trauma and ease of use. The surgical technique was fastest. The median (IQR [range]) was 81 (62–126 [37–300]) s, followed by the Melker 124 (100–217 [71–300]) s, and the Surgicric 127 (68–171 [43–300]), p = 0.003. The Surgicric device was the most traumatic, as evaluated by a blinded Ear, Nose and Throat surgeon. Subsequently, the authors contacted the device manufacturer, who has now modified the kit in the hope that its clinical application might be improved. Further studies are required to evaluate the revised model.
Hyperbilirubinaemia: its utility in non‐perforated appendicitis
Authors: Sandstrom Anna , Grieve David A. 
Published: November 2015

AbstractBackgroundThe diagnosis of acute appendicitis is made using clinical findings and investigations. Recent studies have suggested that serum bilirubin, a cheap and simple biochemical test, is a positive predictor in the diagnosis of appendiceal perforation and may be more specific than C‐reactive protein (CRP) and white cell count (WCC). The aim of this study was to investigate the utility of the serum bilirubin level in patients with suspected acute but non‐perforative appendicitis.MethodsA retrospective chart review of 213 patients who presented with suspected appendicitis in a 6‐month period to Nambour General Hospital was performed. Serum bilirubin, WCC and CRP were recorded and analysed as to their utility in relation to the final diagnosis.ResultsA total of 196 patients underwent an appendicectomy and 41 of these were negative. The specificity of hyperbilirubinaemia for appendicitis overall was 0.83 with a positive predictive value (PPV) of 0.86, compared with CRP (specificity 0.40, PPV 0.75) and WCC (specificity 0.67, PPV 0.85). The area under the receiver operating characteristic curve for bilirubin was 0.6289 compared to 0.6171 for CRP and 0.7219 for WCC. A subgroup analysis of those with complicated appendicitis demonstrated a PPV for bilirubin of 0.66 compared to 0.58 for WCC and 0.34 for CRP in agreement with the literature. Subgroup analysis of hyperbilirubinaemia in simple appendicitis demonstrated a PPV of 0.81 compared to CRP (0.71) and WCC (0.82).ConclusionBilirubin had a higher specificity than CRP and WCC overall in patients with appendicitis. Hyperbilirubinaemia had a high PPV in patients with simple appendicitis.
Colonic transit: what is the impact of a diverting loop ileostomy?
Authors: Huang Sean , Theophilus Mary , Cui Jiamei , Bell Stephen W. , Wale Roger , Chin Martin , Farmer Chip , Warrier Satish K. 
Published: November 2015

AbstractBackgroundDiverting loop ileostomy (DLI) is used following low anterior resections (LAR) or ultra‐low anterior resections (ULAR) to reduce anastomotic leak (AL). Preoperative mechanical bowel preparation (MBP) is traditionally used with DLI. However, clearance of the left colon can be achieved with a fleet enema without the physiological compromise of MBP. We aimed to assess colonic transit following DLI in this context.MethodsA prospective, observational study was performed with patients with rectal cancer undergoing LAR or ULAR in a tertiary colorectal unit with preoperative fleet enema. Radiopaque markers were inserted into the caecum following rectal resection and formation of a DLI with placement confirmed by image intensifier and endoscopy. X‐rays were performed at days 1, 3, 5 and 14 post‐operation with data collected prospectively.ResultsTen patients (mean age 57, nine males) were enrolled. Mean time to functioning stoma was 1.9 days (range 1–3). There was no movement in the majority of markers in all patients at Day 5 post‐operation. In all seven patients with Day 14 X‐rays, the majority of markers remained in the right colon. Two patients had delayed AL, with markers found within the pelvis in both of these patients.ConclusionsThis is the first study to assess colonic transit following DLI using fleet enema only, with results suggesting colonic motility is abolished in this setting. The use of a fleet enema without MBP may be sufficient prior to rectal resection surgery when DLI is employed. AL may actually increase colonic transit. Further research is warranted.
Cost‐analysis of robotic‐assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia
Authors: Herling Suzanne F. , Palle Connie , Møller Ann M. , Thomsen Thordis , Sørensen Jan 
Published: November 2015

