bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracking tumor boundary in MV‐EPID images without implanted markers: A feasibility study
Authors: Zhang Xiaoyong , Homma Noriyasu , Ichiji Kei , Takai Yoshihiro , Yoshizawa Makoto 
Published: April 2015

Purpose:To develop a markerless tracking algorithm to track the tumor boundary in megavoltage (MV)‐electronic portal imaging device (EPID) images for image‐guided radiation therapy.Methods:A level set method (LSM)‐based algorithm is developed to track tumor boundary in EPID image sequences. Given an EPID image sequence, an initial curve is manually specified in the first frame. Driven by a region‐scalable energy fitting function, the initial curve automatically evolves toward the tumor boundary and stops on the desired boundary while the energy function reaches its minimum. For the subsequent frames, the tracking algorithm updates the initial curve by using the tracking result in the previous frame and reuses the LSM to detect the tumor boundary in the subsequent frame so that the tracking processing can be continued without user intervention. The tracking algorithm is tested on three image datasets, including a 4‐D phantom EPID image sequence, four digitally deformable phantom image sequences with different noise levels, and four clinical EPID image sequences acquired in lung cancer treatment. The tracking accuracy is evaluated based on two metrics: centroid localization error (CLE) and volume overlap index (VOI) between the tracking result and the ground truth.Results:For the 4‐D phantom image sequence, the CLE is 0.23 ± 0.20 mm, and VOI is 95.6% ± 0.2%. For the digital phantom image sequences, the total CLE and VOI are 0.11 ± 0.08 mm and 96.7% ± 0.7%, respectively. In addition, for the clinical EPID image sequences, the proposed algorithm achieves 0.32 ± 0.77 mm in the CLE and 72.1% ± 5.5% in the VOI. These results demonstrate the effectiveness of the authors’ proposed method both in tumor localization and boundary tracking in EPID images. In addition, compared with two existing tracking algorithms, the proposed method achieves a higher accuracy in tumor localization.Conclusions:In this paper, the authors presented a feasibility study of tracking tumor boundary in EPID images by using a LSM‐based algorithm. Experimental results conducted on phantom and clinical EPID images demonstrated the effectiveness of the tracking algorithm for visible tumor target. Compared with previous tracking methods, the authors’ algorithm has the potential to improve the tracking accuracy in radiation therapy. In addition, real‐time tumor boundary information within the irradiation field will be potentially useful for further applications, such as adaptive beam delivery, dose evaluation.
CRISPR Immunity Drives Rapid Phage Genome Evolution in Streptococcus thermophilus
Authors: Paez-Espino David , Sharon Itai , Morovic Wesley , Stahl Buffy , Thomas Brian C. , Barrangou Rodolphe , Banfield Jillian F. 
Published: April 2015

ABSTRACT

Many bacteria rely on CRISPR-Cas systems to provide adaptive immunity against phages, predation by which can shape the ecology and functioning of microbial communities. To characterize the impact of CRISPR immunization on phage genome evolution, we performed long-term bacterium-phage (
Streptococcus thermophilus
-phage 2972) coevolution experiments. We found that in this species, CRISPR immunity drives fixation of single nucleotide polymorphisms that accumulate exclusively in phage genome regions targeted by CRISPR. Mutation rates in phage genomes highly exceed those of the host. The presence of multiple phages increased phage persistence by enabling recombination-based formation of chimeric phage genomes in which sequences heavily targeted by CRISPR were replaced. Collectively, our results establish CRISPR-Cas adaptive immunity as a key driver of phage genome evolution under the conditions studied and highlight the importance of multiple coexisting phages for persistence in natural systems.

IMPORTANCE
Phages remain an enigmatic part of the biosphere. As predators, they challenge the survival of host bacteria and archaea and set off an “arms race” involving host immunization countered by phage mutation. The CRISPR-Cas system is adaptive: by capturing fragments of a phage genome upon exposure, the host is positioned to counteract future infections. To investigate this process, we initiated massive deep-sequencing experiments with a host and infective phage and tracked the coevolution of both populations over hundreds of days. In the present study, we found that CRISPR immunity drives the accumulation of phage genome rearrangements (which enable longer phage survival) and escape mutations, establishing CRISPR as one of the fundamental drivers of phage evolution.
Acupuncture for Melasma in Women: A Systematic Review of Randomised Controlled Trials
Authors: Chai Qianyun , Fei Yutong , Cao Huijuan , Wang Congcong , Tian Jinzhou , Liu Jianping 
Published: April 2015

