bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of perioperative, renal and oncologic outcomes in robotic‐assisted versus open partial nephrectomy
Authors: Tan Jo‐Lynn , Frydenberg Mark , Grummet Jeremy , Hanegbi Uri , Snow Ross , Mann Sarah , Begashaw Kirobel , Moon Daniel 
Published: September 2017

BackgroundTo compare perioperative, renal and oncological outcomes after robotic‐assisted partial nephrectomy (RAPN) versus open partial nephrectomy (OPN) for the treatment of renal tumours.MethodsAll partial nephrectomies performed at a Metropolitan Urology Centre between 2010 and 2016 were analysed. Baseline data was collected for patient demographics, tumour characteristics (tumour size, laterality and polarity, RENAL scores), and perioperative variables (e.g. warm ischaemic time, operation time, estimated blood loss (EBL), length of stay). Tumour characteristics included malignancy, clinical stage, Fuhrman nuclear grade and surgical margin status. Day‐1 post‐operative serum creatinine, estimated glomerular filtration rate (eGFR) and 6‐month eGFR stage were used for assessing renal function.ResultsTwo hundred patients underwent partial nephrectomy between 2010 and 2016 (n = 200; 55 OPN versus 145 RAPN). Baseline data was similar between groups, except for lower age (P = 0.0001) and higher RENAL scores (P = 0.001) in the RAPN group. RAPN demonstrated significantly lower complication rates (P = 0.015), lesser EBL (P = <0.0001), shorter hospital stays (P = <0.001) and reduced positive tumour resection margins (P = 0.039). There was no significant difference in mean operation time between RAPN and OPN (137.2 (±48.0) OPN versus 146.07 (±35.91) RAPN; P = 0.16). No statistical difference was shown for post‐operative eGFR stage between groups at Day‐1 and 6‐month post‐surgery (P = 0.15 and P = 0.861, respectively).ConclusionWe present the largest reported Australian series on partial nephrectomy, confirming that a robotic‐assisted approach is equivalent to OPN, with reduced complications, EBL, length of hospital stays and fewer positive margins, even when resecting more complex tumours.
Wound tension and ‘closability’ with keystone flaps, V‐Y flaps and primary closure: a study in fresh‐frozen cadavers
Authors: Donovan Lewis C. , Douglas Charles D. , Van Helden Dirk 
Published: September 2017

BackgroundPrevious publications have implied that the keystone flap provides mechanical benefits compared to primary closure. This has not been objectively demonstrated.MethodsElliptical defects were created in ‘fresh‐frozen’ cadaveric specimens. Two approaches were used to investigate the potential mechanical benefits of keystone flaps. Experiment 1 (wound closure): 18 defects were incrementally enlarged until they could not be closed primarily either with a single ‘midpoint’ suture or with a continuous suture. Attempts were then made to close these wounds with island flaps: 13 keystone flaps (seven ‘typeIIA’ and six ‘Sydney Melanoma Unit (SMU) modification’) and five V‐Y flaps. Experiment 2 (tension reduction): 28 defects were fashioned to be ‘closable’ under high tension. The ‘pre‐flap tension’ was measured with a single midpoint suture and tensiometer. Fourteen keystone flaps (seven typeIIAand sevenSMUmodifications) and seven V‐Y flaps were then developed and mobilized with no flap constructed on the remaining seven ‘primary closure’ wounds. The secondary defects resulting from flap mobilization were closed leaving the primary defect unsutured. The primary defect ‘post‐flap tension’ was then measured using the same technique.ResultsFor Experiment 1, V‐Y flaps enabled closure in four of five ‘unclosable’ defects. Keystone flaps did not enable closure in any of the 13 cases (P < 0.001). For Experiment 2, the V‐Y flap (n = 7) was the only group that produced a significant drop in wound tension across the primary defect (mean ‘pre‐flap’ to ‘post‐flap’ tension change: −53%, 95%CI: −67 to −39%,P < 0.001).ConclusionThe data raise questions about the biomechanical benefits of keystone flaps.
Changing face of robot‐assisted radical prostatectomy in Melbourne over 12 years
Authors: Sathianathen Niranjan J. , Lamb Alastair D. , Lawrentschuk Nathan L. , Goad Jeremy R. , Peters Justin , Costello Anthony J. , Murphy Declan G. , Moon Daniel A. 
Published: September 2017

