bluuebunny/crossref_metadata_2025_split huggingface dataset:
High‐grade mucoepidermoid carcinoma of the columella successfully reconstructed using bilateral nasolabial flaps set up in a sandwich shape and an auricular cartilage graft after surgical resection
Authors: Nakamura Yoshiyuki , Nakamura Yasuhiro , Saito Akimasa , Fujisawa Yasuhiro , Kawachi Yasuhiro , Otsuka Fujio 
Published: October 2013

AbstractMucoepidermoid carcinoma (MEC) usually originates from the salivary glands. However, there has been no report on mucoepidermoid carcinoma of the columella. In this study, we report the case of a high‐grade MEC of the columella that was successfully reconstructed after surgical resection with bilateral nasolabial flaps set up in a sandwich shape and an auricular cartilage graft. A 66‐year‐old man presented with a nodule on the columella. Histological findings were suggestive of a high‐grade mucoepidermoid carcinoma. Wide excision was performed, and the defects of the columella and the nasal floor were reconstructed with bilateral nasolabial flaps set up in a sandwich shape and an auricular cartilage graft. The postoperative cosmetic result was good with excellent tissue texture. The reconstructed columella had an appropriate, not bulky, width as well as satisfactory height and depth. This reconstructive technique is particularly useful for correcting the large defect of the columella with nasal septum and/or nasal floor defects.
Combined measurement of multiple acute phase reactants to predict relapse of rheumatoid arthritis
Authors: Lv Fang , Song Li‐Jun , Li Xing‐Fu 
Published: October 2013

AbstractAimAcute phase reactants (APRs), such as serum C‐reactive protein (CRP), ferritin, plasma fibrinogen and platelet count, are common biomarkers used to monitor the status of inflammatory diseases. The aim of this study was to determine whether APRs are predictive markers of relapse in rheumatoid arthritis (RA).MethodWe analyzed forty RA patients in clinical remission (disease activity score [DAS28] < 2.6; baseline [t0]) or with low disease activity (DAS28 score ≤ 3.2; t0). The pre‐existing therapeutic regimens were retained for each patient during a 4‐week study period. APRs and patient characteristics were analyzed for normality of distribution by using the Kolmogorov–Smirnov test and correlations were assessed by Pearson's or Spearman's rank correlation coefficient.ResultsAPR levels were found to be significantly correlated with DAS28 score of RA, and serum CRP was the most strongly correlated APR for both the clinical remission and high disease activity groups. For all APRs, the correlation strength paralleled the increase in disease activity.ConclusionMeasurement of multiple APRs in remission or low disease activity RA patients may predict relapse to active disease, thereby facilitating more timely clinical management and promoting efficacy of therapeutic intervention.
The Distribution of the H‐index Among Academic Emergency Physicians in the United States
Authors: DeLuca Lawrence A. , St. John Alex , Stolz Uwe , Matheson Lincoln , Simpson Allan , Denninghoff Kurt R. 
Published: October 2013