Background Melasma is a common facial skin disorder seen in women. Manual acupuncture (MA) is widely used alone or in combination with conventional treatments for melasma in China. Objectives To assess the effectiveness and safety of MA for melasma, and explore the range of treatments applied. Methods Six databases were searched systematically for randomised controlled trials (RCTs) on acupuncture for melasma in women up to November 2014. RevMan software was used for data analysis. The Cochrane tool of Risk of Bias was used to assess the methodological quality of the RCTs. Results Eight RCTs involving 587 women were included. Seven studies used the encircling needling method, four studies used the quick needling method and four studies used intensive needle manipulations. Five studies provided individualised acupuncture treatments. Points used with highest frequency were SP6, ST36 and SP10. MA was compared with oral tranexamic acid, vitamin C and E, vitamin C and tamoxifen, topical 20% azelaic acid, hydroquinone, vitamin A and no treatment. Studies were too heterogeneous to conduct a meta-analysis. For global outcome measures, seven trials showed that MA groups were significantly better than the conventional treatments either with a better cure rate or with a better combined cure rate and markedly effective rate, and one trial did not (MA vs vitamin A). No acupuncture-related adverse events were reported. Conclusions MA appeared to be beneficial and safe for women with melasma, but insufficient evidence was found to reach conclusions. The encircling needling method, the quick needling method, intensive needle manipulations and individualised points’ selection were widely used. Well-designed trials are required. Trial Registration Number PROSPERO Systematic review registration: CRD42013006396.
The lifetime cost to English students of borrowing to invest in a medical degree: a gender comparison using data from the Office for National Statistics
Authors: Ercolani Marco G , Vohra Ravinder S , Carmichael Fiona , Mangat Karanjit , Alderson Derek 
Published: April 2015

ObjectiveTo evaluate this impact on male and female English medical graduates by estimating the total time and amount repaid on loans taken out with the UK's Student Loans Company (SLC).SettingUK.Participants4286 respondents with a medical degree in the Labour Force Surveys administered by the Office for National Statistics (ONS) between 1997 and 2014.OutcomesAge-salary profiles were generated to estimate the repayment profiles for different levels of initial graduate debt.Results2195 female and 2149 male medical graduates were interviewed by the ONS. Those working full-time (73.1% females and 96.1% males) were analysed in greater depth. Following standardisation to 2014 prices, average full-time male graduates earned up to 35% more than females by the age of 55. The initial graduate debt from tuition fees alone amounts to £39 945.69. Owing to interest charges on this debt the average full-time male graduate repays £57 303 over 20 years, while the average female earns less and so repays £61 809 over 26 years. When additional SLC loans are required for maintenance, the initial graduate debt can be as high as £81 916 and, as SLC debt is written off 30 years after graduation, the average female repays £75 786 while the average male repays £110 644.ConclusionsMedical graduates on an average salary are unlikely to repay their SLC debt in full. This is a consequence of higher university fees and as SLC debt is written off 30 years after graduation. This results in the average female graduate repaying more when debt is low, but a lower amount when debt is high compared to male graduates.
Targeting Wnts at the Source—New Mechanisms, New Biomarkers, New Drugs
Authors: Madan Babita , Virshup David M. 
Published: April 2015

AbstractWnt signaling is dysregulated in many cancers and is therefore an attractive therapeutic target. The focus of drug development has recently shifted away from downstream inhibitors of β-catenin. Active inhibitors of Wnt secretion and Wnt/receptor interactions have been developed that are now entering clinical trials. Such agents include inhibitors of Wnt secretion, as well as recombinant proteins that minimize Wnt–Frizzled interactions. These new therapies arrive together with the recent insight that cancer-specific upregulation of Wnt receptors at the cell surface regulates cellular sensitivity to Wnts. Loss-of-function mutations in RNF43 or ZNRF3 and gain-of-function chromosome translocations involving RSPO2 and RSPO3 are surprisingly common and markedly increase Wnt/β-catenin signaling in response to secreted Wnts. These mutations may be predictive biomarkers to select patients responsive to newly developed upstream Wnt inhibitors. Mol Cancer Ther; 14(5); 1087–94. ©2015 AACR.
Cerebral Computed Tomography-Graded White Matter Lesions Are Associated With Worse Outcome After Thrombolysis in Patients With Stroke
Authors: Curtze Sami , Melkas Susanna , Sibolt Gerli , Haapaniemi Elena , Mustanoja Satu , Putaala Jukka , Sairanen Tiina , Tiainen Marjaana , Tatlisumak Turgut , Strbian Daniel 
Published: April 2015

Background and Purpose—
Compared with other stroke causes, small-vessel disease is associated with better 3-month outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. Another question is the impact of coexisting cerebral white matter lesions (WMLs; a surrogate marker of small-vessel disease) on outcome, which was addressed in the current study.

