bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malignant Otitis Externa: An Asian Perspective on Treatment Outcomes and Prognostic Factors
Authors: Loh Shaun , Loh Woei Shyang 
Published: April 2013

ObjectiveMalignant otitis externa (MOE) is a severe disease with varying outcomes. Despite advances in antibiotic treatment, a significant proportion still succumbs to this disease. We aimed to analyze the effect of clinical factors on prognosis and to review treatment outcomes in our institution.Study DesignCase series with retrospective chart review of MOE cases from 2006 to 2011.SettingDepartment of Otolaryngology–Head and Neck Surgery, National University Hospital, Singapore, a tertiary referral center.Subjects and MethodsPatients with MOE admitted for treatment were studied and divided into 2 outcome groups depending on response to a 6‐week course of intravenous antibiotics. Demographic and disease factors were analyzed with regard to outcome.ResultsNineteen cases were analyzed. Disease resolved in 63.2% after 6 weeks of antibiotics. Mortality was 21.1%. Age, diabetic control, duration of diagnostic delay, cranial nerve involvement, and inflammatory markers were not found to predict prognosis. Erythrocyte sedimentation rate and C‐reactive protein levels correlated with disease activity and can be used to monitor progress. Clival involvement was associated with persistent disease (P =. 002). Only 63.2% of cases had positive cultures. Pseudomonas aeruginosa was the main organism, and 33.3% of isolates were multidrug resistant. Outcome was not different in cases where culture‐directed therapy was employed vs those where empirical ceftazidime and fluoroquinolone were used (P =. 650).ConclusionMalignant otitis externa remains an insidious disease with significant mortality. Involvement of the clivus portends a poorer prognosis. Combination therapy with intravenous ceftazidime and oral fluoroquinolone remains relevant despite concerns of culture‐negative cases and multidrug‐resistant Pseudomonas.
In vitro Evaluation of Sialyl Lewis X Relationship with Head and Neck Cancer Stem Cells
Authors: Czerwinski Michael J. , Desiderio Vincenzo , Shkeir Omar , Papagerakis Petros , Lapadatescu Martian C. , Owen John H. , Athanassiou‐Papaefthymiou Maria , Zheng Li , Papaccio Gianpaolo , Prince Mark E. , Papagerakis Silvana 
Published: April 2013

ObjectiveTo evaluate in vitro the potential links between sialyl Lewis X (sLeX) and cancer stem cells (CSC) in head and neck squamous cell carcinoma (HNSCC). HNSCC is an aggressive malignancy with high mortality mainly due to metastasis. CSC have emerged as important players in HNSCC metastasis. sLeX is a tetrasaccharide carbohydrate known to play a key role in metastatic dissemination by promoting binding of the tumor cells to the endothelium.Study DesignExperimental, in vitro.SettingLaboratory of Head and Neck Cancer Metastasis, University of Michigan.Subjects and MethodsA panel of stage‐ and anatomic‐site specific primary and metastatic HNSCC cell lines was assessed by flow cytometry to quantify sLeX relative expression levels. Serum‐free conditioned media from the same HNSCC lines was collected over a time course of 72 hours and assessed by Western blot for secreted sLeX expression. Representative HNSCC cell lines were cultured as floating orospheres (condition that enhance CSC growth) or under normal adherent conditions and characterized by flow cytometry for CSC markers (CD44, aldehyde dehydrogenase [ALDH]) comparatively with sLeX expression.ResultssLeX is predominantly expressed in carcinomas originating from the oral cavity. Secreted sLeX is also found to be high in oral carcinomas and increased over the analyzed time course. Floating orospheres were strongly positive for CD44 and ALDH, confirming CSC enrichment of the orospheres. Tumor cells grown as orospheres are 95% to 100% positive for sLeX compared to 10% to 40% of adherent counterpart.ConclusionThese studies provide the first evidence of sLeX relationship with CSC in HNSCC.
European guidelines for sclerotherapy in chronic venous disorders
Authors: Rabe E , Breu FX , Cavezzi A , Smith P Coleridge , Frullini A , Gillet JL , Guex JJ , Hamel-Desnos C , Kern P , Partsch B , Ramelet AA , Tessari L , Pannier F ,   for the Guideline Group
Published: April 2013

