bluuebunny/crossref_metadata_2025_split huggingface dataset:
AVM Management Equipoise Survey: physician opinions regarding the management of brain arteriovenous malformations
Authors: Cockroft Kevin M , Chang Ki-Eun , Lehman Erik B , Harbaugh Robert E 
Published: December 2013

IntroductionManagement of unruptured brain arteriovenous malformations (AVMs) is controversial, and conducting clinical trials in this area has been a challenge. We sought to determine which, if any, patient/AVM characteristics were most likely to influence clinicians’ decisions regarding management and clinical trial enrollment.MethodsWe performed an online survey (Survey Monkey) of members of the American Association of Neurological Surgeons (AANS) (n=4836) and Society of NeuroInterventional Surgeons (SNIS) (n=512). Physicians were asked to rate the likelihood that various patient/AVM characteristics would influence their treatment decisions and recommendations for clinical trial enrollment. 10 hypothetical case vignettes were also provided, and respondents were asked to select a management recommendation.Results277 (5.2%) responses were received. Characteristics that the majority (>50%) of respondents felt should lead to treatment included size <3 cm, superficial or cerebellar location, single draining vein, age <30 years, venous aneurysm, prior AVM hemorrhage, poorly controlled seizures, intranidal aneurysm, and patient's desire for treatment. However, a significant minority (>30%) felt that six of these same characteristics should lead to observation or should not influence treatment decisions. Characteristics that the majority (>50%) of respondents felt should lead to clinical trial enrollment included size > 6cm, deep or eloquent location, and age 51–70 years. The only characteristic that the majority felt should not lead to enrollment was the presence of an intranidal aneurysm. For the 10 vignettes, the majority of respondents (>50%) favored a specific course of management in only five cases.ConclusionsClinicians’ opinions on which patient/AVM characteristics are important for decisions regarding treatment or trial enrollment vary widely. These results suggest that there is no uniform opinion of clinical equipoise with regard to the management of brain AVMs.
Prognosis and management of chronic kidney disease (CKD) at the end of life
Authors: Davison Rachel , Sheerin Neil S 
Published: December 2013

Abstract
The prevalence of chronic kidney disease (CKD) increases with age. As people are living longer, nephrologists are responsible for a progressively older cohort of patients with substantial comorbidities. Patients with CKD have a significant symptom burden and can benefit from intervention and symptom control from an early stage in the illness. It is also increasingly recognised that renal replacement therapy may not always offer an improvement in symptoms or a survival advantage to older patients with high levels of comorbidity. For these reasons, non-dialytic (conservative) management and end-of-life care is becoming part of routine nephrology practice. Such patients will also frequently be encountered in other specialities, requiring generalists to have some renal-specific skills and knowledge. Although there have been significant advances in this field in recent years, the optimum model of care and some of the care preferences of patients remain challenges that need to be addressed.
NF-κB Activation-Induced Anti-apoptosis Renders HER2-Positive Cells Drug Resistant and Accelerates Tumor Growth
Authors: Bailey Shannon T. , Miron Penelope L. , Choi Yoon J. , Kochupurakkal Bose , Maulik Gautam , Rodig Scott. J. , Tian Ruiyang , Foley Kathleen M. , Bowman Teresa , Miron Alexander , Brown Myles , Iglehart J. Dirk. , Biswas Debajit K. 
Published: December 2013