BackgroundThis study aims to characterize the trends in disease presentation for robot‐assisted radical prostatectomy (RARP) over a 12‐year period in Melbourne, Australia.MethodsAll patients undergoing an RARP between 2004 and October 2016 while under the care of six high‐volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer.ResultsOver the 12‐year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P < 0.001). There was also a significant trend to increased D'Amico risk groups over time with the percentage procedures for high‐risk patients increasing from 12.6% to 28.10% from 2004 to 2016 (P < 0.001). Upgrade rates between biopsy and pathological Gleason grade scoring significantly trended down over the period of the study (P < 0.001). There was also a shift to increased pathological stage over the 12 years with 22.1% of men having T3 disease in 2004 compared with 49.8% in 2016.ConclusionOur analysis demonstrates increasing treatment of older men with higher risk tumours, consistent with international trends. While this largely reflects a shift in case selection, further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher risk disease.
Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary?
Authors: Tallapragada Krishna , Peddada Ratna Soundarya , Dexter Mark 
Published: September 2017

BackgroundPrevious studies have shown that children with isolated linear skull fractures have excellent clinical outcomes and low risk of surgery. We wish to identify other injury patterns within the spectrum of paediatric mild head injury, which need only conservative management. Children with low risk of evolving neurosurgical lesions could be safely managed in primary hospitals.MethodsWe retrospectively analysed all children with mild head injury (i.e. admission Glasgow coma score 13–15) and skull fracture or haematoma on a head computed tomography scan admitted to Westmead Children's Hospital, Sydney over the years 2009–2014. Data were collected regarding demographics, clinical findings, mechanism of injury, head computed tomography scan findings, neurosurgical intervention, outcome and length of admission. Wilcoxon paired test was used with P value <0.05 considered significant.ResultsFour hundred and ten children were analysed. Three hundred and eighty‐one (93%) children were managed conservatively, 18 (4%) underwent evacuation of extradural haematoma (TBI surgery) and 11 (3%) needed fracture repair surgery. Two children evolved a surgical lesion 24 h post‐admission. Only 17 of 214 children transferred from peripheral hospitals needed neurosurgery. Overall outcomes: zero deaths, one needed brain injury rehabilitation and 63 needed child protection unit intervention. Seventy‐five percentage of children with non‐surgical lesions were discharged within 2 days. Eighty‐three percentage of road transfers were discharged within 3 days.ConclusionsChildren with small intracranial haematomas and/or skull fractures who need no surgery only require brief inpatient symptomatic treatment and could be safely managed in primary hospitals. Improved tertiary hospital transfer guidelines with protocols to manage clinical deterioration could have cost benefit without risking patient safety.
Delayed cord clamping and cord gas analysis at birth
Authors: Xodo Serena , Xodo Luigi , Berghella Vincenzo 
Published: September 2017

AbstractDelayed cord clamping for at least 60 s in both term and preterm babies is a major recent change in clinical care. Delayed cord clamping has several effects on other possible interventions. One of these is the effect of delayed cord clamping on umbilical artery gas analysis. When indicated, umbilical artery gas analysis can safely be done either with early cord clamping or, probably most of the times it is necessary, during delayed cord clamping with the cord still unclamped. Paired blood samples (one from the umbilical artery and one from the umbilical vein) can be taken from the pulsating and unclamped cord, immediately after birth, during delayed cord clamping, without any effect on either the accuracy of umbilical artery gas analysis or the transfusion of blood through delayed cord clamping. Umbilical artery gas analysis should instead not be done after delayed cord clamping, since delayed cord clamping alters several acid‐based parameters and lactate values.
Mechanisms of Moral Disengagement and Prisoner Abuse
Authors: Weill Joanna , Haney Craig 
Published: September 2017

AbstractBandura's research and theory on the mechanisms of moral disengagement demonstrate the various ways that persons distance themselves from their mistreatment of others to avoid or circumvent ethical constraints that should and otherwise would govern their behavior. This article examines the serious problem of prisoner abuse through the lens of moral disengagement theory to understand in part why such abuse occurs and persists. This application of moral disengagement theory underscores the importance of addressing these social psychological dynamics in any program of prison reform and the need for further research in a setting that traditionally has resisted in‐depth empirical examination.
Recent changes in the plant composition of wetlands in the Jura Mountains
Authors: Rion Vanessa , Gallandat Jean‐Daniel , Gobat Jean‐Michel , Vittoz Pascal 
Published: September 2017

