bluuebunny/crossref_metadata_2025_split huggingface dataset:
PET and MRI: Is the Whole Greater than the Sum of Its Parts?
Authors: Gillies Robert J. , Beyer Thomas 
Published: October 2016

Abstract
Over the past decades, imaging in oncology has been undergoing a “quiet” revolution to treat images as data, not as pictures. This revolution has been sparked by technological advances that enable capture of images that reflect not only anatomy, but also of tissue metabolism and physiology in situ. Important advances along this path have been the increasing power of MRI, which can be used to measure spatially dependent differences in cell density, tissue organization, perfusion, and metabolism. In parallel, PET imaging allows quantitative assessment of the spatial localization of positron-emitting compounds, and it has also been constantly improving in the number of imageable tracers to measure metabolism and expression of macromolecules. Recent years have witnessed another technological advance, wherein these two powerful modalities have been physically merged into combined PET/MRI systems, appropriate for both preclinical or clinical imaging. As with all new enabling technologies driven by engineering physics, the full extent of potential applications is rarely known at the outset. In the work of Schmitz and colleagues, the authors have combined multiparametric MRI and PET imaging to address the important issue of intratumoral heterogeneity in breast cancer using both preclinical and clinical data. With combined PET and MRI and sophisticated machine-learning tools, they have been able identify multiple coexisting regions (“habitats”) within living tumors and, in some cases, have been able to assign these habitats to known histologies. This work addresses an issue of fundamental importance to both cancer biology and cancer care. As with most new paradigm-shifting applications, it is not the last word on the subject and introduces a number of new avenues of investigation to pursue. Cancer Res; 76(21); 6163–6. ©2016 AACR.
Long-Term Outcome of Patients Initially Diagnosed With Idiopathic Ventricular Fibrillation
Authors: Visser Marloes , van der Heijden Jeroen F. , van der Smagt Jasper J. , Doevendans Pieter A. , Wilde Arthur A. , Loh Peter , Hassink Rutger J. 
Published: October 2016

Background—
Idiopathic ventricular fibrillation (IVF) is a rare cause of sudden cardiac arrest. Limited data are available on the long-term outcome of IVF patients.

Methods and Results—
In this retrospective cohort study, 107 consecutive patients with an initial diagnosis of IVF were analyzed (age at index event 40.4 years, 60% male). Missing diagnostic data were acquired during follow-up, including genetic testing, to exclude underlying disease. A specific diagnosis was revealed in 22 of 107 patients (21%) during a median follow-up of 10.2 years. Mortality rate was 9% in IVF patients (8/85). Appropriate implantable cardioverter–defibrillator therapy was delivered in 23 patients (29%) of 78 IVF patients with an implantable cardioverter–defibrillator, with a median of 3 appropriate shocks per patient.

Conclusions—
One fifth of the patients initially diagnosed with IVF reveal a specific diagnosis during long-term follow-up. Additional diagnostic testing, including genetic testing, contributes to the detection of specific diseases. The recurrence rate of ventricular arrhythmias in IVF patients is high. Our data show the importance of thorough follow-up and reassessment of diagnosis in IVF patients.
Impact of Statin Use After Heart Transplantation
Authors: Vallakati Ajay , Reddy Siddharth , Dunlap Mark E. , Taylor David O. 
Published: October 2016

Background—
Although various studies revealed the beneficial effects of statins in post–cardiac transplant patients, these were relatively small and low-powered studies. We performed a meta-analysis of published studies to evaluate the role of statins in post–cardiac transplant patients, specifically examining the effects on hemodynamically significant/fatal graft rejection, coronary vasculopathy, terminal cancer, and overall survival.