Abstract
Breast cancers with HER2 overexpression are sensitive to drugs targeting the receptor or its kinase activity. HER2-targeting drugs are initially effective against HER2-positive breast cancer, but resistance inevitably occurs. We previously found that NF-κB is hyperactivated in a subset of HER2-positive breast cancer cells and tissue specimens. In this study, we report that constitutively active NF-κB rendered HER2-positive cancer cells resistant to anti-HER2 drugs and cells selected for lapatinib resistance upregulated NF-κB. In both circumstances, cells were antiapoptotic and grew rapidly as xenografts. Lapatinib-resistant cells were refractory to HER2 and NF-κB inhibitors alone but were sensitive to their combination, suggesting a novel therapeutic strategy. A subset of NF-κB–responsive genes was overexpressed in HER2-positive and triple-negative breast cancers, and patients with this NF-κB signature had poor clinical outcome. Anti-HER2 drug resistance may be a consequence of NF-κB activation, and selection for resistance results in NF-κB activation, suggesting that this transcription factor is central to oncogenesis and drug resistance. Clinically, the combined targeting of HER2 and NF-κB suggests a potential treatment paradigm for patients who relapse after anti-HER2 therapy. Patients with these cancers may be treated by simultaneously suppressing HER2 signaling and NF-κB activation.
Implications: The combination of an inhibitor of IκB kinase (IKK) inhibitor and anti-HER2 drugs may be a novel treatment strategy for drug-resistant human breast cancers. Mol Cancer Res; 12(3); 408–20. ©2013 AACR.
Interrogating Congenital Heart Defects With Noninvasive Fetal Echocardiography in a Mouse Forward Genetic Screen
Authors: Liu Xiaoqin , Francis Richard , Kim Andrew J. , Ramirez Ricardo , Chen Guozhen , Subramanian Ramiah , Anderton Shane , Kim Youngsil , Wong Liyin , Morgan Judy , Pratt Herbert C. , Reinholdt Laura , Devine William , Leatherbury Linda , Tobita Kimimasa , Lo Cecilia W. 
Published: December 2013

Background—
Congenital heart disease (CHD) has a multifactorial pathogenesis, but a genetic contribution is indicated by heritability studies. To investigate the spectrum of CHD with a genetic pathogenesis, we conducted a forward genetic screen in inbred mice using fetal echocardiography to recover mutants with CHD. Mice are ideally suited for these studies given that they have the same four-chamber cardiac anatomy that is the substrate for CHD.

Methods and Results—
Ethylnitrosourea mutagenized mice were ultrasound-interrogated by fetal echocardiography using a clinical ultrasound system, and fetuses suspected to have cardiac abnormalities were further interrogated with an ultrahigh-frequency ultrasound biomicroscopy. Scanning of 46 270 fetuses revealed 1722 with cardiac anomalies, with 27.9% dying prenatally. Most of the structural heart defects can be diagnosed using ultrasound biomicroscopy but not with the clinical ultrasound system. Confirmation with analysis by necropsy and histopathology showed excellent diagnostic capability of ultrasound biomicroscopy for most CHDs. Ventricular septal defect was the most common CHD observed, whereas outflow tract and atrioventricular septal defects were the most prevalent complex CHD. Cardiac/visceral organ situs defects were observed at surprisingly high incidence. The rarest CHD found was hypoplastic left heart syndrome, a phenotype never seen in mice previously.

Conclusions—
We developed a high-throughput, 2-tier ultrasound phenotyping strategy for efficient recovery of even rare CHD phenotypes, including the first mouse models of hypoplastic left heart syndrome. Our findings support a genetic pathogenesis for a wide spectrum of CHDs and suggest that the disruption of left–right patterning may play an important role in CHD.
Stability and change in the mental health of New Zealand secondary school students 2007–2012: Results from the national adolescent health surveys
Authors: Fleming Theresa M , Clark Terryann , Denny Simon , Bullen Pat , Crengle Sue , Peiris-John Roshini , Robinson Elizabeth , Rossen Fiona V , Sheridan Janie , Lucassen Mathijs 
Published: December 2013

Objective: To describe the self-reported mental health of New Zealand secondary school students in 2012 and to investigate changes between 2007 and 2012. Methods: Nationally representative health and wellbeing surveys of students were completed in 2007 ( n=9107) and 2012 ( n=8500). Logistic regressions were used to examine the associations between mental health and changes over time. Prevalence data and adjusted odds ratios are presented. Results: In 2012, approximately three-quarters (76.2%, 95% CI 74.8–77.5) of students reported good overall wellbeing. By contrast (also in 2012), some students reported self-harming (24.0%, 95% CI 22.7–25.4), depressive symptoms (12.8%, 95% CI 11.6–13.9), 2 weeks of low mood (31%, 95% CI 29.7–32.5), suicidal ideation (15.7%, 95% 14.5–17.0), and suicide attempts (4.5%, 95% CI 3.8–5.2). Between 2007 and 2012, there appeared to be slight increases in the proportions of students reporting an episode of low mood (OR 1.14, 95% CI 1.06–1.23, p=0.0009), depressive symptoms (OR 1.16, 95% CI 1.03–1.30, p=0.011), and using the Strengths and Difficulties Questionnaire - emotional symptoms (OR 1.38, 95% CI 1.23–1.54, p<0.0001), hyperactivity (OR 1.16, 95% CI 1.05–1.29, p=0.0051), and peer problems (OR 1.27, 95% CI 1.09–1.49, p=0.0022). The proportion of students aged 16 years or older reporting self-harm increased slightly between surveys, but there was little change for students aged 15 years or less (OR 1.29, 95% CI 1.15–1.44 and OR 1.10, 95% 0.98–1.23, respectively, p=0.0078). There were no changes in reported suicidal ideation and suicide attempts between 2007 and 2012. However, there has been an improvement in self-reported conduct problems since 2007 (OR 0.78, 95% CI 0.70–0.87, p<0.0001). Conclusions: The findings suggest a slight decline in aspects of self-reported mental health amongst New Zealand secondary school students between 2007 and 2012. There is a need for ongoing monitoring and for evidence-based, accessible interventions that prevent mental ill health and promote psychological wellbeing.
Development of an emulation method for the performance evaluation of radiant floor heating systems
Authors: Rhee KN , Yeo MS , Kim KW 
Published: December 2013

