bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aquablation – image‐guided robot‐assisted waterjet ablation of the prostate: initial clinical experience
Authors: Gilling Peter , Reuther Rana , Kahokehr Arman , Fraundorfer Mark 
Published: October 2015

ObjectiveTo assess the safety and feasibility of aquablation in a first‐in‐man study. Aquablation is a novel minimally invasive water ablation therapy combining image guidance and robotics (AquaBeam®) for the targeted and heat‐free removal of prostatic tissue in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).Patients and MethodsA prospective, non‐randomised, single‐centre trial in men aged 50–80 years with moderate‐to‐severe LUTS was conducted. Under real‐time image‐based ultrasonic guidance, AquaBeam technology enables surgical planning and mapping, and leads to a controlled heat‐free resection of the prostate using a high‐velocity saline stream. Patients were evaluated at 1, 3, and 6 months after aquablation.ResultsIn all, 15 patients were treated with aquablation under general anaesthesia. The mean (range) age was 73 (59–86) years and prostate size was 54 (27–85) mL. A substantial median lobe was present in six of the 15 patients. The mean International Prostate Symptom Score (IPSS) was 23 and the maximum urinary flow rate (Qmax) was 8.4 mL/s at baseline. The mean procedural time was 48 min with a mean aquablation treatment time of 8 min. All procedures were technically successful with no serious or unexpected adverse events (AEs). All but one patient had removal of catheter on day 1, and most of the patients were discharged on the first postoperative day. No patient required a blood transfusion, and postoperative sodium changes were negligible. There were no serious 30‐day AEs. One patient underwent a second aquablation treatment within 90 days of the first procedure. The mean IPSS score statistically improved from 23.1 at baseline to 8.6 at 6 months (P < 0.001) and the Qmax increased from 8.6 mL/s at baseline to 18.6 mL/s at the 6‐month follow‐up (P < 0.001). At 6 months, the mean detrusor pressure at Qmax decreased to 45 cmH20 from 66 cmH20 at baseline (P < 0.05), and the mean prostate size was reduced to 36 mL, a 31% reduction in size vs baseline (P < 0.001). No cases of urinary incontinence or erectile dysfunction were reported.ConclusionsThese preliminary results from this initial study show aquablation of the prostate is technically feasible with a safety profile comparable to other BPH technologies. The combination of surgical mapping by the operating surgeon and the high‐velocity saline provides a promising technique delivering a conformal, quantifiable, and standardised heat‐free ablation of the prostate. Advantages of this technique include reduction in resection time compared with other endoscopic methods, as well as the potential to preserve sexual function.
Successful maintenance on sulphonylurea therapy and low diabetes complication rates in a HNF1A–MODY cohort
Authors: Bacon S. , Kyithar M. P. , Rizvi S. R. , Donnelly E. , McCarthy A. , Burke M. , Colclough K. , Ellard S. , Byrne M. M. 
Published: October 2015

AbstractAimsHNF1A gene mutations are the most common cause of maturity‐onset diabetes of the young (MODY) in the UK. Persons with HNF1A–MODY display sensitivity to sulphonylurea therapy; however, the long‐term efficacy is not established. There is limited literature as to the prevalence of micro‐ and macrovascular complications in this unique cohort. The aim of this study was to determine the natural progression and clinical management of HNF1A–MODY diabetes in a dedicated MODY clinic.MethodsSixty patients with HNF1A–MODY and a cohort of 60 BMI‐, age‐, ethnicity‐ and diabetes duration‐matched patients with Type 1 diabetes mellitus participated in the study. All patients were phenotyped in detail. Clinical follow‐up of the HNF1A–MODY cohort occurred on a bi‐annual basis.ResultsFollowing a genetic diagnosis of MODY, the majority of the cohort treated with sulphonylurea therapy remained insulin independent at 84–month follow‐up (80%). The HbA1c in the HNF1A–MODY group treated with sulphonylurea therapy alone improved significantly over the study period [from 49 (44–63) mmol/mol, 6.6 (6.2–7.9)% to 41 (31–50) mmol/mol, 5.9 (5–6.7)%; P = 0.003]. The rate of retinopathy was significantly lower than that noted in the Type 1 diabetes mellitus group (13.6 vs. 50%; P = 0.0001).There was also a lower rate of microalbuminuria and cardiovascular disease in the HNF1A–MODY group compared with the Type 1 diabetes mellitus group.ConclusionsThis study demonstrates that the majority of patients with HNF1A–MODY can be maintained successfully on sulphonylurea therapy with good glycaemic control. We note a significantly lower rate of micro‐ and macrovascular complications than reported previously. The use of appropriate therapy at early stages of the disorder may decrease the incidence of complications.
Sympathetic activation in cardiovascular disease: evidence, clinical impact and therapeutic implications
Authors: Grassi Guido , Seravalle Gino , Mancia Giuseppe 
Published: October 2015

