bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Pragmatic Trial of Nasogastric Tube Placement in Patients with Upper Gastrointestinal Tract Bleeding
Authors: Rockey Don C , Ahn Chul , de Melo Silvio W 
Published: January 2017

The value of nasogastric (NG) tube placement in patients with upper gastrointestinal tract bleeding (UGIB) is unclear. We therefore aimed to determine the usefulness of NG tube placement in patients with UGIB. The study was a single-blind, randomized, prospective, non-inferiority study comparing NG placement (with aspiration and lavage) to no NG placement (control). The primary outcome was the probability that physicians could predict the presence of a high-risk lesion (ie, requiring endoscopic therapy). 140 patients in each arm were included; baseline clinical features were similar in each group. The probability that there would be a high-risk lesion in the control arm was predicted to be 35% compared with 39% in the NG arm (after NG placement)—a probability difference of −4% (95% CI −12% to 3%), which confirmed non-inferiority of the 2 arms (p=0.002). All patients underwent endoscopy and all patients with high-risk lesions had endoscopic therapy. Physicians predicted the specific culprit lesion in 38% (53/140) and 39% (55/140) of patients in the control and NG (after NG placement) groups, respectively. The presence of coffee grounds or red blood in the NG aspirate did not change physician assessments. Pain, nasal bleeding, or failure of NG occurred in 47/140 (34%) patients. There were no differences in rebleeding rates or mortality. In patients with acute UGIB, the ability of physicians to predict culprit bleeding lesions and/or the presence of high-risk lesions was poor. Routine NG placement did not improve physician's predictive ability, did not affect outcomes, and was complicated in one-third of patients. Trail Registration Number NCT00689754.
Low incidence of left atrial delayed enhancement with MRI in patients with AF: a single-centre experience
Authors: Bois John P , Glockner James , Young Phillip M , Foley Thomas A , Sheldon Seth , Newman Darrell B , Lin Grace , Packer Douglas L , Brady Peter A 
Published: January 2017

BackgroundAtrial fibrillation (AF) is the most common sustained atrial arrhythmia. One potential target for ablation is left atrial (LA) scar (LAS) regions that may be the substrate for re-entry within the atria, thereby sustaining AF. Identification of LAS through LA delayed gadolinium enhancement (LADE) with MRI has been proposed.ObjectivesWe sought to evaluate LADE in patients referred for catheter ablation of AF.MethodsProspective analysis was conducted of consecutive patients who underwent pulmonary vein antrum isolation (PVAI) ablation for AF at a single institution. Patients underwent LADE with MRI to determine LAS regions before ablation. MRI data were analysed independently in accordance with prespecified institutional protocol by two staff cardiac radiologists to whom patient outcomes were masked, and reports of LADE were documented. Where no initial consensus occurred regarding delayed enhancement (DE), a third staff cardiac radiologist independently reviewed the case and had the deciding vote.ResultsOf the 149 consecutive patients (mean (SD) age, 59 (9) years), AF was persistent in 64 (43%) and paroxysmal in 85 (57%); 45 (30%) had prior ablation. Only five patients (3%) had identifiable DE in LA walls (persistent AF, n=1; paroxysmal AF, n=4). LADE was present in two (4%) of the 45 patients with previous left PVAI. The presence of LADE was not associated with a higher recurrence rate of AF.ConclusionsIn contrast to previous studies, the finding of DE within LA walls was uncommon and, when present, did not correlate with AF type or risk of AF recurrence. It therefore is of unclear clinical significance.
Dimethyl Fumarate Controls the NRF2/DJ-1 Axis in Cancer Cells: Therapeutic Applications
Authors: Saidu Nathaniel Edward Bennett , Noé Gaëlle , Cerles Olivier , Cabel Luc , Kavian-Tessler Niloufar , Chouzenoux Sandrine , Bahuaud Mathilde , Chéreau Christiane , Nicco Carole , Leroy Karen , Borghese Bruno , Goldwasser François , Batteux Frédéric , Alexandre Jérôme 
Published: January 2017

