bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bouveret’s syndrome: presentation of two cases with review of the literature and development of a surgical treatment strategy
Authors: Nickel Felix , Müller-Eschner Matthias M , Chu Jackson , von Tengg-Kobligk Hendrik , Müller-Stich Beat P 
Published: September 2013

Abstract

Background
Bouveret’s syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. It is a rare condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnostic and treatment strategies are required for optimal management and outcome. The purpose of this paper is to develop a surgical strategy for optimized individual treatment of Bouveret’s syndrome based on the available literature and motivated by our own experience.

Case presentation
Two cases of Bouveret’s syndrome are presented with individual management and restrictive surgical approaches tailored to the condition of the patients and intraoperative findings.

Conclusions
Improved diagnostics and restrictive individual surgical approaches have shown to lower the mortality rates of Bouveret’s syndrome. For optimized outcome of the individual patient: The medical and perioperative management and time of surgery are tailored to the condition of the patient. CT-scan is most often required to secure the diagnosis. The surgical approach includes enterolithotomy alone or in combination with simultaneous or subsequent cholecystectomy and fistula repair. Lower overall morbidity and mortality are in favor of restrictive surgical approaches. The surgical strategy is adapted to the intraoperative findings and to the risk for secondary complications vs. the age and comorbidities of the patient.
Analysis of serum exosomal microRNAs and clinicopathologic features of patients with pancreatic adenocarcinoma
Authors: Que Risheng , Ding Guoping , Chen Jionghuang , Cao Liping 
Published: September 2013

Abstract

Background
Altered expression of serum microRNAs (miRNAs) have been reported to correlate with carcinogenesis and progression of pancreatic adenocarcinoma (PC), but descriptions of serum exosomal miRNAs in PC are still lacking. This study was designed to evaluate serum exosomal miRNA levels in PC patients and to investigate their relationships with clinicopathologic features and prognosis.

Methods
Four miRNAs (miR-17-5p, miR-21, miR-155 and miR-196a) related to PC were selected for examination in our research. Serum miRNA was examined by RT-PCR in a group of 49 patients, including 22 with PCs, 6 with benign pancreatic tumors, 7 with ampullary carcinomas, 6 with chronic pancreatitis and 8 healthy participants. The clinicopathologic data were also collected, and PC patients were classified according to the presence of metastasis, tumor differentiation and advanced stage.

Results
There were low expressions of exosomal miR-155 and miR-196a in serum samples of PC patients when U-6 was used as a control. Serum exosomal miR-17-5p was higher in PC patients than in non–PC patients and healthy participants. High levels of miR-17-5p were significantly correlated with metastasis and advanced stage of PC. The serum exosomal miR-21 level in PC was higher than that in the normal and chronic pancreatitis groups, but was not significantly correlated with PC differentiation and tumor stage.

Conclusions
There were high expressions of serum exosomal miR-17-5p and miR-21 in PC patients. Examination of serum exosomal microRNA is a useful serum biomarker for PC diagnosis other than serum-free microRNA. It is postulated that exosomal miR-17-5p participates in the progression of PC.
Promoting universal financial protection: a policy analysis of universal health coverage in Costa Rica (1940–2000)
Authors: Vargas Juan Rafael , Muiser Jorine 
Published: September 2013

Abstract

Background
This paper explores the implementation and sustenance of universal health coverage (UHC) in Costa Rica, discussing the development of a social security scheme that covered 5% of the population in 1940, to one that finances and provides comprehensive healthcare to the whole population today. The scheme is financed by mandatory, tri-partite social insurance contributions complemented by tax funding to cover the poor.

Methods
The analysis takes a historical perspective and explores the policy process including the key actors and their relative influence in decision-making. Data were collected using qualitative research instruments, including a review of literature, institutional and other documents, and in-depth interviews with key informants.

Results
Key lessons to be learned are: i) population health was high on the political agenda in Costa Rica, in particular before the 1980s when UHC was enacted and the transfer of hospitals to the social security institution took place. Opposition to UHC could therefore be contained through negotiation and implemented incrementally despite the absence of real consensus among the policy elite; ii) since the 1960s, the social security institution has been responsible for UHC in Costa Rica. This institution enjoys financial and managerial autonomy relative to the general government, which has also facilitated the UHC policy implementation process; iii) UHC was simultaneously constructed on three pillars that reciprocally strengthened each other: increasing population coverage, increasing availability of financial resources based on solidarity financing mechanisms, and increasing service coverage, ultimately offering comprehensive health services and the same benefits to every resident in the country; iv) particularly before the 1980s, the fruits of economic growth were structurally invested in health and other universal social policies, in particular education and sanitation. The social security institution became a flagship of Costa Rica’s national development strategy which reinforced its political importance and contributed to its longer-term sustainability and that of UHC.