Methods and Results—

We searched PubMed, Cochran CENTRAL, and Web of Science databases using the search terms “cardiac transplant” or “heart transplant,” and “statin” for a literature search. A random-effects model with Mantel–Haenszel method was used to pool the data. We identified 10 studies, 4 randomized controlled trials, and 6 nonrandomized studies, which compared outcomes in heart transplant recipients undergoing statin therapy to statin-naive patients. A pooled analysis of 9 studies reporting mortality revealed that the use of statins was associated with significant reduction in all-cause mortality (odds ratio, 0.26; 95% confidence interval, 0.20–0.35;
P
<0.0001). Statins also decreased the odds of hemodynamically significant/fatal rejection (odds ratio, 0.37; 95% confidence interval, 0.21–0.65;
P
=0.0005), incidence of coronary vasculopathy (odds ratio, 0.33; 95% confidence interval, 0.16–0.68;
P
=0.003), and terminal cancer (odds ratio, 0.30; 95% confidence interval, 0.15–0.63;
P
=0.002).

Conclusions—
The evidence from a pooled analysis suggests that statins improve survival in heart transplant recipients. Statins may prevent fatal rejection episodes, decrease terminal cancer risk, and reduce the incidence of coronary vasculopathy. Additional prospective studies are needed to further investigate and explain this association.
Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function
Authors: Demmer Ryan T. , Allison Matthew A. , Cai Jianwen , Kaplan Robert C. , Desai Ankit A. , Hurwitz Barry E. , Newman Jill C. , Shah Sanjiv J. , Swett Katrina , Talavera Gregory A. , Thai Ashley , Youngblood Marston E. , Rodriguez Carlos J. 
Published: October 2016

Background—
We examined the relationship between glucose homeostasis and comprehensive measures of cardiac structure and function among a representative sample of US Hispanics.

Methods and Results—

ECHO-SOL (Echocardiographic Study of Latinos), an echocardiographic ancillary study of the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), enrolled 1818 Hispanic/Latino men (43%) and women (57%) aged ≥45 years (mean=56). Glucose intolerance was defined as follows: (1) prediabetes: hemoglobin (HbA1c) ≥5.7 and <6.5% and (2) diabetes mellitus: fasting plasma glucose ≥126 mg/dL, 2-hour postload glucose ≥200 mg/dL, HbA1c ≥6.5%, or hypoglycemic agent use. Uncontrolled diabetes mellitus was defined as HbA1c ≥7.0%. Insulin resistance was defined using the homeostatic model assessment for insulin resistance. Echocardiography examinations assessed left ventricular structure and systolic/diastolic function. Multivariable linear and logistic regression models were used. Prediabetes prevalence was 42%, and diabetes mellitus prevalence was 28% (47% uncontrolled). Glucose intolerance was associated with increased left ventricular posterior wall and interventricular septal and relative wall thicknesses (all
P
<0.05), reduced ejection fraction (
P
<0.01), reduced stroke and end-diastolic volumes (both
P
<0.001), decreased peak E′ velocity (lateral and septal
P
<0.001), and increased E/E′ ratio (lateral and septal
P
<0.01). The odds ratios (95% confidence intervals) for diastolic dysfunction among individuals with prediabetes and diabetes mellitus (versus diabetes mellitus free) were 1.36 (0.96–1.9) and 1.90 (1.3–2.8), respectively(
P
=0.006). Results were consistent for uncontrolled diabetes mellitus versus diabetes mellitus. Homeostatic model assessment for insulin resistance was associated with increased E/E′ (
P
<0.001), and greater relative wall thickness and septal thickness (both
P
<0.05); lower stroke volume (
P
<0.0001); and lower peak lateral and septal E′ velocities (both
P
<0.01).

Conclusions—
Glucose intolerance and insulin resistance are associated with unfavorable cardiac structure and function, particularly worsened measures of diastolic function, even before the development of diabetes mellitus.
Association of Retinopathy and Retinal Microvascular Abnormalities With Stroke and Cerebrovascular Disease
Authors: Hughes Alun D. , Falaschetti Emanuela , Witt Nicholas , Wijetunge Sumangali , Thom Simon A. McG. , Tillin Therese , Aldington Steve J. , Chaturvedi Nish 
Published: October 2016

Background and Purpose—
Abnormalities of the retinal circulation may be associated with cerebrovascular disease. We investigated associations between retinal microvascular abnormalities and (1) strokes and subclinical cerebral infarcts and (2) cerebral white matter lesions in a UK-based triethnic population-based cohort.