AbstractIntroductionThe aim of this study was to analyse the hospital cost of treatment with robotic‐assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost.Material and methodsThis cost analysis was based on two cohorts: women treated with robotic‐assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity‐based cost analysis including consumables and healthcare professionals’ salaries. As cost‐drivers we included severe complications, duration of surgery, anesthesia and stay at the post‐anesthetic care unit, as well as number of hospital bed‐days. Ordinary least‐squares regression was used to explore the cost variation. The primary outcome was cost difference in Danish kroner between total abdominal hysterectomy and robotic‐assisted laparoscopic hysterectomy.ResultsThe average cost of consumables was 12 642 Danish kroner more expensive per patient for robotic‐assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7.50 Danish kroner). When including all cost‐drivers, the analysis showed that the robotic‐assisted laparoscopic hysterectomy procedure was 9386 Danish kroner (17%) cheaper than the total abdominal hysterectomy (p = 0.003). When the robot investment was included, the cost difference reduced to 4053 Danish kroner (robotic‐assisted laparoscopic hysterectomy was 7% cheaper than total abdominal hysterectomy) (p = 0.20). Increasing age and Type 2 diabetes appeared to influence the overall costs.ConclusionFor women with endometrial cancer or atypical complex hyperplasia, robotic‐assisted laparoscopic hysterectomy was cheaper than total abdominal hysterectomy, mostly due to fewer complications and shorter length of hospital stay.
Judicious use of oxytocin augmentation for the management of prolonged labor
Authors: Rossen Janne , Østborg Tilde B. , Lindtjørn Elsa , Schulz Jørn , Eggebø Torbjørn M. 
Published: November 2015

AbstractIntroductionA protocol including judicious use of oxytocin augmentation was investigated to determine whether it would change how oxytocin was used and eventually influence labor and fetal outcomes.Material and methodsThe population of this cohort study comprised 20 227 delivering women with singleton pregnancies ≥37 weeks, cephalic presentation, spontaneous or induced onset of labor, without previous cesarean section. Women delivering from 2009 to 2013 at Stavanger University Hospital, Norway, were included. Data were collected prospectively. Before implementing the protocol in 2010, oxytocin augmentation was used if progression of labor was perceived as slow. After implementation, oxytocin could only be started when the cervical dilation had crossed the 4‐h action line in the partograph.ResultsThe overall use of oxytocin augmentation was significantly reduced from 34.9% to 23.1% (p < 0.01). The overall frequency of emergency cesarean sections decreased from 6.9% to 5.3% (p < 0.05) and the frequency of emergency cesarean sections performed due to fetal distress was reduced from 3.2% to 2.0% (p = 0.01). The rate of women with duration of labor over 12 h increased from 4.4% to 8.5% (p < 0.01) and more women experienced severe estimated postpartum hemorrhage (2.6% vs. 3.7%; p = 0.01). The frequency of children with pH <7.1 in the umbilical artery was reduced from 4.7% to 3.2% (p < 0.01).ConclusionsThe frequency of emergency cesarean section was reduced after implementing judicious use of oxytocin augmentation. Our findings may be of interest in the ongoing discussion of how the balanced use of oxytocin for labor augmentation can best be achieved.
Optimal Bayesian Adaptive Trials When Treatment Efficacy Depends on Biomarkers
Authors: Zhang Yifan , Trippa Lorenzo , Parmigiani Giovanni 
Published: November 2015