Conclusions
UHC has been achieved in Costa Rica because it was supported at the highest political level within a favourable socio-economic and political context. Once achieved, UHC became an entitlement for the population and now enjoys broad public support.
Design considerations of conventional angle diversity receivers for indoor optical wireless communications
Authors: Rodríguez Pérez Silvestre , Rodríguez Mendoza Beatriz , Pérez Jiménez Rafael , González Hernández Oswaldo , García-Viera Fernández Alberto 
Published: September 2013

Abstract
A conventional angle diversity receiver uses multiple receiving elements that are oriented in different directions, where each element employs its own filter and nonimaging concentrator, such as a compound parabolic concentrator (CPC) or hemispheric lens. In this paper, a study of the design of a conventional receiver structure using angle diversity that offers improved performance with respect to the infrared channel characteristics is presented. To this end, a recently proposed model for the effective signal collection area of a conventional angle diversity receiver that more closely approximates real behaviour than the ideal model is used. The inclusion of this model in a Monte Carlo ray-tracing algorithm allows us to investigate the effects of conventional receiver parameters on the main infrared channel parameters, such as path loss and rms delay spread. Furthermore, in order to determine the number of receiver elements, the outage probability and the average error probability are also considered. Based on the results, a conventional angle diversity receiver composed of seven elements is proposed, with one of them oriented towards the ceiling, and six angled at a 56° elevation with a 60° separation in azimuth. For each element, a CPC with a 50° field of view must be used.
Automated identification of animal species in camera trap images
Authors: Yu Xiaoyuan , Wang Jiangping , Kays Roland , Jansen Patrick A , Wang Tianjiang , Huang Thomas 
Published: September 2013

Abstract
Image sensors are increasingly being used in biodiversity monitoring, with each study generating many thousands or millions of pictures. Efficiently identifying the species captured by each image is a critical challenge for the advancement of this field. Here, we present an automated species identification method for wildlife pictures captured by remote camera traps. Our process starts with images that are cropped out of the background. We then use improved sparse coding spatial pyramid matching (ScSPM), which extracts dense SIFT descriptor and cell-structured LBP (cLBP) as the local features, that generates global feature via weighted sparse coding and max pooling using multi-scale pyramid kernel, and classifies the images by a linear support vector machine algorithm. Weighted sparse coding is used to enforce both sparsity and locality of encoding in feature space. We tested the method on a dataset with over 7,000 camera trap images of 18 species from two different field cites, and achieved an average classification accuracy of 82%. Our analysis demonstrates that the combination of SIFT and cLBP can serve as a useful technique for animal species recognition in real, complex scenarios.
At the borders of medical reasoning: aetiological and ontological challenges of medically unexplained symptoms
Authors: Eriksen Thor Eirik , Kerry Roger , Mumford Stephen , Lie Svein Anders Noer , Anjum Rani Lill 
Published: September 2013

Abstract
Medically unexplained symptoms (MUS) remain recalcitrant to the medical profession, proving less suitable for homogenic treatment with respect to their aetiology, taxonomy and diagnosis. While the majority of existing medical research methods are designed for large scale population data and sufficiently homogenous groups, MUS are characterised by their heterogenic and complex nature. As a result, MUS seem to resist medical scrutiny in a way that other conditions do not. This paper approaches the problem of MUS from a philosophical point of view. The aim is to first consider the epistemological problem of MUS in a wider ontological and phenomenological context, particularly in relation to causation. Second, the paper links current medical practice to certain ontological assumptions. Finally, the outlines of an alternative ontology of causation are offered which place characteristic features of MUS, such as genuine complexity, context-sensitivity, holism and medical uniqueness at the centre of any causal set-up, and not only for MUS. This alternative ontology provides a framework in which to better understand complex medical conditions in relation to both their nature and their associated research activity.
Hybrid debranching and TEVAR of the aortic arch off-pump, in re-do patients with complicated chronic type-A aortic dissections: a critical report
Authors: Brechtel Klaus , Kalender Günay , Stock Ulrich A , Wildhirt Stephen M 
Published: September 2013

Abstract

Background
Patients suffering from acute type A aortic dissection undergo replacement of the ascending aorta, the proximal hemiarch or complete aortic arch, depending on the extent of the individual pathology. In a subset of these treated patients, secondary pathologies of the distal anastomosis or the remaining distal part of the aorta occur. The treatment of these pathologies is challenging, requiring major surgical re-do procedures with aortic arch replacement under extracorporeal circulation and hypothermic circulatory arrest.