Methods—
We analyzed 2485 consecutive intravenous thrombolysis–treated patients at the Helsinki University Central Hospital, 2001 to 2014. WMLs were scored according to 4 previously published computed tomographic visual rating scales from all baseline head scans. The inter-rater agreement was calculated. The primary outcome measure was shift analysis, and the secondary examined all possible binary cutoffs in the modified Rankin Scale at 3 months. The associations of modified Rankin Scale with nominal, ordinal, and continuous variables were analyzed in univariate and adjusted in multivariate binary and ordinal regression (shift analysis) models.

Results—
In univariate and multivariate regression analyses, all 4 tested visual WML rating scales (as continuous variables, or dichotomized at different cutoff points) were associated with worse outcome at all binary levels and in shift analyses of the modified Rankin Scale. After adjusting for confounders, the statistically strongest association in shift analyses remained for the Blennow scale dichotomized at >3 points, reflecting at least moderate WMLs (odds ratio, 1.90; 95% confidence interval, 1.48–2.44).

Conclusions—
WMLs on admission computed tomographic scan are independently associated with worse outcome in intravenous thrombolysis–treated patients with stroke.
Place of Care at End of Life
Authors: Loh Alvona Zi Hui , Tan Julia Shi Yu , Jinxuan Tan , Lyn Teo Yi , Krishna Lalit Kumar Radha , Goh Cynthia Ruth 
Published: April 2015

Background: Few Asian studies have elucidated factors influencing patients and their family members on their preferred place of care at the end of life. This pilot study describes the perceptions of Singaporean patients with cancer and their family members that affect their choices in place of care. Methodology: Patients with cancer and their family members were surveyed at a tertiary hospital in Singapore. This convenience sample was recruited from April to July 2012. Results: Fourteen pairs of patients and their family members (N = 28) were recruited. A majority of patients (64.3%) and family members (71.4%) were found to have a preferred place of care at the end of life. Of the respondents who expressed a preference (n = 19), 88.9% of patients and 90.0% of family members named “home” as their preferred place of care. Quality of care at home was rated “good” or “excellent” by all patients and 85.7% of family members. Conclusion: Home is the most favored choice among patients and family members who have a preferred place of care.
Spettroscopia protonica in vivo nello studio della sclerosi laterale amiotrofica
Authors: Sarchielli P. , Tarducci R. , Presciutti O. , Vicinanza F. , Guercini G. , Pelliccioli G.P. , Gobbi G. , Gallai V. 
Published: April 2015

Il presente studio è stato volto a verificare le modificazioni di alcuni metaboliti cerebrali in corso di SLA mediante RM spettroscopica cerebrale e quantificazione assoluta dei metaboliti. Sono stati studiati 12 pazienti affetti da sclerosi laterale amiotrofica, di sesso maschile ed età media: 53,0 ± 5,32 anni, 7 nella forma definita e 5 nella forma probabile. Lo studio ha evidenziato, a livello della sostanza grigia dell'area motoria primaria, una riduzione significativa dei livelli di N-Acetil-Aspartato rispetto ai soggetti di controllo (8,5 ± 0,6 mM vs 10,4 ± 0,7 mM, p< 0,001), più marcata nei pazienti ad esordio bulbare ed in quelli con evidenze neuroradiologiche di ipointensità di segnale a carico della corteccia motoria. Non erano evidenti differenze significative relativamente ai valori di N-Acetil-Aspartato tra pazienti con diagnosi definita e quelli con forma probabile.
L'impiego della maschera laringea in anestesia pediatrica per RM
Authors: Febi G. , Arcidiacono G. , Marchesi P. , Tosetti M. , Battini R. 
Published: April 2015