Aim Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy. Methods This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7–10 May 2012 in Mainz. The conference was organized by the German Society of Phlebology. These guidelines review the present state of knowledge as reflected in published medical literature. The regulatory situation of sclerosant drugs differs from country to country but this has not been considered in this document. The recommendations of this guideline are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. Results This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, polidocanol and sodium tetradecyl sulphate. Other sclerosants are not discussed in detail. The guideline gives recommendations concerning indications, contraindications, side-effects, concentrations, volumes, technique and efficacy of liquid and foam sclerotherapy of varicose veins and venous malformations.
Gastroduodenal artery recanalization after transcatheter fibered coil embolization for prevention of hepaticoenteric flow: incidence and predisposing technical factors in 142 patients
Authors: Enriquez Jose , Javadi Sanaz , Murthy Ravi , Ensor Joe , Mahvash Armeen , Abdelsalam Mohamed E , Madoff David C , Wallace Michael J , Avritscher Rony 
Published: April 2013

Background Prophylactic occlusion of extrahepatic vessels prior to radioembolization or chemotherapy infusion is an effective method to prevent gastrointestinal complications. Unfortunately, vascular recanalization can occur. Purpose To retrospectively determine the rate and technical factors associated with gastroduodenal artery (GDA) recanalization after transcatheter occlusion with fibered coils. Material and Methods Patients with hepatic malignancy who underwent fibered coil occlusion of the GDA origin for radioembolization or hepatic arterial chemotherapy infusion with at least one subsequent hepatic angiogram between March 2006 and January 2011 were included. One hundred and forty-two patients (men, 71; women, 71) met study criteria. Hepatic arteriograms were reviewed to determine the frequency of arterial recanalization. Additional parameters included: patients’ demographics, GDA diameter, length of coil pack, distance between GDA origin and most cephalad coil, persistent flow at the conclusion of the initial GDA occlusion procedure, platelet count, and international normalized ratio (INR). Chi-square test and pooled t-test were used to compare the two groups. Prospective multivariate analysis was performed with a logistic regression model. Results Twenty-nine of 142 patients (20.4%) experienced GDA recanalization. The distance between the GDA origin and most cephalad coil was significantly greater in the recanalization group than in the non-recanalization group (9.6 mm vs. 12.6 mm, P = 0.01). A prospective multivariate analysis established that the further the coil was from the origin the more likely the GDA was to recanalize. The two groups did not differ on the basis of any other factors examined. Conclusion GDA origin recanalization after fibered coil occlusion is common. The distance between the GDA origin and most cephalad coil appears to be a predisposing factor for recanalization. Familiarity with this phenomenon is beneficial to reduce the likelihood of gastrointestinal tract complications during hepatic locoregional therapy.
Sigmoid sinus diverticulum and pulsatile tinnitus: analysis of CT scans from 15 cases
Authors: Liu Zhaohui , Chen Chengfang , Wang Zhenchang , Gong Shusheng , Xian Junfang , Wang Yongzhe , Liang Xihong , Ma Xiaobo , Li Yi 
Published: April 2013

Background Although the imaging features of sigmoid sinus diverticulum induced pulsatile tinnitus (PT) have been presented in some extent, detailed imaging findings still have not been systematically evaluated and precise diagnostic radiographic criteria has not been established. Purpose To examine the computed tomography (CT) characteristics of sigmoid sinus diverticulum accompanied with PT. Material and Methods Fifteen PT patients with sigmoid sinus diverticula proven by surgery were recruited after consenting. CT images of 15 patients were obtained and analyzed, including features of diverticula, brain venous systems, integrity of the sigmoid plate, and the degree of temporal bone pneumatization. Results Sigmoid sinus diverticulum was located on the same side of PT in 15 patients. Diverticula originated at the superior curve of the sigmoid sinus in 11 patients and the descending segment of the sigmoid sinus in four patients. Sigmoid sinus diverticula focally eroded into the adjacent mastoid air cells in 12 patients and mastoid cortex in three patients. Among eight patients with unilateral dominant brain venous systems, the diverticula were seen on the dominant side in seven patients and non-dominant side in one patient. In contrast, the other seven patients showed co-dominant brain venous systems, with three presenting diverticula on the right side and four on the left. More notably, dehiscent sigmoid plate on the PT side was demonstrated in all patients. In addition, temporal bone hyper-pneumatization was found in nine patients, good and moderate pneumatization in three patients, respectively. Conclusion Dehiscent sigmoid plate and extensive temporal bone pneumatization are two important imaging characteristics of the PT induced by sigmoid sinus diverticulum.
Non-enhanced MR angiography of renal arteries: comparison with contrast-enhanced MR angiography
Authors: Angeretti MG , Lumia D , Canì A , Barresi M , Cardim L Nocchi , Piacentino F , Maresca AM , Novario R , Genovese EA , Fugazzola C 
Published: April 2013