Methods
We report our experience of five patients with complex aortic pathologies after previous aortic surgery treated with a single stage re-do hybrid procedure, consisting of bypass grafting of the supraaortic branches off-pump, stent graft placement for endovascular aortic repair (TEVAR) and surgical debranching of the aortic arch.

Results
In all patients the surgical vascular grafts and stent grafts were deployed successfully, there were no intraoperative deaths. Four out of five patients were discharged from hospital in good clinical condition. One patient died postoperatively due to cardiac tamponade. In one patient a type I endoleak persisted leading to occlusion of a bypass branch requiring surgical revision at one year after debranching.

Conclusion
We discuss the prerequisites, all steps and potential pitfalls of this hybrid aortic arch replacement. The current procedure avoids cardiopulmonary bypass and circulatory arrest, which may benefit early patient outcome; however, patient and device selection plays a key role for immediate success and midterm outcomes. In addition, precise procedural planning and development of customized stents may help to develop this procedure into a true alternative for conventional aortic arch replacement.
Phenylketonuria: reduced tyrosine brain influx relates to reduced cerebral protein synthesis
Authors: de Groot Martijn J , Hoeksma Marieke , Reijngoud Dirk-Jan , de Valk Harold W , Paans Anne MJ , Sauer Pieter JJ , van Spronsen Francjan J 
Published: September 2013

AbstractBackgroundIn phenylketonuria (PKU), elevated blood phenylalanine (Phe) concentrations are considered to impair transport of large neutral amino acids (LNAAs) from blood to brain. This impairment is believed to underlie cognitive deficits in PKU via different mechanisms, including reduced cerebral protein synthesis. In this study, we investigated the hypothesis that impaired LNAA influx relates to reduced cerebral protein synthesis.MethodsUsing positron emission tomography, L-[1-11C]-tyrosine (11C-Tyr) brain influx and incorporation into cerebral protein were studied in 16 PKU patients (median age 24, range 16 – 47 years), most of whom were early and continuously treated. Data were analyzed by regression analyses, using either11C-Tyr brain influx or11C-Tyr cerebral protein incorporation as outcome variable. Predictor variables were baseline plasma Phe concentration, Phe tolerance, age, and11C-Tyr brain efflux. For the modelling of cerebral protein incorporation,11C-Tyr brain influx was added as a predictor variable.Results11C-Tyr brain influx was inversely associated with plasma Phe concentrations (median 512, range 233 – 1362 μmol/L; delta adjusted R2=0.571, p=0.013). In addition,11C-Tyr brain influx was positively associated with11C-Tyr brain efflux (delta adjusted R2=0.098, p=0.041). Cerebral protein incorporation was positively associated with11C-Tyr brain influx (adjusted R2=0.567, p<0.001). All additional associations between predictor and outcome variables were statistically nonsignificant.ConclusionsOur data favour the hypothesis that an elevated concentration of Phe in blood reduces cerebral protein synthesis by impairing LNAA transport from blood to brain. Considering the importance of cerebral protein synthesis for adequate brain development and functioning, our results support the notion that PKU treatment be continued in adulthood. Future studies investigating the effects of impaired LNAA transport on cerebral protein synthesis in more detail are indicated.
Identification of upstream regulators for prognostic expression signature genes in colorectal cancer
Authors: Bae Taejeong , Rho Kyoohyoung , Choi Jin Woo , Horimoto Katsuhisa , Kim Wankyu , Kim Sunghoon 
Published: September 2013

Abstract

Background
Gene expression signatures have been commonly used as diagnostic and prognostic markers for cancer subtyping. However, expression signatures frequently include many passengers, which are not directly related to cancer progression. Their upstream regulators such as transcription factors (TFs) may take a more critical role as drivers or master regulators to provide better clues on the underlying regulatory mechanisms and therapeutic applications.

Results
In order to identify prognostic master regulators, we took the known 85 prognostic signature genes for colorectal cancer and inferred their upstream TFs. To this end, a global transcriptional regulatory network was constructed with total >200,000 TF-target links using the ARACNE algorithm. We selected the top 10 TFs as candidate master regulators to show the highest coverage of the signature genes among the total 846 TF-target sub-networks or regulons. The selected TFs showed a comparable or slightly better prognostic performance than the original 85 signature genes in spite of greatly reduced number of marker genes from 85 to 10. Notably, these TFs were selected solely from inferred regulatory links using gene expression profiles and included many TFs regulating tumorigenic processes such as proliferation, metastasis, and differentiation.