Per eseguire un esame di risonanza magnetica (RM) in età pediatrica è necessario “sedare” in sicurezza il bambino per garantirne durante le scansioni I'immobilità e l'omeostasi delle funzioni vitali. Nella ricerca di una metodica che riassumesse caratteristiche di invasività minima, scarsa produzione di inquinamento ambientale e che consentisse un esatto e costante controllo del livello di anestesia e della pervietà delle vie aeree, siamo giunti all'utilizzo della maschera laringea (LMA) abbinato ad anestesia generale inalatoria in respiro spontaneo. In un periodo di 18 mesi 482 bambini non premedicati di classe ASA I-III (5,5 + 4,3 aa; range 1 giorno − 18 aa) affetti da patologie del SNC sono stati sottoposti in sequenza ad anestesia inalatoria con LMA per eseguire una RM cerebrale. Utilizzando un circuito Mapleson “F” modificato allungando le branche inspiratoria ed espiratoria e collegando quest'ultima ad un sistema di aspirazione “Venturi”, l'anestesia veniva indotta, in presenza di un genitore, facendo respirare al bambino alotano a concentrazioni rapidamente crescenti in una miscela gassosa di ossigeno e protossido d'azoto al 50%. Alla scomparsa del riflesso ciliare il. genitore poteva allontanarsi, si provvedeva ad incannulare una vena periferica e quindi si introduceva una maschera laringea di misura appropriata. Utilizzando un monitor amagnetico compatibile con gli alti campi magnetici presenti, si provvedeva quindi a monitorare la saturazione trans-cutanea dell'ossigeno (Sa02), l'ECG, la PA non invasiva, la pressione parziale della C02 di fine espirazione (EtPC02) e la concentrazione sia dell'alogenato che dei gas respirati. Si posizionava poi il bambino all'interno del magnete continuando l'anestesia in respiro spontaneo con alotano a 1,5 della sua concentrazione minima alveolare inibente (MAC) in miscela gassosa di ossigeno ed aria, con un flusso respiratorio minimo di 300 ml/Kg/min. Circa alla metà della durata dell'esame la concentrazione dell'alogenato veniva diminuita a circa 1,0 MAC. Al termine dell'esame si sospendeva l'erogazione dell'alogenato togliendo la maschera laringea alla comparsa dei primi riflessi delle vie aeree superiori. Il piccolo veniva poi adagiato su un lettino di un'altra stanza dove si risvegliava accanto allo stesso genitore che aveva precedentemente assistito all'induzione. In tutta l'esperienza descritta, sia durante l'induzione, che nel periodo intraesame, come al risveglio, non sono stati registrati casi rilevanti di desaturazione, ipotensione, bradicardie, aritmie, convulsioni o altri incidenti clinicamente significativi. Non si è mai constatato rigurgito gastro-esofageo. Questo lavoro durato quasi due anni ci porta senz'altro a concludere che l'utilizzo della LMA con anestesia inalatoria in respiro spontaneo per il paziente in età pediatrica in risonanza magnetica, comporta ottimi risultati in fatto di sicurezza ed efficacia anestesiologica.
Microadenomi ipofisari: Aspetti RM
Authors: Calabrò F. , Michelozzi G. , Schiavoni S. , Schizzi R. , Rovere G. , Capellini C. 
Published: April 2015

La RM per le sue caratteristiche specifiche ed uniche ha sostituito la TC nello studio della patologia ipofisaria in genere e dei microadenomi in particolare. La RM consente infatti nella pressoche totalità dei casi di accertare la presenza di un microadenoma di cui inoltre ne consente un agevole monitoraggio in corso di terapia medica e dopo terapia chirurgica. La diagnostica RM dei microadenomi si avvale dell'impiego combinato di sequenze T2 e T1 prima e dopo mdc e di sequenze dinamiche in corso di iniezione di mdc: l'accertamento di microadenoma è in funzione della presenza di segni RM diretti ed indiretti. Nei rari casi per i quali la diagnostica RM non consente una diagnosi sicura e specie se esiste il sospetto di adenomi a secrezione ACTH è indicato il ricorso al cateterismo dei seni petrosi. La TC potrebbe essere utilizzata esclusivamente nei casi che per differenti ragioni non possono giovarsi dell'impiego della RM.
Patologia traumatica del massiccio facciale superiore e dell'orbita
Authors: Arcuri T. , Calabrò F. , Delucchi S. , Tartaglione A. , Capellini C. 
Published: April 2015