AbstractBackgroundThe sympathetic nervous exerts a key role in cardiovascular homeostasis control by regulating cardiac output, systemic vascular resistance, heart rate and blood pressure.Materials and methodsData collected during the past 30 years have unequivocally shown that in a considerable number of cardiovascular as well as noncardiovascular disease there is a marked activation of the sympathetic nervous system which exerts in the long‐term period unfavourable haemodynamic, metabolic, cardiovascular and renal effects.ResultsThis paper will review the current knowledge on the alterations in sympathetic function described in cardiovascular disease, with particular focus on hypertension, heart failure and myocardial infarction.ConclusionsThe consequences of the phoenomenon will be discussed together with its therapeutic implications. This will be done by examining the impact of nonpharmacological as well as pharmacological interventions on sympathetic cardiovascular drive. The effects of new invasive approaches, such as carotid baroreceptor stimulation as well as renal nerves ablation, will be also briefly discussed.
Morphological spectrum of neovaginitis in autologous sigmoid transplant patients
Authors: van der Sluis Wouter B , Neefjes‐Borst Eskelina A , Bouman Mark‐Bram , Meijerink Wilhelmus J H J , De Boer Nanne K H , Mullender Margriet G , van Bodegraven Adriaan A 
Published: October 2015

AimsAutologous intestinal grafts are used to (re)create a vagina in selected patients. The risk of diversion colitis is mentioned as a disadvantage, although its prevalence remains unclear. This study aimed to assess the histopathological characteristics of the sigmoid‐derived neovaginal epithelial lining after diverting surgery and correlate these with clinical findings.Methods and resultsBiopsy specimens were obtained from the epithelial lining of the sigmoid‐derived neovagina and remaining rectosigmoid as regular follow‐up from 26 patients with a median age of 22 years (range 19–52) and median postoperative follow‐up of 13 months (range 6–52). Medical history, neovaginal symptoms and sexual activity were documented. An experienced gastrointestinal histopathologist assessed the specimens using a descriptive item‐score, comprising signs of chronic and active inflammation. Inflammatory changes were observed in 21 (80.7%) neovaginal and one (3.8%) rectosigmoid specimens. The neovaginal appearance was characterized by an increase of lymphoid aggregates and lymphoplasmacellular infiltrate. Other common features were the presence of polymorphonuclear neutrophils and Paneth cell metaplasia. Neovaginal discharge was correlated with the presence of inflammatory changes (P = 0.008, Spearman's rho = 0.506).DiscussionAcute and chronic inflammation of the sigmoid‐derived neovagina was commonly observed and consistent with a proposed diagnosis of diversion neovaginitis. Neovaginal discharge correlates with this histopathological entity.
Risk factors for major amputation in hospitalised diabetic foot patients
Authors: Namgoong Sik , Jung Suyoung , Han Seung‐Kyu , Jeong Seong‐Ho , Dhong Eun‐Sang , Kim Woo‐Kyung 
Published: October 2015

AbstractDiabetic foot ulcers are the main cause of non‐traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate‐adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis,GIdisorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels.
How does the post‐fire facultative seeding strategy impact genetic variation and phylogeographical history? The case of Bossiaea ornata (Fabaceae) in a fire‐prone, mediterranean‐climate ecosystem
Authors: Bradbury Donna , Tapper Sarah‐Louise , Coates David , Hankinson Margaret , McArthur Shelley , Byrne Margaret 
Published: October 2015