AbstractThe transcription factor NRF2 (NFE2L2), regulates important antioxidant and cytoprotective genes. It enhances cancer cell proliferation and promotes chemoresistance in several cancers. Dimethyl fumarate (DMF) is known to promote NRF2 activity in noncancer models. We combined in vitro and in vivo methods to examine the effect of DMF on cancer cell death and the activation of the NRF2 antioxidant pathway. We demonstrated that at lower concentrations (&lt;25 μmol/L), DMF has a cytoprotective role through activation of the NRF2 antioxidant pathway. At higher concentrations, however (&gt;25 μmol/L), DMF caused oxidative stress and subsequently cytotoxicity in several cancer cell lines. High DMF concentration decreases nuclear translocation of NRF2 and production of its downstream targets. The pro-oxidative and cytotoxic effects of high concentration of DMF were abrogated by overexpression of NRF2 in OVCAR3 cells, suggesting that DMF cytotoxicity is dependent of NRF2 depletion. High concentrations of DMF decreased the expression of DJ-1, a NRF2 protein stabilizer. Using DJ-1 siRNA and expression vector, we observed that the expression level of DJ-1 controls NRF2 activation, antioxidant defenses, and cell death in OVCAR3 cells. Finally, antitumoral effect of daily DMF (20 mg/kg) was also observed in vivo in two mice models of colon cancer. Taken together, these findings implicate the effect of DJ-1 on NRF2 in cancer development and identify DMF as a dose-dependent modulator of both NRF2 and DJ-1, which may be useful in exploiting the therapeutic potential of these endogenous antioxidants. Mol Cancer Ther; 16(3); 529–39. ©2017 AACR.
Build Your Own Earth: A Web-Based Tool for Exploring Climate Model Output in Teaching and Research
Authors: Schultz David M. , Fairman Jonathan G. , Anderson Stuart , Gardner Sharon 
Published: January 2017

Abstract
Build Your Own Earth was designed as a web-based tool for the user to select various characteristics of a planet and see what the climate of that planet would be like. Because of the limitations of computer resources, presimulated Earths were run using the Fast Ocean Atmosphere Model at relatively coarse resolution. The tool provides 50 different Earth configurations in three categories: Recent, Ancient, and Alien Earths. Recent Earths fix the continental configuration at the present day and vary the axial tilt, eccentricity, and greenhouse gas concentrations. Ancient Earths include a series of paleoclimate simulations from the Last Glacial Maximum 21,000 years ago to the Ediacaran 600 million years ago. Alien Earths include an aquaplanet, terraplanet, ice planet, and various idealized continental configurations. Fifty different monthly averaged quantities are available to view in an annual cycle from four different map projections. Build Your Own Earth was built and designed for a massive open online course, but it has also been used in the classroom at the University of Manchester, as well as research projects on paleoclimate and planetary habitability, for example. The tool is freely available online (www.buildyourownearth.com) for anyone to access.
Surgery for Cholesteatomatous Labyrinthine Fistula
Authors: Lim John , Gangal Anupriya , Gluth Michael Brian 
Published: January 2017

Objective: There is uncertainty regarding the ideal surgical management of cholesteatomatous labyrinthine fistulae. The objective was to review the published evidence to determine whether a difference exists in hearing outcome for cholesteatoma matrix removal or matrix exteriorization. Data Sources: Systematic MEDLINE and Web of Science searches identified publications describing hearing results after cholesteatoma matrix removal or matrix exteriorization. Review Methods: Three reviewers appraised the studies for quality, level of evidence, and extracted data. Fistula characteristics such as single-site, multisite, size, grade, and follow-up time were extracted for subanalyses, and when appropriate, data were pooled for statistical analysis. Results: Twenty-eight articles met inclusion criteria, and the level of evidence was judged no better than level 3b. There was no difference in hearing preservation detected between matrix removal and exteriorization (87% for matrix removal, 95% CI, 0.82-0.90; 95% for exteriorization, 95% CI, 0.85-0.98). An analysis of the individual cohort studies that compared these groups directly did not show a difference in calculated odds ratio (OR), 0.96 (95% CI, 0.66-1.40). Conclusion: The level of evidence on which to base surgical decision making related to cholesteatomatous labyrinthine fistula is poor, and the data do not demonstrate significant differences in hearing outcomes based on surgical technique.
Experiences in the Surgical Management of Abdominal Aortic Aneurysms
Authors: Short D. W. , Mackey W. A. 
Published: January 2017