Le lesioni del massiccio facciale superiore sono di frequente riscontro nell'ambito della patologia traumatica craniofacciale; esse si presentano con aspetti e localizzazioni molto varie ed assai spesso combinate tra di loro. La tomografia computerizzata è ormai l'esame di elezione nello studio di tale patologia in quanto fornisce informazioni di grande precisione anatomica sia per quanto riguarda le fratture ossee (di cui permette l'evidenziazione di spostamenti di frammenti anche di piccole dimensioni), che, soprattutto, per le lesioni dei tessuti molli in particolare a livello endoorbitario. Tale sensibilità della TC in particolare nella fase acuta del trauma, viene esaltata dalla possibilità di ottenere immagini ricostruite nei vari piani dello spazio con acquisizioni di tipo volumetrico. L'uso della risonanza magnetica è limitato alla valutazione delle complicanze quali le lesioni intrinseche del nervo ottico o nella diagnostica della rinoliquorrea postraumatica.
L'endoscopia stereotassica nel trattamento multimodale del craniofaringioma cistico
Authors: Nicolato A. , Zanotti B. , Rosta M.L. , Foroni R. , Pellegrino M. , Bricolo A. , Gerosa M. 
Published: April 2015

Viene descritta la nostra preliminare esperienza nel trattamento di sei pazienti con craniofaringioma cistico associato o meno a componente solida, per mezzo dell'adozione di un approccio stereotattico multimodale, che comprende l'endoscopia, il posizionamento di un sistema di Ommaya, la somministrazione intracavitaria di Bleomicina e il trattamento stereotattico con Gamma-Knife sul nodulo solido o sul residuo della cisti. Per quanto è a nostra conoscenza questa è la prima descrizione di un trattamento multimodale stereotattico del craniofaringioma. Tale approccio include l'uso della tecnica endoscopica per la fenestrazione della cisti dei possibili setti intracavitari, la somministrazione di chemioterapia intracavitaria con Bleomicina (preferita alla radioterapia intracavitaria per i suoi più modesti effetti collaterali) e la radio chirurgia con Gamma-Knife sulla componente solida (se inferiore a 10 cc) o sul residuo solido della cisti dopo il trattamento con Bleomicina allo scopo di prevenire le frequenti recidive a medio termine. I risultati preliminari di questo approccio originale sono incoraggianti e permettono un eccellente controllo della crescita tumorale (100% dei casi trattati) senza al momento, mortalità o morbidità postoperatoria. Le procedure eseguite sono risultate ben tollerate, senza importanti effetti collaterali.
Microdiscectomia Endoscopica
Authors: Cervellini P. , Curri D. , De Luca G.P. , Colombo E. , Brayda-Bruno M. , Lepori P. 
Published: April 2015

L'approccio percutaneo alla discectomia lombare rimane tuttore piuttosto controverso. Una nuova tecnica percutanea, descritta nel ′97 da Foley e Smith, la Microdiscectomia Endoscopica (MED), permette non solo di trattare le ernie discali lombari contenute, ma anche le patologie discali con frammenti liberi. Riportiamo in questo lavoro la nostra eperienza in 48 pazienti, operati con tale approccio, presso la Neurochirurgia di Vicenza dal 1998. La tecnica si è dimostrata veramente efficace; i risultati sono stati buoni in tutti i casi; vi è stata una sola complicanza intraoperatoria, senza conseguenze per il paziente. Questi casi sono parte di uno studio multicentrico italiano, che attualmente si avvale di un'eperienza di più di 100 casi.
Post-Gadolinium Evaluation of Intracranial Tumours: A Comparative Study of Spin Echo, Fast Spin Echo, Gradient Echo T1-Weighted Sequences, with and without Magnetization Transfer
Authors: Aprile I. , Lavaroni A. , Scott C.A. , Budai R. , Beltrami C.A. , Fabris G. 
Published: April 2015

This study compares the use of six different post-gadolinium T1-weighted sequences on intracranial tumours with the aim of evaluating their efficacy in terms of lesion and edema contrast resolution and cortex visualization. Forty-eight intracranial neoplastic lesions were evaluated after contrast media administration by means of the following T1-weighted sequences: Fast Spin-Echo (FSE), Spin-Echo (SE) and Gradient-Echo (GE) with and without Magnetization Transfer (MT) pulse. For each technique tumour/background contrast resolution (T/B CR), oedema/background contrast resolution (E/B CR) and white matter/grey matter contrast resolution (WM/GM CR) were calculated. GE sequences, with and without MT, showed the lowest contrast resolution values for all parameters. FSE MT sequences showed the highest T/B CR values. SE sequences, instead, showed the best E/B and WM/GM CR values. FSE and SE MT values were intermediate between FSE MT and SE sequences. No sequence had high values for all contrast resolution parameters. The sequence with the best T/B CR was the FSE MT, but that with the best anatomic peritumoural edema and cortex definition was SE. Both FSE MT and SE T1-weighted sequences may be acquired to obtain accurate post-gadolinium tumour evaluation.