AbstractBackgroundHirsch's h‐index (h) attempts to measure the combined academic impact and productivity of a scientist by counting the number of publications by an author, ranked in descending order by number of citations, until the paper number equals the number of citations. This approach provides a natural number or index of the number of publications and the number of citations per publication. H was first described in physics and was demonstrated to be highly predictive of continued academic activity, including recognized measures of scientific excellence such as membership in the National Academy of Sciences and being a Nobel laureate. Citation rates, research environments, and years of experience all affect h, making any comparisons appropriate only for scientists working in the same field for a similar time period. The authors are unaware of any report describing the distribution of h among academic emergency physicians (AEPs).ObjectivesThe objective was to describe the distribution of h for AEPs and to determine whether Hirsch's demonstration of the h‐index as a predictor of continued scholarly activity among physicists would also apply to AEPs.MethodsAcademic EPs were identified from lists provided on allopathic U.S. emergency medicine (EM) residency program websites. “Harzing's Publish or Perish,” a free program available on the Web that queries Google Scholar, was used to calculate h for each AEP. Agreement between raters was analyzed on a subset of 100 EPs. An analysis of the 20 EPs with the top h‐indices was performed to characterize the entire body of their scholarly work, and their h‐indices were calculated at 12 and 24 years into their careers.ResultsA total of 4,744 AEPs from 136 programs were evaluated. Nine programs did not publicly list the faculty at their institutions and were excluded. A linear weighted kappa was used to measure rater concordance, with agreement of 98.3% and κ = 0.92 (95% confidence interval [CI] = 0.861 to 0.957). The majority of AEPs had h‐indices of zero or one (59%), 85% had h‐indices less than six, 95% less than 13, and 99% less than 24. Ten percent of AEPs had h/(years in publication) of 0.5 or greater. For the top 20 EPs, the mean (± standard deviation [±SD]) h‐index increased from 7.6 (±4.6) to 23.5 (±9.4) between years 12 and 24. The mean (±SD) increase in h‐index was 15.8 (±7.6).ConclusionsThe h‐index can be used to characterize the academic productivity of AEPs. An h/year of 0.5 or greater is characteristic of the most productive EPs and represents only 10% of all AEPs. The 12‐year h‐index of top‐performing EPs was strongly related to their future academic productivity. The distribution of h among EPs may provide a means for individual investigators and academic leaders to evaluate performance and identify EPs with future success in EM research.
Near‐infrared Spectroscopy Assessment of Tissue Saturation of Oxygen in Torsed and Healthy Testes
Authors: Schoenfeld Elizabeth M. , Capraro Geoffrey A. , Blank Fidela S. J. , Coute Ryan A. , Visintainer Paul F. 
Published: October 2013

AbstractObjectivesThe objective was to assess whether testicular torsion is associated with low testicular tissue saturation of oxygen (StO2) as measured by transscrotal near‐infrared spectroscopy (NIRS) and to compare the differences in NIRS values between testicles of the same patient, both in patients with testicular torsion and in healthy controls.MethodsThis was an observational study of healthy controls and patients with surgically confirmed testicular torsion who were recruited from males under 30 years of age presenting to the emergency department (ED). The hypothesis was that the difference in NIRS values for the control's two testicles would be zero, and that the difference between the torsed and healthy testicles on an individual patient would not be zero. Based on animal data, the study was powered to detect an absolute difference of StO2 of 47%.ResultsThe mean StO2 for the left control patients' testicles was 73.6% (95% confidence interval [CI] = 68.0% to 79.1%) and the mean StO2 for the right controls' testicles for controls was 73.6% (95% CI = 66.9% to 80.4%; n = 17). The absolute difference in NIRS StO2 for left minus right for each individual was 3.5% (95% CI = 1.8% to 5.4%), which was significantly different (p = 0.0007), and refuted the hypothesis that there was no significant difference in StO2 between left and right testes in healthy patients. In the testicular torsion group, the torsed side had a mean StO2 of 82.8% (95% CI = 68.7% to 96.9%), and the contralateral nontorsed testes had a mean of 85.8% (95% CI = 72.3% to 99.3%). The mean StO2 difference, nontorsed minus torsed was 3.0% (range = –1% to 9%, 95% CI = –2% to 8%; p = 0.174), refuting the hypothesis that torsed testes would demonstrate significantly lower values for StO2.ConclusionsWhile pilot animal investigations support a potential role for transscrotal NIRS for the detection of testicular torsion, this first clinical translation of animal findings reveals that the investigated, transcutaneous, reflectance geometry NIRS device failed to demonstrate symmetric oxygenation of left and right testes in healthy controls and also failed to demonstrate depressed tissue saturation of oxygen values in patients with confirmed testicular torsion. While limited by a small sample size, other problems such as inability to calibrate depth of measurement of StO2 may have led to falsely elevated readings in patients with torsion.
When Coverage Expands: Children's Health Insurance Program as a Natural Experiment in Use of Health Care Services
Authors: Haggins Adrianne , Patrick Stephen , Demonner Sonya , Davis Matthew M. 
Published: October 2013