From 1954 until 1967, a total of 52 patients with abdominal aortic aneurysms were referred to the University Surgical Unit and in 44 instances the aneurysm was resected. Nine patients (including one who had the aneurysm resected at a later date) were either rejected for surgery on general grounds or were explored but did not have the aneurysm resected. These cases are discussed. Out of the 44 cases undergoing aneurysmectomy, 11 died during the operation or in the first week after the operation, giving an overall mortality rate of 25 per cent. There were 13 asymptomatic aneurysms with no deaths, 16 aneurysms with symptoms indicating rapid expansion of the aneurysm with 2 deaths (mortality rate of 12.5%) and 15 aneurysms which had ruptured with 9 deaths (mortality rate of 60%). The main operative complications were haemorrhage, cardiac arrest and peripheral arterial thrombosis. Post-operative complications were respiratory insufficiency, renal insufficiency or failure, bowel ischaemia, wound infection and wound dehiscence. Of the 44 patients operated upon, 33 survived operation and left the hospital alive. Three patients have been lost to follow-up and there were 9 known late deaths due to suture-line rupture (2), coronary artery thrombosis (1), renal failure (1), pneumonia (2), embolism (1), bronchial carcinoma (1). Twenty-one patients are still alive having survived the operation for periods ranging from 6 months to 9 years. Atherosclerotic aortic aneurysms occur in elderly patients with other evidence of advanced systemic atherosclerosis. Nevertheless, these aneurysms are specifically dangerous and in the absence of surgical treatment the majority of the patients may be expected to die from rupture of the aneurysm. At the present time, in good circumstances, resection of an unruptured aortic abdominal aneurysm has an overall mortality rate of less than 10 per cent but, should surgery be deferred until the aneurysm has ruptured, the operative mortality rate is 50 per cent or more. Patients surviving operation can expect a very satisfactory restoration of physical well-being.
The Birth of a Child with Down's Syndrome: A Medico-Social Study of Thirty-One Children and Their Families
Authors: Stone H. 
Published: January 2017

In a study of 31 children with Down's syndrome and their families in the Glasgow area, medico-social help was found to be adequate in dealing with the major physical problems (especially congenital heart disease) of the child, and in providing genetic advice to those families in whom recurrence was a major anxiety. Help was deficient in catering for the emotional and social needs of many of the families of these children. It is suggested that these findings reflect the narrow medical concept of Down's syndrome as an isolated pathological entity, and that a major shift of emphasis of medical attention from the child on to the family unit is required to effect changes in the standards of care of such children and their families.
Experience with Duodenofiberscopes
Authors: Dellipiani A. W. 
Published: January 2017

The endoscopic experience in a district general hospital is described in two consecutive six monthly periods during the first of which 112 patients were examined using the Olympus Duodenofiberscope model JF-B and during the the second of which 148 patients were examined using this instrument in conjunction with the Olympus Gastrointestinal Fiberscope model GIF-D. The cases examined were a group of dyspeptic patients (patients with suspected peptic ulceration with chronic anaemia, weight loss or suspected carcinoma), a group of patients with gastrointestinal bleeding and a group of patients who had undergone gastric surgery. In this total of 260 patients the duodenal bulb was examined in 169 cases. During the period when both instruments were available there was a preference for using the end viewing Olympus GIF but for a complete examination both instruments are required in a very significant proportion of cases. During the period when both instruments were available, examination of the duodenal bulb was possible in every case apart from two in which there was organic obstruction. In general with either instrument adequate histological material was obtained. When the endoscopic and radiological results are compared it is seen that the radiologist and the endoscopist agree in over half of the cases examined. However, in the others the endoscopist plays an important part in establishing the presence of radiologically undetected or undetectable disease and in confirming or excluding radiologically doubtful disease.
Pulmonary Embolism—A Clinical and Autopsy Study
Authors: Macintyre I. M. C. , Ruckley C. V. 
Published: January 2017