Summary
Clinical biomarkers play an important role in precision medicine and are now extensively used in clinical trials, particularly in cancer. A response adaptive trial design enables researchers to use treatment results about earlier patients to aid in treatment decisions of later patients. Optimal adaptive trial designs have been developed without consideration of biomarkers. In this article, we describe the mathematical steps for computing optimal biomarker-integrated adaptive trial designs. These designs maximize the expected trial utility given any pre-specified utility function, though we focus here on maximizing patient responses within a given patient horizon. We describe the performance of the optimal design in different scenarios. We compare it to Bayesian Adaptive Randomization (BAR), which is emerging as a practical approach to develop adaptive trials. The difference in expected utility between BAR and optimal designs is smallest when the biomarker subgroups are highly imbalanced. We also compare BAR, a frequentist play-the-winner rule with integrated biomarkers and a marker-stratified balanced randomization design (BR). We show that, in contrasting two treatments, BR achieves a nearly optimal expected utility when the patient horizon is relatively large. Our work provides novel theoretical solution, as well as an absolute benchmark for the evaluation of trial designs in personalized medicine.
Multiphoton microscopy for rapid histopathological evaluation of kidney tumours
Authors: Jain Manu , Robinson Brian D. , Aggarwal Amit , Shevchuk Maria M. , Scherr Douglas S. , Mukherjee Sushmita 
Published: November 2015

ObjectiveTo explore the potential of multiphoton microscopy (MPM) for rapid evaluation and triaging of ex vivo kidney tissue.Materials and MethodsFresh neoplastic and non‐neoplastic tissues from nephrectomy specimens (n = 40) were imaged with MPM and later submitted for routine histopathology.ResultsOn MPM, normal kidney architecture was evident and clearly distinguishable from tumour. Forty malignant tumours (20 clear‐cell renal cell carcinomas [RCCs], 10 papillary RCCs, five chromophobe RCCs and five papillary urothelial carcinomas [UCs], as diagnosed by haematoxylin and eosin staining) were imaged and subtyped as non‐papillary and papillary, based on their architecture. Non‐papillary tumours were further classified based on their unique cytoplasmic signatures. Clear‐cell RCCs had a predominant population of cells with fat droplets in cytoplasm. Chromophobe RCCs had cells with non‐fatty/homogeneous cytoplasm and distinct intra‐cytoplasmic granules. Papillary RCCs had single‐cell‐lined papillae with often abundant histiocytes in their core, whereas PUC had multi‐layered urothelium‐lined papillae. The diagnostic accuracy of tumour subtyping by two independent uropathologists was 95%.ConclusionsWe showed that MPM can reliably differentiate neoplastic from non‐neoplastic kidney tissue and subtype kidney tumours in fresh, unprocessed tissue, MPM might therefore be useful as a rapid real‐time diagnostic tool for the evaluation of kidney biopsies, and surgical margins in partial nephrectomies, to improve overall patient management.
Circulating serum chemerin levels are elevated in lipodystrophy
Authors: Miehle Konstanze , Ebert Thomas , Kralisch Susan , Hoffmann Annett , Kratzsch Jürgen , Schlögl Haiko , Stumvoll Michael , Fasshauer Mathias 
Published: November 2015

SummaryObjectiveLipodystrophy (LD) is characterized by loss of adipose tissue, dysregulation of adipokines and severe metabolic complications. Regulation of the insulin resistance‐inducing and proinflammatory adipokine chemerin has not been assessed in LD. Therefore, we determined chemerin serum levels in LD, chemerin mRNA expression in insulin‐sensitive tissues of LD mice, as well as the impact of metreleptin treatment on circulating chemerin in LD patients.Research Design and MethodsSerum chemerin, as well as clinical and biochemical parameters of glucose metabolism, lipid metabolism, and inflammation, was measured in 37 LD patients and 37 age‐, gender‐ and body mass index‐matched controls. Furthermore, chemerin mRNA expression was determined in LD mice and controls. Moreover, circulating chemerin was assessed at five different time points in 10 LD patients treated with metreleptin over 1 year.ResultsMedian serum chemerin levels were significantly higher in 37 subjects with LD (234·3 μg/l) as compared to controls (204·0 μg/l) (P = 0·002). Multiple linear regression analysis showed that circulating chemerin was independently and positively associated with glycosylated haemoglobin A1c (HbA1c) and C‐reactive protein (CRP). Chemerin mRNA expression was significantly increased 2·5‐fold in visceral adipose tissue (VAT) and 5·3‐fold in brown adipose tissue (BAT) of LD mice as compared to controls (P < 0·01). Circulating chemerin was not significantly altered by metreleptin treatment.ConclusionsCirculating levels of the adipokine chemerin are elevated in LD, as well as independently and positively associated with HbA1c and CRP. Increased chemerin might originate from VAT and BAT.
Effects of different doses of nandrolone decanoate on estrous cycle and ovarian tissue of rats after treatment and recovery periods
Authors: Simão Vinícius Augusto , Berloffa Belardin Larissa , Araújo Leite Gabriel Adan , de Almeida Chuffa Luiz Gustavo , Camargo Isabel Cristina Cherici 
Published: November 2015

