bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Activation of the Kynurenine Pathway Predicts Early Death and Long‐term Outcome in Patients Resuscitated From Out‐of‐Hospital Cardiac Arrest
Authors: Ristagno Giuseppe , Latini Roberto , Vaahersalo Jukka , Masson Serge , Kurola Jouni , Varpula Tero , Lucchetti Jacopo , Fracasso Claudia , Guiso Giovanna , Montanelli Alessandro , Barlera Simona , Gobbi Marco , Tiainen Marjaana , Pettilä Ville , Skrifvars Markus B. ,   the FINNRESUSCI Investigators
Published: August 2014

Background

The kynurenine pathway (
KP
) is the major route of tryptophan (
TRP
) catabolism and is activated by inflammation and after cardiac arrest in animals. We hypothesized that the
KP
activation level correlates with severity of post–cardiac arrest shock, early death, and long‐term outcome.

Methods and Results

Plasma was obtained from 245 patients enrolled in a prospective multicenter observational study in 21 intensive care units in Finland. Time to return of spontaneous circulation, lowest systolic arterial pressure, and bicarbonate during the first 24 hours were collected. A cerebral performance category of 3 to 5 defined 12‐month poor outcome. Plasma
TRP
and
KP
metabolites, kynurenine (
KYN
), kynurenic acid, 3‐hydroxyanthranilic acid, and the ratio of
KYN
to
TRP
were measured by liquid chromatography and mass spectrometry. All
KP
metabolites at intensive care unit admission were significantly higher in cardiac arrest patients with a nonshockable rhythm compared to those with a shockable rhythm, and
kynurenic acid
and 3‐hydroxyanthranilic acid correlated with time to
return of spontaneous circulation
. Patients with higher levels of
KYN
,
KYN
to
TRP
,
kynurenic acid
, and 3‐hydroxyanthranilic acid had lower 24‐hour systolic arterial pressure and bicarbonate. All
KP
metabolites and the ratio of
KYN
to
TRP
, but not
TRP
, were significantly higher in patients who died in the intensive care unit in comparison to those who survived. Multivariable logistic regression showed that high
kynurenic acid
(odds ratio: 1.004; 95% confidence interval: 1.001 to 1.008;
P
=0.014), and 3‐hydroxyanthranilic acid (
odds ratio:
1.011; 95% confidence interval: 1.001 to 1.022;
P
=0.03) were independently associated with 12‐month poor outcome and significantly improved risk reclassification.

Conclusions

KP
is activated early after cardiac arrest and is associated with severity of post–
cardiac arrest
shock, early death, and poor long‐term outcome.
Molecular Resonance Tonsillectomy in Children: Comparative Study over Standard Techniques in an 11‐Year Study
Authors: D'Eredità Riccardo 
Published: August 2014

ObjectivesLearn the molecular resonance (MR) technology for tonsillectomy. An analysis of outcomes of MR compared to standard cold‐knife (CK) and monopolar cautery (MPC) for pediatric tonsillectomy offers new possibilities, lowering postoperative morbidity.Study DesignEleven‐year, prospective, randomized, 3‐group trial.SettingTertiary care pediatric institution.Subjects and MethodsEight hundred and seventy‐three children undergoing adenotonsillectomy were randomly assigned to MR (n = 283), CK (n = 279), or MPC (n = 279) techniques. Outcome measures included intraoperative time, blood loss, postoperative pain, weight loss, and histopathologic examination on excised tonsils.ResultsHistopathologic evaluation revealed reduced thermal injury with MR over MPC (43 µm vs 186, P <. 001), statistically associated with reduced muscular, blood vessel, and nerve fiber damage compared to CK (P <. 001). Blood loss was minimal in MR. Significant reduced pain scores were related to MR (P <. 002). Two MR, 15 CK, and 12 MPC patients experienced delayed bleeding.ConclusionMR for pediatric tonsillectomy resulted in reduced histopathologic thermal injury, lower pain scores, and reduced postoperative morbidity compared with CK and MPC techniques in an 11‐year study.
The clinical value of dynamic contrast-enhanced magnetic resonance imaging at 3.0T to detect prostate cancer
Authors: Zhang Xuhui , Quan Xianyue , Lu Shilong , Huang Fanheng , Yang Jianming , Chan Queenie , Lin Ting 
Published: August 2014

Objective To compare dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and T2-weighted imaging (T2WI) at 3.0T for detection of prostate cancer. Methods Patients with elevated prostate-specific antigen underwent T2WI and DCE-MRI prior to prostate needle biopsy. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of T2WI and DCE-MRI to diagnose prostate cancer were evaluated. The relationship between Gleason score and prostate cancer detection by DCE-MRI was evaluated. Results Prostate adenocarcinoma was histopathologically confirmed in 44/75 patients. DCE-MRI had significantly higher sensitivity, accuracy and NPV than T2WI. The detection rate of prostate cancer by DCE-MRI was significantly better for tumours with Gleason score 7–9 than for those Gleason score 4–6. Conclusion DCE-MRI at 3.0T can significantly improve prostate cancer detection using simple visual diagnostic criteria, compared with T2WI.
Preferential Cyclooxygenase 2 Inhibitors as a Nonhormonal Method of Emergency Contraception
Authors: Weiss Erich A. , Gandhi Mona 
Published: August 2014