AbstractAimFire regimes are a significant driver of plant adaptation and evolution, and projected changes under a changing climate will have significant implications for demographic and evolutionary responses of plant populations in fire‐prone regions globally. We tested predictions regarding level and pattern of genetic variation within a model post‐fire facultative seeder, Bossiaea ornata (Fabaceae), that exhibits a combination of both post‐fire resprouting and seeding strategies.LocationFire‐prone forests in the mediterranean‐climate region of south‐western Australia.MethodsWe genotyped individuals with eight microsatellite markers and four non‐coding chloroplast sequence regions to assess population genetic variation and reconstruct phylogeographical history.ResultsExtremely high levels of chloroplast (HD = 0.95) and nuclear (HE = 0.81) diversity were detected. Nuclear population differentiation was weak (FST = 0.06) and chloroplast phylogeographical structure was absent. A significant excess of rare chloroplast haplotypes was detected (D, FS, R2; all P < 0.01), consistent with demographic expansion.Main conclusionsResults suggest that a facultative seeding life‐history affords the benefits of both obligate resprouting and obligate seeding strategies in terms of resistance and resilience to fire. High diversity and low differentiation are likely driven by long generational overlap (resprouter feature), regular post‐fire population supplementation from a persistent soil seed bank (seeder feature) and long‐term stability. Expansion signals may be a feature of species with regular, synchronous post‐fire recruitment from a soil seed bank, rather than evidence of a single range or demographic expansion event, as typically interpreted. The facultative seeding strategy may therefore offer resilience to potential increases in fire frequency under a changing climate in fire‐prone regions.
The antiquity of Cyclocarya paliurus (Juglandaceae) provides new insights into the evolution of relict plants in subtropical China since the late Early Miocene
Authors: Kou Yixuan , Cheng Shanmei , Tian Shuang , Li Bo , Fan Dengmei , Chen Yongjun , Soltis Douglas E. , Soltis Pamela S. , Zhang Zhiyong 
Published: October 2015

AbstractAimThe accumulation of supraspecific lineages in Asia has been linked to climatic changes and tectonic events starting in the Miocene, but few studies have extended the intraspecific history of relict plants in subtropical China back to the Early or Middle Miocene. In this study, we investigate the effects of events from the late Early Miocene onwards on the evolutionary history of a relict plant, Cyclocarya paliurus, in subtropical China.LocationSubtropical China.MethodsSequence variation in two chloroplast intergenic spacers (atpB–rbcL and psbA–trnH) and one nuclear gene (PHYA) was investigated across 57 populations of C. paliurus. Standard population genetic analyses, estimation of the most recent common ancestor of chloroplast haplotypes and diversification rate analyses were carried out, and Bayesian skyline plots were constructed.ResultsThe time to the most recent common ancestor of all 17 chloroplast haplotypes in C. paliurus was 16.69 Ma (95% HPD 8.42–27.86 Ma), which largely coincides with the initial intensification of the Asian monsoon and global climate cooling during the Early to Middle Miocene. Chloroplast lineage diversification started to increase in the early Late Miocene, with peaks at c. 9.6 Ma and c. 3.6 Ma, corresponding temporally to two subsequent intensification events of the Asian monsoon. Bayesian skyline plots of both markers revealed that C. paliurus could have experienced at least two waves of expansion since the middle Pleistocene. The distributions of chlorotypes and clades were both consistent with a multiple‐refugia model but with strong signals of range expansion.Main conclusionsThis study provides a long evolutionary profile of an archaic plant species in subtropical China, dating from the late Early Miocene. Our results suggest that the occurrence of the Asian monsoon and associated tectonic events, as well as Pleistocene climate changes, had a pervasive influence on the phylogeographical structure of plants in subtropical China.
Associations between amount of smoking and alcohol intake and risk of colorectal neoplasm
Authors: Jung Yoon Suk , Jung Hwanseok , Yun Kyung Eun , Ryu Seungho , Chang Yoosoo , Park Dong Il , Choi Kyuyong 
Published: October 2015