AbstractAimTo assess vegetation changes in montane fens and wet meadows and their causes over 38 years.LocationWetlands, Jura Mountains (Switzerland and France).MethodsPlots were inventoried in 1974 and re‐located in 2012 (quasi‐permanent plots) on the basis of sketches to assess changes in plant communities. The 110 plots belonged to five phytosociological alliances, two in oligotrophic fens (Caricion davallianae, Caricion fuscae) and three in wet meadows (Calthion, Molinion, Filipendulion). Changes between surveys were assessed with NMDS, and changes in species richness, Simpson diversity, species cover and frequency and the causes of these changes were evaluated by comparing ecological indicator values.ResultsChanges in species composition varied between alliances, with a general trend towards more nutrient‐rich flora with less light at ground level. Species diversity declined, with a marked decreasing trend for the typical species of each alliance. These species were partly replaced by species belonging to nitrophilous and mesophilous grasslands. However, no trend towards drier conditions was detected in these wetlands. The largest changes, with an important colonization by nitrophilous species, occurred in the Swiss sites, where grazing was banned 25 years ago. As a result of floral shifts, many plots previously belonging to fens or wet mesotrophic meadows shifted to an alliance of the wet meadows, generally Filipendulion. Moreover, communities showed a slight trend towards more thermophilous flora.ConclusionsThe investigated wetlands in the Jura Mountains have suffered mainly from eutrophication due to land‐use abandonment and N deposition, with a loss of typical species. Areas with constant land use (grazing or mowing) showed less marked changes in species composition. The most important action to conserve these wetlands is to maintain or reintroduce the traditional practices of extensive mowing and livestock grazing in the wetlands, especially in areas where they were abandoned 25 years ago. This previous land‐use change was intended to improve fen conservation, but it was obviously the wrong measure for conservation purposes.
Pharmacodynamics and pharmacokinetics of ticagrelor vs. clopidogrel in patients with acute coronary syndromes and chronic kidney disease
Authors: Wang Heyang , Qi Jing , Li Yi , Tang Yunbiao , Li Chao , Li Jing , Han Yaling 
Published: September 2017

BackgroundPivotal clinical trials found that ticagrelor reduced ischaemic complications to a greater extent than clopidogrel, and also that the benefit gradually increased with the reduction in creatinine clearance. However, the underlying mechanisms remains poorly explored.MethodsThis was a single‐centre, prospective, randomized clinical trial involving 60 hospitalized Adenosine Diphosphate (ADP) P2Y12 receptor inhibitor‐naïve patients with chronic kidney disease (CKD) (estimated glomerular filtration rate <60 ml min–1 1.73 m–2) and non‐ST‐elevation acute coronary syndromes (NSTE‐ACS). Eligible patients were randomly assigned in a 1:1 ratio to receive ticagrelor (180 mg loading dose, then followed by 90 mg twice daily) or clopidogrel (600 mg loading dose, then followed by 75 mg once daily). The primary endpoint was the P2Y12 reactive unit (PRU) value assessed by VerifyNow at 30 days. The plasma concentrations of ticagrelor and clopidogrel and their active metabolites were measured in the first 10 patients in each group at baseline, and at 1 h, 2 h, 4 h, 8 h, 12 h and 24 h after the loading dose.ResultsBaseline characteristics were well matched between the two groups. Our results indicated a markedly lower PRU in patients treated with ticagrelor vs. clopidogrel at 30 days (32.6 ± 11.29 vs. 203.7 ± 17.92; P < 0.001) as well as at 2 h, 8 h and 24 h after the loading dose (P < 0.001). Ticagrelor and its active metabolite AR‐C124910XX showed a similar time to reach maximum concentration (Cmax) of 8 h, with the maximum concentration (Cmax) of 355 (242.50–522.00) ng ml–1and 63.20 (50.80–85.15) ng ml–1, respectively. Both clopidogrel and its active metabolite approached the Cmax at 2 h, with a similar Cmax of 8.67 (6.64–27.75) ng ml–1 vs. 8.53 (6.94–15.93) ng ml–1.ConclusionTicagrelor showed much more potent platelet inhibition in comparison with clopidogrel in patients with CKD and NSTE‐ACS.
First‐line therapy with dacomitinib, an orally available pan‐HER tyrosine kinase inhibitor, for locally advanced or metastatic penile squamous cell carcinoma: results of an open‐label, single‐arm, single‐centre, phase 2 study
Authors: Necchi Andrea , Lo Vullo Salvatore , Perrone Federica , Raggi Daniele , Giannatempo Patrizia , Calareso Giuseppina , Nicolai Nicola , Piva Luigi , Biasoni Davide , Catanzaro Mario , Torelli Tullio , Stagni Silvia , Togliardi Elena , Colecchia Maurizio , Busico Adele , Gloghini Annunziata , Testi Adele , Mariani Luigi , Salvioni Roberto 
Published: September 2017