AbstractBackgroundExpanding insurance coverage is designed to improve access to primary care and reduce use of emergency department (ED) services. Whether expanding coverage achieves this is of paramount importance as the United States prepares for the Affordable Care Act.ObjectivesEmergency and outpatient department use was examined after the State Children's Health Insurance Program (CHIP) coverage expansion, focusing on adolescents (a major target group for CHIP) versus young adults (not targeted). The hypothesis was that coverage would increase use of outpatient services, and ED use would decrease.MethodsUsing the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), the years 1992–1996 were analyzed as baseline and then compared to use patterns in 1999–2009, after the CHIP launch. Primary outcomes were population‐adjusted annual visits to ED versus nonemergency outpatient settings. Interrupted time series were performed on use rates to ED and outpatient departments between adolescents (11 to 18 years old) and young adults (19 to 29 years old) in the pre‐CHIP and CHIP periods. Outpatient‐to‐ED ratios were calculated and compared across time periods. A stratified analysis by payer and sex was also performed.ResultsThe mean number of outpatient adolescent visits increased by 299 visits per 1,000 persons (95% confidence interval [CI] = 140 to 457), while there was no statistically significant increase in young adult outpatient visits across time periods. There was no statistically significant change in the mean number of adolescent ED visits across time periods, while young adult ED use increased by 48 visits per 1,000 persons (95% CI = 24 to 73). The adolescent outpatient‐to‐ED ratio increased by 1.0 (95% CI = 0.49 to 1.6), while the young adults ratio decreased by 0.53 across time periods (95% CI = –0.90 to –0.16).ConclusionsSince CHIP, adolescent non‐ED outpatient visits have increased, while ED visits have remained unchanged. In comparison to young adults, expanding insurance coverage to adolescents improved use of health care services and suggests a shift to non‐ED settings. Expanding insurance through the Affordable Care Act of 2010 will likely increase use of outpatient services, but may not decrease ED volumes.
A Re‐examination of Analyst Under‐reaction
Authors: Baik Bok , Lee Su Jeong 
Published: October 2013

AbstractPrior studies suggest that analysts under‐react to past information (Klein, ; Abarbanell and Bernard, ; Easterwood and Nutt, ). We examine whether evidence interpreted as analyst under‐reaction to negative news can be attributed to analyst self‐selection. Analyst self‐selection arises when analysts' information production efforts are focused toward stocks that analysts expect to perform well. Using a large sample of firms for the period of 1983–2004, we find evidence suggesting that self‐selection is responsible, at least in part, for analyst under‐reaction to past negative information about the firm's performance.
Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node‐positive bladder cancer who are unfit for or who decline adjuvant chemotherapy
Authors: Zehnder Pascal , Studer Urs E. , Daneshmand Siamak , Birkhäuser Frédéric D. , Skinner Eila C. , Roth Beat , Miranda Gus , Burkhard Fiona C. , Cai Jie , Skinner Donald G. , Thalmann George N. , Gill Inderbir S. 
Published: October 2013

Objective
To analyse the long‐term outcomes of patients with lymph node (LN)‐positive bladder cancer, who did not receive any adjuvant therapy after radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND).
Patients and Methods
We conducted a retrospective, combined cohort analysis based on two prospectively maintained cystectomy databases from the University of Southern California and the University of Bern.
Eligible patients underwent RC with ePLND for cN0M0 disease but were found to have LN‐positive disease.
No patient had neoadjuvant therapy, and all had negative surgical margins.
Kaplan–Meier plots were used to estimate recurrence‐free survival (RFS) and overall survival (OS). Subgroup comparisons were performed using log‐rank tests, and multivariable analysis was based on Cox proportional hazard models.
Results
Of 521 patients with LN‐positive disease, 251 (48%) never received adjuvant therapy. Although the pathological stage distribution was similar, the 251 patients who did not receive adjuvant therapy were older and had both fewer total and positive LNs than those who underwent adjuvant therapy.
The median RFS for patients treated with RC alone was 1.6 years.
Recurrences mainly occurred <2 years after RC, resulting in 5‐ and 10‐year RFS rates of 32 and 26%, respectively.
Pathological T stage, the total number of LNs and the number of positive LNs detected were independent predictors of RFS and OS.
Conclusions
In this study, 25% of patients with documented LN metastases who did not receive adjuvant therapy were cured with RC and ePLND; however, a few relapses may occur later than 3 years.
Predictors of survival were pathological T stage, the number of total LNs and the number of positive LNs identified.
Donor pre‐treatment in clinical kidney transplantation: a critical appraisal
Authors: de Vries Dorottya K. , Wijermars Leonie G. M. , Reinders Marlies E. J. , Lindeman Jan H. N. , Schaapherder Alexander F. M. 
Published: October 2013