Methods—
A total of 1185 participants (age, 68.8±6.1 years; 77% men) underwent retinal imaging and cerebral magnetic resonance imaging. Cerebral infarcts and white matter hyperintensities were identified on magnetic resonance imaging, retinopathy was graded, and retinal vessels were measured.

Results—
Higher retinopathy grade (odds ratio [OR], 1.40 [95% confidence interval (95% CI), 1.16–1.70]), narrower arteriolar diameter (OR, 0.98 [95% CI, 0.97–0.99]), fewer symmetrical arteriolar bifurcations (OR, 0.84 [95% CI, 0.75–0.95]), higher arteriolar optimality deviation (OR, 1.16 [95% CI, 1.00–1.34]), and more tortuous venules (OR, 1.20 [95% CI, 1.09–1.32]) were associated with strokes/infarcts and white matter hyperintensities. Associations with quantitative retinal microvascular measures were independent of retinopathy.

Conclusions—
Abnormalities of the retinal microvasculature are independently associated with stroke, cerebral infarcts, and white matter lesions.
Integrative Medicine in Head and Neck Cancer
Authors: Matovina Chloe , Birkeland Andrew C. , Zick Suzanna , Shuman Andrew G. 
Published: October 2016

ObjectiveComplementary and alternative medicine, or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this article is to use recent data to outline the decision making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers’ understanding of integrative medicine.Data SourcesRandomized controlled trials involving integrative medicine or complementary and alternative medicine treatment for cancer patients.Review MethodsTrials were drawn from a systematic PubMed database search categorized into cancer prevention, treatment, and symptom management.ConclusionsIntegrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine.Implications for PracticeIn the management of head and neck cancer, there is an increasing demand for awareness of, dialogue about, and research evaluating integrative medicine therapies. It is important for otolaryngologists to become aware of integrative therapy options, their risks and benefits, and resources for further information to effectively counsel their patients.
Participants’ safety versus confidentiality: A case study of HIV research
Authors: Leyva-Moral Juan Manuel , Feijoo-Cid Maria 
Published: October 2016

Background When conducting qualitative research, participants usually share lots of personal and private information with the researcher. As researchers, we must preserve participants’ identity and confidentiality of the data. Objective To critically analyze an ethical conflict encountered regarding confidentiality when doing qualitative research. Research design Case study. Findings and discussion one of the participants in a study aiming to explain the meaning of living with HIV verbalized his imminent intention to commit suicide because of stigma of other social problems arising from living with HIV. Given the life-threatening situation, the commitment related to not disclosing the participant’s identity and/or the content of the interview had to be broken. To avoid or prevent suicide, the therapist in charge of the case was properly informed about the participant’s intentions. One important question arises from this case: was it ethically appropriate to break the confidentiality commitment? Conclusion confidentiality could be broken if a life-threatening event is identified during data collection and participants must know that. This has to be clearly stated in the informed consent form.
Thrombophilic Gene Mutations in Relation to Different Manifestations of Venous Thromboembolism: A Single Tertiary Center Study
Authors: Bezgin Tahir , Kaymaz Cihangir , Akbal Özgür , Yılmaz Fatih , Tokgöz Hacer Ceren , Özdemir Nihal 
Published: October 2016