Since radiant floor heating systems utilise part of the building as a system for controlling the indoor environment, the integrated analysis considering the interaction between the building and the system needs to be conducted for the performance evaluation. Integrated simulation can be applied for this purpose; however, it is somewhat difficult to evaluate the impact of the system hardware such as hydronic circuits and heat sources due to the lack of modeling information. Although the experimental methods can guarantee the most reliable results, they have a limitation on the repetitive comparison due to the restriction of time, space and cost. For this reason, this study presents an emulation method that can mitigate the disadvantage of the simulation as well as experimental methods, especially for the performance evaluation of radiant floor heating systems. To achieve this, the factors to be considered in radiant floor heating systems were examined by reviewing the previous studies on the emulation. This study suggested an emulation method that can physically represent pressure loss in the hydronic circuits and heat output from the floor structure, which are distinguishing features of radiant floor heating systems. With the developed emulation method, this study showed that the control performance and energy consumption of a radiant floor heating system can be investigated. Practical application: This study presents an emulation method to evaluate the energy consumption and control performance of radiant floor heating systems. The proposed emulation method will be able to supplement a pure simulation and to contribute to the development of an evaluation method considering the impact of system hardware on the overall performance of radiant floor heating systems. Therefore, it is expected that the results will be helpful to researchers for indoor environment, heating, ventilating and air conditioning engineers, system manufacturers and those who want to analyse the energy performance of radiant floor heating systems.
Use of the Supraclavicular Artery Island Flap for Reconstruction of Cervicofacial Defects
Authors: Kokot Niels , Mazhar Kashif , Reder Lindsay S. , Peng Grace L. , Sinha Uttam K. 
Published: December 2013

ObjectiveTo describe the supraclavicular artery island (SAI) flap as an alternative flap for reconstruction of cervicofacial defects.Study DesignCase series with chart review.SettingAcademic, tertiary referral center.Subjects and MethodsTwenty‐two patients with defects of the face, temporal bone, and neck were reconstructed with an SAI flap. Each defect was deemed unsuitable for primary or local flap closure and would require regional or free tissue transfer. Outcome measures included size and location of the defect, time to raise the flap, flap size and viability, and complications. Mean follow‐up was 7.4 months (range, 1‐31 months). Statistical analysis was performed using SAS 9.1 (SAS Institute, Cary, North Carolina).ResultsDefects of the cervical skin (n = 10), face (n = 8), and temporal bone (n = 4) were reconstructed. Mean flap dimensions were 6.1 cm (range, 5‐7 cm) wide and 21.8 cm (range, 16‐28 cm) long. The proximal portion of the flap was deepithelialized to match the defect, resulting in a mean skin paddle length of 9.6 cm (range, 5‐18 cm). Minor donor site dehiscence occurred in 3 patients. Partial skin flap necrosis occurred in 2 patients, while 1 patient had complete loss of the skin paddle. There was no statistical correlation between flap necrosis and flap length (P =. 3, χ2) or defect location (P =. 13, χ2).ConclusionThe SAI flap is a viable alternative to cervicofacial advancement or microvascular reconstruction of cervicofacial defects in select cases. This flap is reliable, easy to harvest, and versatile, and it provides a good color match for cervicofacial defects.
Clothing Hanger Injuries: Pediatric Head and Neck Traumas in the United States, 2002‐2012
Authors: Walls Andrew , Pierce Matthew , Wang Hongkun , Harley Earl H. 
Published: December 2013