AbstractKidney transplantation represents one of the medical achievements of the 20th century. However, its continued success is limited by the increasing shortage of donor grafts. As a result, more kidney grafts from marginal donors are being considered for transplantation, with concomitantly more initial graft injury and limited organ and patient survival. This has led to an increased need for interventions aiming to optimize and preserve graft quality. Interventions within the donor may protect against ischemia/reperfusion injury, and therefore, donor pre‐treatment is a promising strategy to increase graft function and survival. During the last decade, diverse donor pre‐treatment interventions have been explored in animal studies. Moreover, the first human trials concerning donor pre‐treatment in kidney transplantation have provided encouraging results. Unfortunately, it remains difficult to determine how and where to intervene in the multifactorial and complex processes that affect the donor kidney. Moreover, ethical matters play a critical role in donor interventions, and pre‐treatment should principally not have any potentially unfavorable effects on other organs to be transplanted or on the living donor. This review provides an overview of promising therapeutical strategies for donor pre‐treatment in kidney transplantation and discusses the clinical trials that have been conducted thus far.
Stimulating ERK/PI3K/NFκB signaling pathways upon activation of mGluR2/3 restores OGD‐induced impairment in glutamate clearance in astrocytes
Authors: Lin Chia‐Ho , You Jie‐Ru , Wei Kai‐Che , Gean Po‐Wu 
Published: October 2013

AbstractWe used the oxygen and glucose deprivation (OGD) method in cultured astrocytes as anin vitroischemic model. We investigated whether activation of group‐II metabotropic glutamate receptors (mGluR2/3) can reverseOGD‐induced impairment in astrocytic glutamate/aspartate transporter (GLAST) expression and elucidated the signaling pathways involving theGLASTexpression. Cultured astrocytes exposed toOGDfor 6 h resulted in significant reductions in theGLASTexpression and extracellular glutamate clearance. These reductions were effectively restored bymGluR2/3 activation withmGluR2/3 agonists, LY379268 orDCG‐IV, after the 6 hOGDinsult. ThesemGluR2/3‐mediated restorative effects were inhibited by selectivemGluR2/3 antagonists LY341459 orEGLU. ThemGluR2/3 activation also induced activations of signaling pathways including extracellular signal‐regulated kinase (ERK), phosphatidylinositol 3‐kinase (PI3K) and nuclear transcription factor‐κB (NFκB). These activations were prevented by blockingmGluR2/3 with LY341459, anmGluR2/3 antagonist. Furthermore, blockingERK, PI3K and NFκB signaling pathways with U0126, LY294002 and pyrrolidine dithiocarbamate, respectively, significantly inhibited themGluR2/3‐mediated restorative effects. These results suggest that application ofmGluR2/3 agonists afterOGDinsult can effectively reverse theOGD‐reduced expression ofGLASTproteins and restore clearance of extracellular glutamate by serially activating ERK/PI3K/NFκB signaling pathways in cultured astrocytes.
Does periosteal scraping of the third metacarpal bone reduce the incidence of ‘bucked shins’ in young Thoroughbred racehorses?
Authors: Plevin S. , McLellan J. 
Published: October 2013