ObjectiveTo harness the frontline therapy in advanced penile squamous cell carcinoma (PSCC), for which chemotherapy exerts moderate activity but poor efficacy. Dacomitinib is an irreversible, pan‐epidermal growth factor receptor (HER) inhibitor.Patients and MethodsIn a phase 2 study (NCT01728233), patients received dacomitinib 45 mg/day, orally, continuously. Inclusion criteria were SCC histology, clinical stage N2–3 or M1 (Tumour‐Node‐Metastasis classification system 2009), and no prior chemotherapy administration. The primary endpoint was the objective response rate (ORR, according to the Response Evaluation Criteria in Solid Tumors, version 1.1). Stopping rules based on the Bayesian posterior probability (PP) to demonstrate that the ORR exceeded 20% were set.ResultsFrom June 2013 to October 2016, 28 patients were treated. Eight (28.6%) had visceral metastases, 14 (50%) had pelvic and 17 (60.7%) clinically involved bilateral lymph nodes. One complete and eight partial responses were obtained (ORR 32.1%, 80% credibility interval 21.0–43.0%). The median (interquartile range [IQR]) follow‐up duration was 19.8 (6.3–25.7) months; 12‐month progression‐free survival was 26.2% (95% confidence interval [CI] 13.2–51.9); 12‐month overall survival (OS) was 54.9% (95% CI 36.4–82.8). The median (IQR) OS of locally advanced patients was 20 (11.1–not reached) months. The Bayesian PP of exceeding the 20% ORR target was 92.3%. Grade 3 adverse events (skin rash) were seen in three patients (10.7%). Tissue samples from 25 patients were analysed. Only two patients had high‐risk human papillomavirus‐positive tumours. Epidermal growth factor receptor (EGFR) amplification was found in four patients (equally responders and non‐responders) and it was confirmed in all post‐dacomitinib samples. Telomerase reverse transcriptase (TERT) mutations were found in responders only (60%), and phosphatidylinositol 3‐kinase/mammalian target of rapamycin (PI3K/mTOR) pathway gene mutations were found in 42.9% of responders vs 8.3% of non‐responders.ConclusionDacomitinib was active and well tolerated in patients with advanced PSCC and may represent an option when combined chemotherapy cannot be administered. Mutations in downstream effectors of EGFR signalling in relation to dacomitinib activity deserve further studies.
Palaeoceanographic evolution of the SW Svalbard shelf over the last 14 000 years
Authors: Telesiński Maciej M. , Przytarska Joanna E. , Sternal Beata , Forwick Matthias , Szczuciński Witold , Łącka Magdalena , Zajączkowski Marek 
Published: September 2017