ObjectiveTo discuss pediatric clothing hanger injuries and review the National Electronic Injury Surveillance System to elucidate frequency and promote increased public awareness among pediatric otolaryngologists.Study DesignCross‐sectional analysis of a national database.Study SettingNational Electronic Injury Surveillance System Database.MethodsA retrospective review of the National Electronic Injury Surveillance System provided a nationally weighted sampling estimate of 394 pediatric incident reports involving clothing hangers. Each incident report was analyzed for impalement, facial laceration, and contusion injuries to the mouth, face, and head. In addition, hospital disposition and location of the described incident were also obtained.ResultsUpon review of the National Electronic Injury Surveillance System, incident rates of pediatric oral impalement (95% confidence interval [CI], 0.10‐0.41), facial laceration (95% CI, 0.22‐0.41), and facial abrasion injuries (95% CI, 0.15‐0.44) frequently involved the metal clothing hanger design. In addition, most of the reported injuries occurred within the home and involved lacerations to the oral cavity.ConclusionsThis is the first multiyear, nationally representative study to analyze clothing hanger injuries in the pediatric population. We demonstrate that these injuries occur more frequently than the medical literature currently reports and also elucidate that children are more likely to obtain laceration injuries by metal clothing hangers within the home. Furthermore, we provide a recommendation for standardization of the National Electronic Injury Surveillance System such that product safety analysis may occur and reduce further pediatric incidents.
Intercostal muscle flap and intracostal suture to reduce post-thoracotomy pain
Authors: Sapkota Ranjan , Shrestha Uttam Krishna , Sayami Prakash 
Published: December 2013

Background Thoracotomy is considered to be the most painful surgical access, the main culprit being intercostal nerve injury. Despite the use of many techniques, this remains a major problem, pointing towards prevention as a better strategy. The effect of protecting both the upper and lower intercostal nerves during surgery has attracted many researchers. Method A prospective study spanning 15 months was undertaken in 48 patients randomized to a conventional group ( n = 25) and a study group ( n = 23). Pericostal sutures in the former and intracostal sutures in the latter were used for closure. An intercostal muscle flap was harvested at the start of the operation in the study group only. The groups were comparable in terms of baseline characteristics. With a similar pain protocol, pain scores and analgesic consumption were recorded and analyzed. Results Times for pedicle harvest, intracostal suture, and pericostal suture were 5.2 ± 1.56, 3.65 ± 0.71, and 6.4 ± 1.20 min, respectively, in the study group. Total operative time was similar in both groups. Postoperative pain scores and the overall frequency of pain were consistently lower in the study group. Conclusion these techniques lead to a reduction in the acute and chronic post-thoracotomy pain, without increasing complications.
Elevated hemoglobin A1c is associated with readmission but not complications
Authors: Engoren Milo , Schwann Thomas A , Habib Robert H 
Published: December 2013

Background studies have shown that elevated hemoglobin A1c levels are associated with worse short-term outcomes after cardiac surgery. However, the effect on readmission has not been studied. The primary purpose of this study was to determine the independent effect of hemoglobin A1c level on the readmission rate after cardiac surgery. The secondary purpose was assess its effect on complications and mortality. Methods consecutive patients undergoing coronary artery bypass surgery between April 2007 and August 2010 were divided into 3 groups based on preoperative hemoglobin A1c levels. Outcomes were controlled for demographics, comorbidities, and surgery. Results 300 (34%) patients had normal hemoglobin A1c levels (<6.0%), 305 (35%) had mildly elevated levels (6.0%–6.9%), and 275 (31%) had markedly elevated levels (≥7.0%). Postoperative glucose levels were similar among all 3 hemoglobin A1c groups. Compared to patients with normal hemoglobin A1c levels, those with higher levels were more likely to be readmitted: adjusted odds ratio 2.091 (95% confidence interval: 1.074–4.069, p = 0.036) for hemoglobin A1c 6.1%–6.9%; and adjusted odds ratio 2.089 (95% confidence interval: 1.050–4.155, p = 0.036) for hemoglobin A1c ≥ 7.0. Overall, 381 (43%) patients suffered complications, and hemoglobin A1c levels were similar in those with and without complications (6.8% ± 1.6% vs. 6.9% ± 1.7%, p = 0.837). Mortality was equivalent in all 3 hemoglobin A1c groups. Conclusions elevated preoperative hemoglobin A1c levels are associated with an increased risk of readmission but not complications.
Interobserver variability in the assessment of the clinical severity of superficial venous insufficiency
Authors: Sinabulya Helen , Holmberg A , Blomgren L 
Published: December 2013