AbstractBackground and Aim:Although smoking and alcohol has been linked to an increased risk of colorectal neoplasm (CRN), large‐scale studies to identify dose‐dependent relationship between amount of smoking and alcohol consumption and risk of CRN are rare. We aimed to investigate the risk for CRN according to the amount of smoking and alcohol intake in a large sample of Korean adults.Methods:A cross‐sectional study was performed on 31 714 examinees aged ≥30 years undergoing their first colonoscopy as part of routine preventive health care between 2010 and 2011. Never smokers were compared with six groups of smokers according to smoking amount, and individuals with alcohol intake of ≤ 6.25 g ethanol per day were compared with three groups according to alcohol amount.Results:In adjusted models, the risk of overall CRN increased with increasing amount of smoking (P for trend < 0.001). The adjusted odds ratios for overall CRN comparing never smokers with six smoker groups according to smoking amount (≤2.50, 2.51–5.60, 5.61–9.00, 9.01–13.00, 13.01–19.50, and ≥19.51 pack‐years) were 1.02, 1.19, 1.35, 1.53, 1.63, and 2.03, respectively. In addition, the risk of both non‐advanced and advanced CRN increased with increasing amount of smoking (both P for trend < 0.001). However, the amount of alcohol consumption was not correlated with the risk of CRN.Conclusions:The prevalence of CRN was associated with increasing amount of smoking in a dose–response manner, whereas it was not associated with the amount of alcohol consumption. Our study suggests that smoking amount as well as smoking status should be considered for CRN risk stratification.
Long‐term efficacy of Peg‐Interferon/Ribavirin with and without Lamivudine therapy for HBeAg‐positive hepatitis B and C dual infection
Authors: Yeh Ming‐Lun , Hsieh Ming‐Yen , Huang Ching‐I , Huang Chung‐Feng , Hsieh Meng‐Hsuan , Huang Jee‐Fu , Dai Chia‐Yen , Chuang Wan‐Long , Yu Ming‐Lung 
Published: October 2015

AbstractBackground:The optimal therapeutic strategy for hepatitis B virus (HBV) e antigen (HBeAg)‐seropositive and hepatitis C virus (HCV) dually infected patients remains unknown. We aimed to elucidate the effectiveness of peginterferon (Peg‐IFN)/ribavirin (RBV) with and without lamivudine (LAM) combination therapy in the clinical settings.Patients and Methods:Nine patients seropositive for HBV surface antigen, HBeAg, antibodies to HCV and HCV RNA for >6 months were treated with Peg‐IFN/RBV with (n = 5) and without (n = 4) a 12‐month LAM add‐on therapy at treatment week 12. The treatment duration of Peg‐IFN/RBV was 24 weeks (HCV genotype 1 [HCV‐1] with rapid virological response [RVR] or HCV‐2) or 48 weeks (HCV‐1 without RVR). Primary endpoints included HBeAg loss and HCV‐sustained virological response (SVR).Results:All of the nine patients had undetectable HCV RNA at treatment weeks 4 and 12 and end‐of‐Peg‐IFN/RBV therapy. However, SVR was achieved in 100% of patients treated with triple therapy, compared with only 50% in those with Peg‐IFN/RBV therapy (P = 0.167). The 3‐year durability of HCV SVR was 100%. HBeAg loss and HBV DNA <2000 IU/mL at 6 months post‐LAM treatment were found in 100% and 40% of patients treated with triple therapy, compared with none of the four patients with Peg‐IFN/RBV therapy achieved any HBV responses. Of the five patients with triple therapy, four had persistent HBeAg loss during 3‐year follow‐up period; one developed HBeAg seroreversion 15 months after treatment.Conclusion:For HBeAg‐positive HBV/HCV dually infected patients, Peg‐IFN/RBV was effective for HCV eradication. Add‐on LAM might promote HBeAg loss in the clinical setting.
Endoscopic wire‐guided papillectomy versus conventional papillectomy for ampullary tumors: A prospective comparative pilot study
Authors: Lee Tae Yoon , Cheon Young Koog , Shim Chan Sup , Choi Hyun Jong , Moon Jong Ho , Choi Jung Sik , Oh Hyoung‐Chul 
Published: October 2015