SummaryThis study tested the hypothesis that different doses of nandrolone decanoate (ND) will cause changes in the estrous cycle and ovarian tissue of adult rats; and investigated the duration of the recovery period that is sufficient to restore the damage in the animals treated with different doses. Wistar rats were treated with ND at doses of 1.87, 3.75, 7.5 and 15 mg/kg body weight, or received mineral oil (control group) for 15 days, subcutaneously. All animals were divided into three groups according to the treatment periods: (i) ND treatment for 15 days; (ii) ND treatment followed by a 30‐day recovery; and (iii) ND treatment followed by a 60‐day recovery. Estrous cycle was monitored daily, and at the end of each period, the animals were euthanized for histopathological analysis. During ND treatment and after 30‐day recovery, all animals exhibited persistent diestrus. After a 60‐day recovery, persistent diestrus was only maintained in the group that had received the highest dose. Ovarian weight was decreased significantly after the 30‐day recovery, regardless of ND doses, compared with the control group. There was a reduction (P < 0.05) in the number of corpora lutea and antral and growing follicles, in contrast to an increase (P < 0.05) in atretic follicles in a dose‐ and time‐dependent manner. Remarkable histopathological changes occurred in the ovaries of all ND‐treated groups. In conclusion, the different doses of ND caused changes in the estrous cycle and ovarian tissue of rats, and recovery periods (30 and 60 days) were insufficient to completely restore the damage in the animals treated with the highest dose.
The New Left and Health Care Reform in El Salvador
Authors: Clark Mary A. 
Published: November 2015

AbstractAfter a decade of civil war and four consecutive conservative administrations, El Salvador's leftist FMLN won its first presidential election in 2009. How has public policy changed under this New Left government, and why? This article addresses the question in the area of public health care. An alliance of health sector leaders with both technocratic and diplomatic abilities capitalized on the policy window opened by the FMLN's electoral victory and worked within the parameters set by President Mauricio Funes, the FMLN, and civil society to universalize health care. The new minister of health, a professional highly esteemed inside and outside the country, was able to engage both a large social movement protesting neoliberal policy and an energetic health diplomat sent by the Pan American Health Organization. In designing its reform, this alliance benefited from international as well as “bottom-up” policy diffusion.
A role for ecology in the evolution of colour variation and sexual dimorphism in Hawaiian damselflies
Authors: Cooper I. A. , Brown J. M. , Getty T. 
Published: November 2015

AbstractVariation in traits that are sexually dimorphic is usually attributed to sexual selection, in part because the influence of ecological differences between sexes can be difficult to identify. Sex‐limited dimorphisms, however, provide an opportunity to test ecological selection disentangled from reproductive differences between the sexes. Here, we test the hypothesis that ecological differences play a role in the evolution of body colour variation within and between sexes in a radiation of endemic Hawaiian damselflies. We analysed 17 Megalagrion damselflies species in a phylogenetic linear regression, including three newly discovered cases of species with female‐limited dimorphism. We find that rapid colour evolution during the radiation has resulted in no phylogenetic signal for most colour and habitat traits. However, a single ecological variable, exposure to solar radiation (as measured by canopy cover) significantly predicts body colour variation within sexes (female‐limited dimorphism), between sexes (sexual dimorphism), and among populations and species. Surprisingly, the degree of sexual dimorphism in body colour is also positively correlated with the degree of habitat differences between sexes. Specifically, redder colouration is associated with more exposure to solar radiation, both within and between species. We discuss potential functions of the pigmentation, including antioxidant properties that would explain the association with light (specifically UV) exposure, and consider alternative mechanisms that may drive these patterns of sexual dimorphism and colour variation.
The suppressive effect of nucleos(t)ide analogue treatment on the incidence of hepatocellular carcinoma in chronic hepatitis B patients
Authors: Hiramatsu Naoki , Yamada Ryoko , Takehara Tetsuo 
Published: November 2015