Conclusions
Our network approach leads to the identification of the upstream transcription factors for prognostic signature genes to provide leads to their regulatory mechanisms. We demonstrate that our approach could identify upstream biomarkers for a given set of signature genes with markedly smaller size and comparable performances. The utility of our method may be expandable to other types of signatures such as diagnosis and drug response.
Combined modified atmosphere packaging and low temperature storage delay lignification and improve the defense response of minimally processed water bamboo shoot
Authors: Song Lili , Chen Hangjun , Gao Haiyan , Fang Xiangjun , Mu Honglei , Yuan Ya , Yang Qian , Jiang Yueming 
Published: September 2013

Abstract

Background
Minimally processed water bamboo shoot (WBS) lignifies and deteriorates rapidly at room temperature, which limits greatly its marketability. This study was to investigate the effect of modified atmosphere packaging (MAP) on the sensory quality index, lignin formation, production of radical oxygen species (ROS) and activities of scavenging enzymes, membrane integrity and energy status of minimally processed WBS when packaged with or without the sealed low-density polyethylene (LDPE) bags, and then stored at 20°C for 9 days or 2°C for 60 days.

Results
The sensory quality of minimally processed WBS decreased quickly after 6 days of storage at 20°C. Low temperature storage maintained a higher sensory quality index within the first 30 days, but exhibited higher contents of lignin and hydrogen peroxide (H2O2) as compared with non-MAP shoots at 20°C. Combined MAP and low temperature storage not only maintained good sensory quality after 30 days, but also reduced significantly the increases in lignin content, superoxide anion (

O
2
.-

) production rate, H2O2 content and membrane permeability, maintained high activities of superoxide dismutase (SOD), catalase (CAT) and ascorbate peroxidase (APX), and reduced the increase in activities of lipase, phospholipase D (PLD) and lipoxygenase (LOX). Furthermore, the minimally processed WBS under MAP condition exhibited higher energy charge (EC) and lower adenosine monophosphate (AMP) content by the end of storage (60 days) at 2°C than those without MAP or stored for 9 days at 20°C.

Conclusion
These results indicated that MAP in combination with low temperature storage reduced lignification of minimally processed WBS, which was closely associated with maintenance of energy status and enhanced activities of antioxidant enzymes, as well as reduced alleviation of membrane damage caused by ROS.
A potentiated startle study of uncertainty and contextual anxiety in adolescents diagnosed with autism spectrum disorder
Authors: Chamberlain Paul D , Rodgers Jacqui , Crowley Michael J , White Sarah E , Freeston Mark H , South Mikle 
Published: September 2013

Abstract

Background
Beyond the core symptoms of autism spectrum disorder (ASD), associated symptoms of anxiety can cause substantial impairment for individuals affected by ASD and those who care for them.

Methods
We utilized a potentiated startle paradigm with a puff of air to the neck as the unconditioned stimulus in order to investigate differences between response to cued fear and contextual anxiety among cognitively able adolescents diagnosed with ASD and an age- and IQ-matched typically developing group.

Results
In a threat-modulated startle paradigm, response patterns to neutral, predictable, and unpredictable conditions were comparable across typically developing and ASD youth in terms of startle response magnitude and latency. However, the ASD group showed significantly greater absolute startle responsivity at baseline and throughout the experiment, suggesting possibly enhanced general sensitivity to threatening contexts. The ASD group, but not the control group, demonstrated moderate to strong negative correlations between psychophysiological response to unpredictable threats (uncertainty) and questionnaire measures of generalized anxiety, intolerance of uncertainty, and repetitive behavior.

Conclusions
Our data suggest enhanced general reactivity among the ASD group, possibly reflecting greater sensitivity to the threatening context of the startle paradigm. Associations with the response to uncertainty may help explain shared neurobehavioral mechanisms in ASD and anxiety. This task can provide useful targets for future neuroimaging and genetics studies as well as specific avenues for intervention. We emphasize the importance of further basic and clinical research into links among these important constructs.
Rapid growth, early maturation and short generation time in African annual fishes
Authors: Blažek Radim , Polačik Matej , Reichard Martin 
Published: September 2013

AbstractBackgroundExtreme environmental conditions can give rise to extreme adaptations. We document growth, sexual maturation and fecundity in two species of African annual fish inhabiting temporary savanna pools.ResultsNothobranchius kadlecistarted to reproduce at the age of 17 days and size of 31 mm andNothobranchius furzeriat 18 days and 32 mm. All four study populations demonstrated rapid growth rates of up to 2.72 mm/day (23.4% of their total length). Both species may produce diapausing embryos or embryos that are able to hatch in as few as 15 days, resulting in a minimum generation time as short as only one month. Incubation on the surface of damp peat moss results in high embryo survival (73%) and a high proportion of rapidly developing embryos (58%) that skip diapauses and hatch in less than 30 days. We further demonstrated that rapid growth and maturation do not compromise subsequent fecundity.ConclusionsOur data suggest that both species have the most rapid sexual maturation and minimum generation time of any vertebrate species, and that rapid maturity does not involve paedogenesis.