Background The main causes of renal artery stenosis (RAS) are atherosclerosis and fibromuscular dysplasia. Despite contrast-enhanced magnetic resonance angiography (CE-MRA) being a safe and reliable method for diagnosis of RAS especially in young individuals, recently it has been possible to adopt innovative technologies that do not require paramagnetic contrast agents. Purpose To assess the accuracy of steady-state free-precession (SSFP) non-contrast-enhanced magnetic resonance angiography (NC-MRA) by using a 1.5 T MR scanner for the detection of renal artery stenosis, in comparison with breath-hold CE-MRA as the reference standard. Material and Methods Sixty-three patients (33 men, 30 women) with suspected renovascular hypertension (RVHT) were examined by a 1.5T MR scanner; NC-MRA with an electrocardiography (ECG)-gated SSFP sequence was performed in 58.7% (37/63) of patients; in 41.3% (26/63) of patients a respiratory trigger was used in addition to cardiac gating. CE-MRA, with a three-dimensional gradient echo (3D-GRE) T1-weighted sequence, was performed in all patients within the same session. Maximum intensity projection (MIP) image quality, number of renal arteries, and the presence of stenosis were assessed by two observers (independently for NC-MRA and together for CE-MRA). The agreement between NC-MRA and CE-MRA as well as the inter-observer reproducibility were calculated with Bland-Altman plots. Results MIP image quality was considered better for NC-MRA. NC-MRA identified 143 of 144 (99.3%) arteries detected by CE-MRA (an accessory artery was not identified). Fourteen stenoses were detected by CE-MRA (11 atherosclerotic, 3 dysplastic) with four of 14 (28.5%) significant stenosis. Bland-Altman plot demonstrated an excellent concordance between NC-MRA and CE-MRA; particularly, the reader A evaluated correctly all investigated arteries, while over-estimation of two stenoses occurred for reader B. Regarding NC-MRA, inter-observer agreement was excellent. Conclusion NC-MRA is a valid alternative to CE-MRA for the assessment of renal arteries.
Predicting local recurrence following breast-conserving treatment: parenchymal signal enhancement ratio (SER) around the tumor on preoperative MRI
Authors: Kim Mi Young , Cho Nariya , Koo Hye Ryoung , Yun Bo La , Bae Min Sun , Chie Eui Kyu , Moon Woo Kyung 
Published: April 2013

Background The level of background parenchymal enhancement around tumor is known to be associated with breast cancer risk. However, there is no study investigating predictive power of parenchymal signal enhancement ratio (SER) around tumor for ipsilateral breast tumor recurrence (IBTR). Purpose To investigate whether the breast parenchymal SER around the tumor on preoperative dynamic contrast-enhanced magnetic resonance imaging (MRI) is associated with subsequent IBTR in breast cancer patients who had undergone breast-conserving treatment. Material and Methods Nineteen consecutive women (mean age, 44 years; range, 34–63 years) with breast cancer who developed IBTR following breast-conserving treatment and 114 control women matched for age, as well as T and N stages were included. We compared the clinicopathologic features of the two groups including nuclear grade, histologic grade, hormonal receptor status, human epidermal growth factor receptor-2 (HER-2) status, lymphovascular invasion, negative margin width, use of adjuvant therapy, and parenchymal SER around the tumor on preoperative DCE-MRI. The SER was measured on a slice showing the largest dimension of the tumor. Multivariate conditional logistic regression analysis was used to identify independent factors associated with IBTR. Results In univariate analysis, ER negativity (odds ratio [OR] = 4.7; P = 0.040), PR negativity (OR = 4.0; P = 0.013), HER-2 positivity (OR = 3.6; P = 0.026), and a parenchymal SER greater than 0.53 (OR = 23.3; P = 0.011) were associated with IBTR. In multivariate analysis, ER negativity (OR = 3.8; P = 0.015) and a parenchymal SER greater than 0.53 (OR = 13.2; P = 0.040) on preoperative MRI were independent factors associated with IBTR. Conclusion In addition to ER negativity, a higher parenchymal SER on preoperative MRI was an independent factor associated with subsequent IBTR in patients with breast cancer who had undergone breast-conserving treatment.
Functional Limitations in Older Adults Who Have Cognitive Impairment Without Dementia
Authors: Gure Tanya R. , Langa Kenneth M. , Fisher Gwenith G. , Piette John D. , Plassman Brenda L. 
Published: April 2013