AbstractThe development of nucleos(t)ide analogues (NA) has influenced hepatitis B virus management. However, the annual incidence rate during NA treatment has been reported to be 0.3–1.2% in non‐cirrhosis cases and 1.8–6.0% in cirrhosis cases, indicating that the suppressive effect of NA treatment on hepatocellular carcinoma (HCC) would be insufficient. Past studies, including one randomized control trial that compared lamivudine treatment with placebo, have revealed that NA treatment could suppress the incidence of HCC in patients with advanced fibrosis. However, it remains unknown whether NA treatment can suppress the incidence of HCC in chronic hepatitis patients without advanced fibrosis. The HCC incidence in patients treated with entecavir was similar to that of those treated with lamivudine, although entecavir exhibits a stronger viral suppression than lamivudine. The following risk factors related to the incidence of HCC during NA treatment have been identified: older age, male gender, pre‐existing cirrhosis, a family clustering of hepatitis B virus, lower platelet counts, and higher hepatitis B core‐related antigens as baseline factors and higher alpha fetoprotein levels as an on‐treatment factor. Conversely, the loss of the hepatitis B surface antigen (HBsAg) by interferon or NA was correlated with a lower HCC incidence rate. Because interferon treatment has much more effects on reducing HBsAg levels compared with NA treatment, a combination treatment with NA and pegylated interferon can bring additional reduction of HBsAg levels compared with NA monotherapy. Further study is needed to clarify this.
A statistical analysis of the distribution of cordierite and biotite in hornfels from the Bugaboo contact aureole: implications for the kinetics of porphyroblast crystallization
Authors: Petley‐Ragan A. , Gaidies F. , Pattison D.R.M. 
Published: November 2015

AbstractThe three‐dimensional disposition of cordierite and biotite crystals in a hornfels from the contact aureole of the Bugaboo Batholith is quantified using high‐resolution X‐ray micro‐computed tomography and global as well as scale‐dependent pattern statistics. The results demonstrate a random distribution of cordierite and biotite crystal sizes for all scales across the entire rock volume studied indicative of interface‐controlled prograde metamorphic reaction kinetics. The reaction considered responsible for the mineral assemblage and the formation of cordierite and biotite in the hornfels is Ms + Chl + Qtz = Crd + And + Bt + . Rock‐specific phase equilibria point to metamorphic conditions of ~520 –550 °C and 3 kbar for this reaction. The common approach to approximate the shape of crystals as spherical underestimates the influence of the Strauss hard‐core process on rock texture and may be misinterpreted to reflect ordering of crystal sizes by inhibition of nucleation and growth commonly associated with diffusion‐controlled reaction kinetics. According to our findings, Strauss hard‐core ordering develops at length scales equal to and less than the average major axis of the crystal population. This is significantly larger than what is obtained if a spherical crystal geometry would be assumed, and increases with deviation from sphericity. For the cordierite and biotite populations investigated in this research, Strauss hard‐core ordering developed at length scales of up to ∼2.2 and 1.25 mm, respectively, which is almost 1 mm longer than the scales that would be obtained if a spherical geometry would have been assumed. Our results highlight the importance of a critical assessment of the geometrical model assumptions commonly applied in the three‐dimensional analysis of crystal size distributions, and underline the need for a quantitative understanding of interface processes in order to appreciate their role in the kinetics of contact metamorphic reactions and rock texture formation.