AbstractBackground and Aim:A major concern about endoscopic snare papillectomy (ESP) is the risk of procedure‐related pancreatitis. To maintain pancreatic duct access for stent placement after ESP, wire‐guided ESP (WP) was introduced. The aim of the study was to compare post‐procedure pancreatitis rates, the success rate of pancreatic stent insertion, and complete resection rates between WP and conventional ESP (CP) procedures.Methods:This was a multi‐center, prospective, randomized pilot study. Forty‐five patients with ampullary tumors were randomly assigned to a WP group (n = 22) or a CP group (n = 23). In the WP group, a guidewire was placed in the pancreatic duct prior to ESP. A 5‐Fr pancreatic stent was passed over the guidewire and placed across the pancreatic duct orifice.Results:Complete resection was achieved in 20 patients (91%) in the WP group and 18 patients (78%) in the CP group (P = 0.414). A pancreatic stent was placed successfully in all patients in the WP group but in only 15 patients (65%) in the CP group (P = 0.004). Post‐papillectomy pancreatitis occurred in four (18%) patients in the WP and three (13%) patients in the CP groups (P = 0.960). In the CP group, three of eight (37.5%) patients without stents developed pancreatitis compared with zero of 15 patients with stents (P = 0.032).Conclusions:The WP method is a useful technique used to insert a pancreatic stent after ESP, compared with CP. However, there was no significant difference in the post‐procedure pancreatitis or complete resection rates between the two methods.
The small leucine‐rich repeat proteoglycans in tissue repair and atherosclerosis
Authors: Hultgårdh‐Nilsson A. , Borén J. , Chakravarti S. 
Published: October 2015

AbstractProteoglycans consist of a protein core with one or more covalently attached glycosaminoglycan (GAG) side chains and have multiple roles in the initiation and progression of atherosclerosis. Here we discuss the potential and known functions of a group of small leucine‐rich repeat proteoglycans (SLRPs) in atherosclerosis. We focus on five SLRPs, decorin, biglycan, lumican, fibromodulin and PRELP, because these have been detected in atherosclerotic plaques or demonstrated to have a role in animal models of atherosclerosis. Decorin and biglycan are modified post‐translationally by substitution with chondroitin/dermatan sulphate GAGs, whereas lumican, fibromodulin and PRELP have keratan sulphate side chains, and the core proteins have leucine‐rich repeat (LRR) motifs that are characteristic of the LRR superfamily. The chondroitin/dermatan sulphate GAG side chains have been implicated in lipid retention in atherosclerosis. The core proteins are discussed here in the context of (i) interactions with collagens and their implications in tissue integrity, fibrosis and wound repair and (ii) interactions with growth factors, cytokines, pathogen‐associated molecular patterns and cell surface receptors that impact normal physiology and disease processes such as inflammation, innate immune responses and wound healing (i.e. processes that are all important in plaque development and progression). Thus, studies of these SLRPs in the context of wound healing are providing clues about their functions in early stages of atherosclerosis to plaque vulnerability and cardiovascular disease at later stages. Understanding of signal transduction pathways regulated by the core protein interactions is leading to novel roles and therapeutic potential for these proteins in wound repair and atherosclerosis.
Exploring the past, present and future of care home medicine management systems: pharmacists' perceptions of multicompartment compliance aids
Authors: Gilmartin Julia Fiona-Maree , Jani Yogini , Smith Felicity 
Published: October 2015

Abstract

Objectives
Medicines maintain and improve care home (CH) residents' health and therefore, it is imperative that CH medicine management systems are regularly evaluated to ensure they continually provide a high standard of care. Multicompartment compliance aid (MCA) medicine management systems are often used to assist United Kingdom CH staff with managing the large volume of medicines used by residents. This study aimed to identify the factors that led to the widespread adoption of MCAs into United Kingdom CHs, limitations associated with their current use and their relevance in the future.

Method
In June and July 2014 semi-structured interviews were conducted with eight pharmacists who were purposively selected for their expertise in CH medicine management systems in the United Kingdom. A qualitative thematic approach was employed in the analysis of data.

Key findings
Findings indicated that MCAs were introduced into CHs to address unsafe medicine administration practices and because of pharmacy commercial interest. Identified limitations included reduced staff alertness during medicine administration, restricted ability to identify medicines, and medicine wastage. Participants predicted continued use of MCAs in the future due to their perceived benefits of improved safety and efficiency, although some pharmacists recommended that they be removed and CH staff trained to administer medicines from original packaging.

Conclusion
These findings can contribute towards information used by health care providers when deciding on the relevance of MCAs in their current medicine management systems. Additionally, they can contribute towards information used by policy makers when revising United Kingdom CH medicine management guidelines.