Objective: To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND). Methods: Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents. Results: Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia ( P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%). Conclusions: Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.
Innovation sustainability in challenging health-care contexts: Embedding clinically led change in routine practice
Authors: Martin Graham P , Weaver Simon , Currie Graeme , Finn Rachael , McDonald Ruth 
Published: April 2013

Summary The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change – especially organizational change led ‘bottom-up’ by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities.
Utilizing experience-based co-design to improve the experience of patients accessing emergency departments in New South Wales public hospitals: An evaluation study
Authors: Piper Donella , Iedema Rick , Gray Jane , Verma Raj , Holmes Lee , Manning Nicole 
Published: April 2013

Summary Background This paper presents the findings of three multisite evaluations of Experience-Based Co-design (EBCD) programmes conducted in Emergency Departments (EDs) and associated departments in seven public hospitals in New South Wales, Australia. Method Data for the evaluations were derived from: EBCD documentation provided by the participating sites; interviews with 117 key informants; performance data and the policy and academic literature on EBCD. Results Respondents described EBCD as a successful and sustainable method of improving the individual patient experience and the overall quality of a health service. Demonstrated successes were reported to lead to aspects of the EBCD approach spreading within services. However, like any quality improvement activity, EBCD was not without its challenges. The principal challenge particular to the EBCD projects outlined here was their deployment in ED settings. Because of their ambulant patient populations, these settings made sustaining consumer engagement for the duration of the project problematic and required tailoring EBCD to accommodate consumers’ involvement preferences and constraints. Conclusion The primary strength of EBCD over and above other service development methodologies was reported to be its ability to bring about improvements simultaneously in both the operational efficiency and the inter-personal dynamics of care. However, careful consideration must be given to the constraints inherent in transient patient specialties and what needs to be done to tailor EBCD to suit the particular setting in which it is deployed.
Rituximab treatment for ‘rhupus syndrome’: clinical and power-Doppler ultrasonographic monitoring of response. A longitudinal pilot study
Authors: Piga M , Gabba A , Cauli A , Garau P , Vacca A , Mathieu A 
Published: April 2013

Objective To evaluate the safety and efficacy of rituximab in patients suffering from rhupus unresponsive to therapy with non-biological disease-modifying anti-rheumatic drugs (DMARDs). Methods Six patients fulfilling criteria for both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) and with a DAS28 score >5.1 were enrolled to receive two fortnightly 1000 mg rituximab doses at baseline and after 28 weeks. All patients underwent clinical, laboratory, and power- Doppler (PD) ultrasonographic (US) assessment at baseline and after 14, 28 and 56 weeks. Results A sustained improvement in DAS28, SLEDAI, HAQ, laboratory markers and ultrasound indices together with a significant reduction in the daily dose of prednisone were observed throughout follow-up. Conclusion Rituximab may be a safe and effective therapeutic option in refractory rhupus patients.
A critical analysis of workforce development research use in the transformation of children’s services
Authors: Curran Tillie , Oliver Billie , Benjamin Cathy 
Published: April 2013

Summary This article is based on a study commissioned to find out how agencies providing children’s services in England used workforce development research in the transformation of children’s services. Workforce development research is primarily about how new organisational practices are learnt, embedded and developed. Survey and case study methods provided broad and in-depth data that was mapped against a typology developed to capture a diverse range of research activities. Findings Three cross-cutting themes were identified from the analysis: the involvement of children and young people in workforce development research; the development of reflective practice; and the significance of inter-organisational learning cultures. Workforce development research can contribute to a creative culture of inquiry shaping change processes especially where both practitioners and children and young people are involved. In some specialist areas a lack of engagement was attributed to the demands of complex practice and bureaucracy, but in other similar contexts, learning cultures were evident. Application Accounts of learning cultures producing active concepts of childhood link with ‘new’ childhood studies and contrast with accounts of crisis management informed by individualised models of ‘problem families’ highlighted in critiques of neo-liberal forms of government. The study shows that this opposition is not an inevitable consequence of complex practice or service configuration per se, but is contingent on a range of supporting factors such as partnerships with universities. To strengthen the exponential impact of research use illustrated, a participatory approach to organisational research strategy is advanced.