Background The clinical class C, of the CEAP classification (Clinical-Etiology-Anatomy-Pathophysiology), is often used when selecting patients for treatment within the national healthcare system. The aim of this study was to test the interobserver reproducibility of C when used in a clinical situation where the decision for reimbursement was made. Methods An unselected series of 78 patients (106 limbs) with varicose veins were examined by three independent surgeons with regard to C of CEAP and whether there was a medical indication for treatment. Interobserver reproducibility was calculated with kappa statistic. Results Total agreement between the three observers for clinical class was obtained in 61% of all cases (κ .55–.68 (95% CI)) and for medical indication in 60% of all cases (κ.35–.57 (95% CI)). Conclusion The reproducibility of C when deciding medical indication for treatment is moderate. This may be due to inherent difficulties in the CEAP, lack of specific training, or the simultaneous assessment of reimbursement that may influence the clinical classification.
Characterizing focal hepatic lesions by free-breathing intravoxel incoherent motion MRI at 3.0 T
Authors: Watanabe Haruo , Kanematsu Masayuki , Goshima Satoshi , Kajita Kimihiro , Kawada Hiroshi , Noda Yoshifumi , Tatahashi Yukichi , Kawai Nobuyuki , Kondo Hiroshi , Moriyama Noriyuki 
Published: December 2013

Background Diffusion-weighted (DW) imaging is commonly used to distinguish between benign and malignant liver lesions. Purpose To prospectively evaluate the true molecular-diffusion coefficient ( D), perfusion-related diffusion coefficient ( D*), perfusion fraction ( f), and ADC of focal hepatic lesions using a free-breathing intravoxel incoherent motion (IVIM) DW sequence, and to determine if these parameters are useful for characterizing focal hepatic lesions. Material and Methods One hundred and twenty hepatic lesions (34 metastases, 32 hepatocellular carcinoma [HCC], 33 hemangiomas, and 21 liver cysts) in 74 patients were examined. Mean D, D*, f, and ADC values of hepatic lesions were compared among pathologies. ROC curve analyses were performed to assess the performances of D, D*, f, and ADC values for the characterization of liver lesions as benign or malignant. Results The mean D and ADC values of benign lesions were greater than those of malignant lesions ( P < 0.001). Although the mean D and ADC values of liver cysts were greater than those of hemangiomas ( P < 0.001), and these values were not significantly different between metastases and HCCs ( P = 0.99). Area under the ROC curve for ADC values (0.98) was significantly greater ( P = 0.048) than that for D values (0.96) for the differentiation of benign and malignant lesions. Sensitivity and specificity for the detection of malignant lesion were 89% and 98%, respectively, when an ADC cut-off value of 1.40 was applied. Conclusion D and ADC values have more potential for characterizing focal hepatic lesions than D* or f values, and for the differentiation of malignancy and benignity.
Association between severity of knee osteoarthritis and serum and synovial fluid interleukin 17 concentrations
Authors: Chen Biao , Deng Yu , Tan Yang , Qin Jun , Chen Liao-Bin 
Published: December 2013

Objective To determine interleukin (IL)-17 concentrations in serum and synovial fluid from patients with knee osteoarthritis, and evaluate their correlation with disease severity. Methods Serum and synovial fluid were collected from patients with primary knee osteoarthritis; age- and sex-matched healthy control subjects provided serum samples. This study was conducted retrospectively. IL-17 was quantified by enzyme-linked immunosorbent assay. Osteoarthritis severity and grade were assessed using the Lequesne index and Kellgren and Lawrence (KL) grading system, respectively. Results Serum IL-17 concentrations were significantly higher in patients ( n = 98) than in controls ( n = 50). In the patient group, the synovial fluid IL-17 concentration increased significantly with KL grade and was significantly positively correlated with Lequesne index ( r = 0.6232). Conclusions The synovial fluid IL-17 concentration could represent a useful biochemical marker to reflect knee osteoarthritis severity and progression.