This paper reports 2 retrospective 5-year studies. A clinical review of 120 cases of pulmonary embolism at the Western General Hospital, Edinburgh, between 1965 and 1969 is followed by a review of 303 cases of embolism detected at 2291 routine autopsies in the Edinburgh Northern Hospital Group between 1967 and 1971. The main conclusions drawn from the studies are: 1. Venous thrombo-embolic disease is a major cause of morbidity and mortality in the Edinburgh Northern Group of Hospitals; 2. Greater use should be made of special diagnostic techniques in thrombo-embolic disease; 3. Oral anticoagulants do not protect from further embolism; 21 per cent of patients had recurrent emboli whilst on anticoagulant treatment; 4. The fatal episode in those patients with an otherwise good prognosis had been preceded by a clinically recognised minor episode in 27 per cent. At autopsy 52 per cent of patients dying of embolism showed evidence of previous smaller episodes. Minor embolism must be regarded as heralding major embolism unless phlebography proves otherwise; and 5. Every hospital should have a policy for the management of pulmonary embolism.
Diagnosis of Haemoglobinopathies in West of Scotland
Authors: Bulloch Catherine , Helenglass Gilla , Lucie N. P. 
Published: January 2017

The incidence of various haemoglobinopathies has been recorded for one laboratory for the period 1961 to 1979. Over this period, the heterozygous conditions, particularly the thalassaemic group of disorders, have been found with an increasing frequency, though the more serious homozygous forms have not shown the same trend. Improved diagnostic methods and a raised index of suspicion to a potential haemoglobinopathy contribute to this increase, but the major factor is probably the rise in the immigrant population.
Calcium Carbonate 1250mg/1260mg: An Effective Phosphate Binder
Authors: Taylor J.E. , Henderson I.S. , Stewart W.K. , Mactier R.A. 
Published: January 2017

Calcium carbonate is currently the first choice phosphate binder in renal failure. In the UK its most widely prescribed formulation is a combination of calcium carbonate 420mg and glycine 180mg (TitralacR 3M Riker). In order to achieve adequate reduction in the serum phosphate level, up to 12 of these tablets may be required daily. In a group of seven patients, we have compared Titralac with two alternative preparations containing calcium carbonate 1250mg (Calcium-500R Macarthy's Medical Ltd) and calcium carbonate 1260mg (CalcichewR Shire Pharmaceuticals Ltd). Given at a third of the daily number of Titralac tablets, both these newer preparations were effective phosphate binders and produced no statistically significant change in serum calcium and phosphate. The important advantage of such a reduced tablet load is improved patient compliance with phosphate binder therapy. Calcium-500 is also a cost-effective treatment slightly reducing the cost when compared with combined calcium carbonate 420mg and glycine 180mg.
Procreative Liberty and Harm to Offspring in Assisted Reproduction
Authors: Robertson John A. 
Published: January 2017

Assisted reproductive technologies (“ARTs”) have enabled many infertile couples to have children but have long been controversial. Opposition initially focused on the “unnaturalness” of laboratory conception and the doubts that healthy children would result. Once children were born, ethical debate shifted to the status and ownership of embryos and the novel forms of family that could result.The new century has brought forth both new and old ethical concerns. The growing capacity to screen the genomes of embryos has sparked fears of eugenic selection and alteration. In addition, concerns about safety have reasserted themselves. Several studies suggest that in vitro fertilization (“IVF”) may be associated with lower birth weights and major malformations. Ethical attention has also focused on whether all persons seeking ARTs should be granted access to them, regardless of their child-rearing ability, age, disability, health status, marital status, or sexual orientation.
Patent Buy-Outs for Global Disease Innovations for Low-and Middle-Income Countries
Authors: Outterson Kevin 
Published: January 2017

The World Health Organization’s CHOICE program analyzes the cost effectiveness of various health interventions related to the Millennium Development Goals. The program identifies the best strategies for improving health in low-income countries, using a standard set of methodological assumptions. These studies evaluate interventions in many areas, including child health and HIV/AIDS.For some of these treatments, drug costs are a significant variable: if the drug price doubles, the intervention becomes less cost effective. But if the drug price is reduced by 90%, then more therapies become affordable.Drug prices are uniquely susceptible to radical price reductions through generic competition. Patented pharmaceuticals may be priced at more than 30 times the marginal cost of production; the excess is thepatent rentcollected by the drug company while the patent and exclusive marketing periods remain. Patent rents are significant. AIDS drugs which sell for US$10,000 per person per year in the US are sold generically for less than US$200. If patented drugs could be sold at the marginal cost of production, cost effective treatments would become even more attractive, and other interventions would become affordable.
How Parallel Trade Affects Drug Policies and Prices in Canada and the United States
Authors: Hollis Aidan , Ibbott Peter 
Published: January 2017