Background: Venous thromboembolism (VTE) is a common and potentially lethal disorder that manifests mainly as deep vein thrombosis (DVT) of the extremities or pulmonary embolism (PE) and occurs as a consequence of genetic and environmental risk factors. We aimed to assess the role of inherited thrombophilia as a causative or additive factor in the development of VTE. Methods: The study included 310 patients (female: 154; mean age: 52.3 ± 16.9 years) with a first episode of VTE and 289 age- and sex-matched healthy controls. All participants underwent screening for thrombophilia-associated polymorphisms including factor V Leiden (FVL), prothrombin G20210A (PTG), factor V H1299 R (factor V HR2), factor XIII V34 L, β-fibrinogen-455 G>A, plasminogen activator inhibitor-1 4G/5G, human platelet antigen-1 a/b, methylene tetrahydrofolate reductase (MTHFR) C677 T, MTHFR A1298C, angiotensin-converting enzyme I/D, apolipoprotein B R3500Q, and apolipoprotein E (Apo E). In addition, serum homocysteine (Hcy) levels were measured. Results: In the patient group, 247 (80%) had isolated DVT, 43 (14%) had DVT plus PE, and 20 (6%) had isolated PE. The mean Hcy levels were similar in VTE subgroups and controls. Compared to controls, patients with isolated DVT, DVT plus PE, and isolated PE showed significantly higher frequencies for the following—heterozygous FVL mutation, isolated DVT (28.3%), DVT plus PE (44.2%), isolated PE (50%), controls (8.3%; P < .001); heterozygous PTG mutation, isolated DVT (11.3%), DVT plus PE (20.9%), isolated PE (25%), controls (5.9%; P < .01); Apo E 2/4, isolated DVT (9.7%), DVT plus PE (9.3%), isolated PE (5%), controls (1%; P < .01).The MTHFR A1298C mutation showed a significantly higher frequency in isolated patients with PE than in those with isolated DVT ( P = .006) and in controls ( P = .008). The frequencies of other genetic mutations or polymorphisms showed similar frequencies in all comparisons. In logistic regression analysis, heterozygous FVL mutation was the only independent predictor of VTE (odds ratio: 3.9, 95% confidence interval: 1.3-11.2; P = .012). Conclusion: Except than FVL, PTG, and Apo E 2/4 mutations, many of aforementioned thrombophilic factors known to be associated with VTE did not demonstrate any relationship with VTE. Heterozygous mutation of FVL was an independent predictor for VTE.
Clinical benefits, referral practice and cost implications of an in-hospital pain service: results of a service evaluation in a London teaching hospital
Authors: Sussman Maya , Goodier Elizabeth , Fabri Izabella , Borrowman Jessica , Thomas Sarah , Guest Charlotte , Bantel Carsten 
Published: October 2016

Background: In-hospital pain services (IPS) are commonplace, but evidence of efficacy is inadequate, and patients’ pain management in any hospital ward remains problematic. This service evaluation aimed to measure the effect of a contemporary IPS, its appropriate use and cost-efficacy. Methods: Records of 249 adults reviewed by the IPS in an inner London Teaching Hospital over an 8-month period were analysed for demographic data, interventions, workload and change in pain intensity measured by numerical rating scale (NRS). Non-parametric tests were used to evaluate differences between initial and final NRS. Spearman’s rank correlation analysis was used to create a correlation matrix to evaluate associations between all identified independent variables with the change in NRS. All strongly correlated variables (ρ > 0.5) were subsequently included in a binary logistic regression analysis to identify predictors of pain resolution greater than 50% NRS and improvement rather than deterioration or no change in NRS. Finally, referral practice and cost of inappropriate referrals were estimated. Referrals were thought to be inappropriate when pain was not optimised by the referring team; they were identified using a set algorithm. Results: Initial median NRS and final median NRS were significantly different when a Wilcoxon signed-rank test was applied to the whole cohort; Z = –5.5 (p = 0.000). Subgroup analysis demonstrated no significant difference in the ‘mild’ pain group; z = –1.1 (p = 0.253). Regression analysis showed that for every unit increase in initial NRS, there was a 62% chance of general and a 33% chance of >50% improvement in final NRS. An estimated annual cost-saving potential of £1546 to £4558 was found in inappropriate referrals and patients experiencing no benefit from the service. Discussion: Results suggest that patients with moderate to severe pain benefit most from IPS input. Also pain management resources are often distributed inefficiently. Future research is required to develop algorithms for easy identification of potential treatment responders.
Quantifying Quadriceps Muscle Strength in Patients With ACL Injury, Focal Cartilage Lesions, and Degenerative Meniscus Tears
Authors: Eitzen Ingrid , Grindem Hege , Nilstad Agnethe , Moksnes Håvard , Risberg May Arna 
Published: October 2016