The palaeoceanographic evolution of the SW Svalbard shelf west of Hornsund over the last 14 000 years was reconstructed using benthic foraminiferal assemblages, stable oxygen and carbon isotopes, and grain‐size and ice‐rafted debris data. The results reveal the complexity of the feedbacks influencing the shelf environment: the inflow of Atlantic and Arctic waters (AW and ArW, respectively), and the influence of sea ice and tidewater glaciers. The inflow of subsurface AW onto the shelf gradually increased with the first major intrusion at the end of the Bølling‐Allerød. During the Younger Dryas, the shelf was affected by fresh water originating from sea ice and glacier discharge. Glaciomarine conditions prevailed until the earliest Holocene with the intense deliveries of icebergs and meltwater from retreating glaciers and the occasional penetration of AW onto the shelf. Other major intrusions of AW occurred before and after the Preboreal oscillation (early Holocene), which resulted in more dynamic and open‐water conditions. Between 10.5 and 9.7 cal. ka BP, the shelf environment transformed from glaciomarine to open marine conditions. Between c. 9.7 and 6.1 cal. ka BP the AW advection reached its maximum, resulting in a highly dynamic and productive environment. At c. 6.1 cal. ka BP, the inflow of AW onto the Svalbard shelf decreased due to the intensification of the Greenland Gyre and the subduction of AW under the sea‐ice‐bearing ArW. Bioproductivity decreased over the next c. 5500 years. During the Little Ice Age, bioproductivity increased due to favourable conditions in the marginal sea‐ice zone despite the effects of cooling. The renewed advection of AW after AD 1850 started the climate warming trend observed presently. Our findings show that δ18O can be used to reconstruct the dominances of different water‐masses and, with some caution, as a proxy for the presence of sea ice in frontal areas over the northwestern Eurasian shelves.
Gα12 facilitates shortening in human airway smooth muscle by modulating phosphoinositide 3‐kinase‐mediated activation in a RhoA‐dependent manner
Authors: Yoo Edwin J , Cao Gaoyuan , Koziol‐White Cynthia J , Ojiaku Christie A , Sunder Krishna , Jude Joseph A , Michael James V , Lam Hong , Pushkarsky Ivan , Damoiseaux Robert , Di Carlo Dino , Ahn Kwangmi , An Steven S , Penn Raymond B , Panettieri Reynold A 
Published: September 2017

Background and PurposePI3K‐dependent activation of Rho kinase (ROCK) is necessary for agonist‐induced human airway smooth muscle cell (HASMC) contraction, and inhibition of PI3K promotes bronchodilation of human small airways. The mechanisms driving agonist‐mediated PI3K/ROCK axis activation, however, remain unclear. Given that G12 family proteins activate ROCK pathways in other cell types, their role in M3 muscarinic acetylcholine receptor‐stimulated PI3K/ROCK activation and contraction was examined.Experimental ApproachGα12 coupling was evaluated using co‐immunoprecipitation and serum response element (SRE)‐luciferase reporter assays. siRNA and pharmacological approaches, as well as overexpression of a regulator of G‐protein signaling (RGS) proteins were applied in HASMCs. Phosphorylation levels of Akt, myosin phosphatase targeting subunit‐1 (MYPT1), and myosin light chain‐20 (MLC) were measured. Contraction and shortening were evaluated using magnetic twisting cytometry (MTC) and micro‐pattern deformation, respectively. Human precision‐cut lung slices (hPCLS) were utilized to evaluate bronchoconstriction.Key ResultsKnockdown of M3 receptors or Gα12 attenuated activation of Akt, MYPT1, and MLC phosphorylation. Gα12 coimmunoprecipitated with M3 receptors, and p115RhoGEF‐RGS overexpression inhibited carbachol‐mediated induction of SRE‐luciferase reporter. p115RhoGEF‐RGS overexpression inhibited carbachol‐induced activation of Akt, HASMC contraction, and shortening. Moreover, inhibition of RhoA blunted activation of PI3K. Lastly, RhoA inhibitors induced dilation of hPCLS.Conclusions and ImplicationsGα12 plays a crucial role in HASMC contraction via RhoA‐dependent activation of the PI3K/ROCK axis. Inhibition of RhoA activation induces bronchodilation in hPCLS, and targeting Gα12 signaling may elucidate novel therapeutic targets in asthma. These findings provide alternative approaches to the clinical management of airway obstruction in asthma.
How Unequal Is the United States? Adolescents’ Images of Social Stratification
Authors: Flanagan Constance A. , Kornbluh Mariah 
Published: September 2017

This study highlights the use of pictorial images to understand adolescents’ views on social stratification. A continuum of five visual images of social stratification were presented to a diverse sample of five hundred ninety‐eight 8th–12th graders (14–18 years old). Adolescents selected which image best represented the United States (today, in 20 years, how it ought to be). Images ranged from inequitable to egalitarian. Results supported reference group and possible selves theories. Adolescents in higher status families chose a more egalitarian image for how the United States is today and how it ought to be. African Americans considered the United States today more unequal. Differences in adolescents’ commitment to an egalitarian ideal depended on their reactions to inequality and their beliefs about government responsiveness, bolstering the measure's validity.