SummaryReasons for performing studyThe occurrence of bucked shins in young Thoroughbred racehorses in North America is high. Although an altered training regime has demonstrated a significant decrease in this condition, trainers can be opposed to altering something as fundamental as their training routine. Periosteal scraping of the third metacarpal bone (McIII) is a putative prophylactic technique used to prevent bucked shins; therefore, a study to investigate the validity of the procedure is warranted.ObjectivesTo investigate whether prophylactic McIII scraping: 1) reduces the incidence of bucked shins in juvenile Thoroughbred horses at race speeds (breeze); and 2) allows increased cumulative breeze miles before the onset of disease.Study designNonrandomised prospective clinical study.MethodsOne hundred and seventy yearling Thoroughbreds from one farm, under one trainer, were enrolled in this study over one training season; 85 horses were treated and 85 horses were control animals. Horses were observed for bucked shins over 5 cumulative breeze miles. The objectives were evaluated by comparing incidence rates and Kaplan‐Meier plots.ResultsThe incidence rate for bucked shins was 0.059 cases per breezed mile in the treatment group, compared with 0.103 cases per breezed mile in the control group. Comparison of Kaplan‐Meier plots of breeze miles for the 2 groups demonstrated a significant difference between groups (P = 0.035). Horses that developed bucked shins following periosteal shin scraping breezed an average of 3.52 miles before the onset of disease, compared to 2.50 miles for horses not prophylactically treated (P = 0.005).ConclusionsPeriosteal McIII scraping reduced the incidence rate of bucked shins. The procedure allowed treated horses to breeze greater cumulative distances before an incident but failed to prevent the disease over the long term. Further investigation into this commonly used prophylactic technique is required.
Vitiligo and alopecia areata: apples and oranges?
Authors: Harris John E. 
Published: October 2013

AbstractVitiligo and alopecia areata are common autoimmune diseases of the skin. Vitiligo is caused by the destruction of melanocytes and results in the appearance of white patches on any part of the body, while alopecia areata is characterized by patchy hair loss primarily on the scalp, but may also involve other areas as well. At first glance, the two diseases appear to be quite different, targeting different cell types and managed using different treatment approaches. However, the immune cell populations and cytokines that drive each disease are similar, they are closely associated within patients and their family members, and vitiligo and alopecia areata have common genetic risk factors, suggesting that they share a similar pathogenesis. Like apples and oranges, vitiligo and alopecia areata have some obvious differences, but similarities abound. Recognizing both similarities and differences will promote research into the pathogenesis of each disease, as well as the development of new treatments.
Screening colonoscopy in HIV‐infected patients: high rates of mucosal abnormalities in a German HIV‐infected cohort
Authors: Kasapovic A , Boesecke C , Schwarze‐Zander C , Anadol E , Vogel M , Hippe V , Schmitz V , Rockstroh JK , Wasmuth JC 
Published: October 2013

ObjectivesBecause of the improved life expectancy provided by successful antiretroviral combination therapy, preventive health measures in HIV‐infected patients have assumed increasing importance. To date, no data exist on rates of mucosal abnormalities detected by screening colonoscopy in > 50‐year‐old HIV‐infected patients in Germany. The aim of this study was to obtain such data.MethodsA screening colonoscopy was offered to 159 HIV‐infected patients (age > 50 years) who presented for HIV standard of care visits at the infectious diseases out‐patient clinic at the university hospital in Bonn over a 1‐year period from February 2010. Pearson's χ2 test, Fisher's exact test and the Mann−Whitney U‐test were used for statistical analysis.ResultsFifty‐one patients (32.1%) had undergone a screening colonoscopy in the past 10 years, and 45 patients (28.3%) were eventually screened in the observation period. The median age of the 96 screened patients (86% male and 14% female) was 58 years [interquartile range (IQR) 54–64 years]. Overall, endoscopic abnormalities were found in 61% of patients. Histological examination showed tubular adenomas in 21.9% of patients, tubulovillous adenomas in 3.1% and serrated adenomas in 1%. Hyperplastic polyps were found in 15.6% of patients, a nonspecific colitis in 16.7% and diverticulosis in 12.5%. In four cases there was even an early‐stage carcinoma (two anal, one rectal and one colon cancer). In univariate analysis, no significant differences with regard to immune status, highly active antiretroviral therapy, family history, personal risk factors or comedication were found between patients with dysplastic and normal mucosas.ConclusionsThe high acceptance rate of screening colonoscopy and the in comparison with the HIV‐negative population comparably higher rate of abnormalities in this cohort of HIV‐infected patients justify enhanced implementation of screening colonoscopy in clinical practice.