Background: Reduced quadriceps strength influences knee function and increases the risk of knee osteoarthritis. Thus, it is of significant clinical relevance to precisely quantify strength deficits in patients with knee injuries. Purpose: To evaluate isokinetic concentric quadriceps muscle strength torque values, assessed both from peak torque and at specific knee flexion joint angles, in patients with anterior cruciate ligament (ACL) injury, focal cartilage lesions, and degenerative meniscus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were synthesized from patients included in 3 previously conducted research projects: 2 prospective cohort studies and 1 randomized controlled trial. At the time of inclusion, all patients were candidates for surgery. Isokinetic concentric quadriceps muscle strength measurements (60 deg/s) were performed at baseline (preoperative status) and after a period of progressive supervised exercise therapy (length of rehabilitation period: 5 weeks for ACL injury, 12 weeks for cartilage lesions and degenerative meniscus). Outcome measures were peak torque and torque at specific knee flexion joint angles from 20° to 70°. All patients had unilateral injuries, and side-to-side deficits were calculated. For comparisons between and within groups, we utilized 1-way analysis of variance and paired t tests, respectively. Results: In total, 250 patients were included. At baseline, cartilage patients had the most severe deficit (39.7% ± 24.3%; P < .001). Corresponding numbers for ACL and degenerative meniscus subjects were 21.7% (±13.2%) and 20.7% (±16.3%), respectively. At retest, there was significant improvement in all groups ( P < .001), with remaining deficits of 24.7% (±18.5%) for cartilage, 16.8% (±13.9%) for ACL, and 3.3% (±17.8%) for degenerative meniscus. Peak torque was consistently measured at 60° of knee flexion, whereas the largest mean deficits were measured at 30° at baseline and 70° at retest for the ACL group, at 70° at baseline and retest for the degenerative meniscus group, and at 60° at baseline and at 50° at retest for the cartilage group. Conclusion: This study underlines the importance of including torque at specific knee flexion joint angles from isokinetic assessments to identify the most severe quadriceps muscle strength deficits. Furthermore, it confirms the importance of progressive exercise therapy interventions before potential surgery in patients with knee injuries.
A comparison of civil religion and remembrance culture in Germany and Japan
Authors: Schmidt Carmen 
Published: October 2016

AbstractJapan and Germany were allies during World War II, and both countries committed crimes. Even though the Nazi persecution of Jews in Germany was unprecedented in history, Japan has also been found guilty of serious misdemeanours. Today, Germany acknowledges the magnitude of its responsibility and strives to deal with this legacy. However, in Japan, we find no consensus on dealing with the matter. Nonetheless, it would be short-sighted to conclude that Germany did a better job than Japan from the outset. In analysing the different approaches to remembrance culture in the two countries, we use the theoretical framework ofcivil religionto assess the impacts of the respective civil religions on the culture of commemoration. We hereby analyzed the structural factors as well as the influence of individual political behaviour. Immediately after the war, neither Germany nor Japan were interested in coming to terms with their past. Both countries were subject to Western integration, and both countries experienced remarkable economic growth. One of the major differences between both countries concerns civil religion. While Germany no longer relied on strong nationalism-based politics and instead pursued European integration, in Japan. Shintôism has continued to influence feelings of national belonging, making it more difficult to establish a critical dialogue with the past. Further differences are apparent: the Western origin of Japan’s constitution, the conflicting international environment in Japan, the late regime change, differences in education and, most importantly, the impacts of generational change in Germany. The 1968 student generation strongly condemned Nazi aggression and demanded that the older generation face responsibility, which strongly contributed to a reappraisal of the past in the public sphere.