U.S. consumers and Canadian pharmacies have rushed to take advantage of the opportunity presented by price differences in patented pharmaceuticals. This rapidly growing parallel trade has brought the Canadian and U.S. systems for determining pharmaceutical pricing under increased scrutiny, and the pressure for change seems to be building. This paper examines why parallel trade in pharmaceuticals has grown and considers some of the policy options confronting both countries.To do this we begin by identifying similarities and differences in the Canadian and U.S. regulatory frameworks governing trade in pharmaceuticals. While the differences are considerable, we show that they are not the only reason for the emergence of the price disparity that has fuelled the growth in parallel trade. In particular, we argue that the price discrimination strategies of pharmaceutical manufacturers and exchange rate fluctuations have played an underappreciated role. Following this, we examine the claims that this trade represents a threat to American and Canadian interests, and find that there are good reasons for policy makers on both sides of the border to be concerned. Unchecked, this rising trade presents a threat to R&D funding and continued Canadian consumer access to pharmaceutical products.
Conflicts of Interest in International Human Drug Research and the Insufficiency of International Protections
Authors: Gatter Robert 
Published: January 2017

The world relies largely on private firms for the development of new medicine, and the system is efficient. Driven by the incentive to profit from sales of new pharmaceuticals, drug companies risk millions of dollars and years of work to shepherd basic scientific discoveries through laboratory and human testing in the hope of developing a marketable drug. For example, it is estimated that in 2002 alone, pharmaceutical companies invested $45 billion the development of new medicine worldwide.While the profit incentive generates such enormous private investment in human drug development, it also encourages firms to pose inappropriate risks to the safety of human subjects when speeding a new drug to the market. The risks posed by financial conflicts of interest associated with human subjects research on new pharmaceutical products are notable examples, both in the U.S. and internationally.
NAFTA & the Alien Tort Claims Act: Making a Case for Actionable Offenses Based on Environmental Harms and Injuries to the Public Health
Authors: Prussia Kevin Scott 
Published: January 2017

Multinational corporations often wield more power than many of the world's nations. Their immense wealth and political capital make them almost hegemonic entities. These domineering enterprises are often able to undertake profit-making endeavors, particularly involving the consumption or extraction of natural resources, in developing nations with little or no regulation, and often without meeting the social and environmental standards adhered to in the United States.The emergence of multilateral free trade agreements, specifically within the developing world, has further enhanced the ability of multinational corporations to proliferate their business. Concomitant with the rise of free trade, political and legal barriers to multinational entry into the economy of developing nations are rapidly disappearing. In addition, many nations are unwilling and unable to protect their citizens from environmental abuses through domestic law. Therefore, finding a legal mechanism capable of checking the hegemonic power of multinational corporations is extremely important to the vitality of most developing nations.
Planning for Pandemic: A New Model for Governing Public Health Emergencies
Authors: Gerwin Leslie E. 
Published: January 2017

Imagine the following scenario:The Centers for Disease Control confirms the appearance of a heretofore-unknown virus. It appears highly contagious since it is spreading easily between human beings. At this initial stage, the largest cohort of victims is youth in their late teens.There is no geographic locus of the disease or single identifiable index case from which the virus's origin can be determined. The disease is independently prevalent in many geographic areas, particularly among those living in the inner cities of major metropolitan areas in the United States and in some of the densely populated immigrant enclaves in European cities.At this point, the mortality is uncertain although in its early phase it is at least as deadly as a seasonal flu. It is the end of May: young people are dreading final exams, anticipating their high school and college graduations, and looking forward to the many end of the year celebrations. The weather is getting warmer, and the public pools are about to open. Despite the hot weather, the prevalence of the disease is not significantly waning.Americans are nervous. They want answers. They expect their government to protect them.