Objective: To review the literature surrounding the use of preferential cyclooxygenase 2 (COX-2) inhibitors as an alternative form of emergency contraception. Data Sources: MEDLINE (1950 to February 2014) was searched using the key words cyclooxygenase or COX-2 combined with contraception, emergency contraception, or ovulation. Results were limited to randomized control trials, controlled clinical trials, and clinical trials. Study Selection and Data Extraction: Human trials that measured the effects of COX inhibition on female reproductive potential were included for review. Data Synthesis: The effects of the COX-2 inhibitors rofecoxib, celecoxib, and meloxicam were evaluated in 6 trials. Each of which was small in scope, enrolled women of variable fertility status, used different dosing regimens, included multiple end points, and had variable results. Conclusions: Insufficient evidence exists to fully support the use of preferential COX-2 inhibitors as a form of emergency contraception. Although all trials resulted in a decrease in ovulatory cycles, outcomes varied between dosing strategies and agents used. A lack of homogeneity in these studies makes comparisons difficult. However, success of meloxicam in multiple trials warrants further study. Larger human trials are necessary before the clinical utility of this method of emergency contraception can be fully appreciated.
Epidemiology, Management, and Outcome of Sport-Related Ankle Fractures in a Standard UK Population
Authors: Robertson Greg A. J. , Wood Alexander M. , Aitken Stuart A. , Court Brown Charles 
Published: August 2014

Background: The literature on the outcome of sport-related ankle fractures has focused on operatively managed fractures, despite a large proportion being treated nonoperatively. We describe the epidemiology, management, and outcome of acute sport-related ankle fractures in a UK population. Methods: All sport-related ankle fractures sustained during 2007 to 2008 in the Lothian Population were prospectively collected when patients attended the only adult orthopaedic service in Lothian. Fractures were classified using the Lauge Hansen and the Pott’s Classification. The presence of fracture displacement was also recorded. Patients were contacted in February 2011 to ascertain their progress in return to sport. Results: Ninety-six sport-related ankle fractures were recorded in 96 patients. Eighty-four fractures (88%) were followed up at a mean interval of 36 months (range, 30-42). Most common associated sports were soccer (n = 49), rugby (n = 15), running (n = 5), and ice skating (n = 3). The mean time for return to sport was 26 weeks (range, 4-104), the return rate to sport 94%, and the persisting symptom rate 42%. Fifty-two fractures (all nondisplaced) were managed nonoperatively—43 isolated lateral malleolar (30 Weber B, 13 Weber A), 2 isolated medial malleolar, 7 bimalleolar. Forty-four fractures were managed operatively—42 were displaced (2 isolated lateral malleolar, 3 isolated medial malleolar, 18 bimalleolar equivalent, 9 bimalleolar, 3 trimalleolar equivalent, 7 trimalleolar), 2 were un-displaced (2 trimalleolar). The mean times for return to sport were 20 weeks (range, 4-52) for the nonoperative cohort (NOC) and 35 weeks (range, 8-104) for the operative cohort (OC) ( P < .001), the return rates to sport were 100% for NOC and 87% for OC ( P < .016), and the persisting symptom rates were 17% for NOC and 71% for OC ( P < .001). Conclusions: Nondisplaced ankle fractures in athletes were successfully managed with nonoperative care. They had greater return rates to sport, quicker return times, and lower persisting symptom rates but had less severe injuries. Level of Evidence: Level III, retrospective comparative study.
Month of birth and risk of multiple sclerosis in Kuwait: A population-based registry study
Authors: Akhtar Saeed , Alroughani Raed , Al-Shammari Ahmad , Al-Abkal Jarrah , Ayad Yasser 
Published: August 2014

Background: Multiple sclerosis (MS) is a complex immune-mediated disorder of central nervous system with undefined etiology. This study examined the month of birth effect on subsequent MS risk later in the life in Kuwait. Methods: The month of birth of MS patients enrolled in Kuwait MS Registry between 1 January 1950–30 April 2013 was compared with the month of births in the general population during the comparable period. Multivariable log-linear Poisson regression model was used to analyze the data. Results: Data on 1035 confirmed MS patients were collected, of which 65.2% were female and 77.1% were Kuwaiti. The overall risk of MS births (per 105 births in general population) was 28.5 (95% confidence interval (CI): 26.8–30.3). Multivariable log-linear Poisson regression model showed a significant ( p=0.004) peak in the number of MS births during December (θo=340o). During this month, the risk of MS birth was 1.3 times the risk of MS birth in the trough month after adjusting for the effects of gender and nationality (adjusted relative risk=1.3; 95% CI: 1.1–1.6). The amplitude (α±standard deviation: 0.13±0.014) of sinusoidal curve showed a significant ( p=0.004) difference of 13% from the mean to maximum MS births during peak month. Conclusions: This study showed a statistically significant month of birth effect on MS risk with 13% excess MS births during December in Kuwait. Future studies may contemplate ascertaining the seasonal factors eliciting the observed association. The insight gained by unraveling such factors may help curtail MS risk in this and other similar settings in the region.
Lack of association between ACE insertion/deletion polymorphism and lung cancer: A meta-analysis
Authors: Cheng Zhenshun , Ma Rongli , Tan Weijun , Zhang Li , Tan Qiuyue 
Published: August 2014

Objective: Previous case-control studies on the relation between the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and lung cancer were controversial. In this study, we aimed to further evaluate the relation between the ACE gene I/D polymorphism and lung cancer. Methods: We selected eight case-control studies related to the ACE gene I/D polymorphism and lung cancer by searching PubMed, EMBase, Chinese Biomedical Literature Database, and Wanfang database. We utilized Q-test and I2 test to test the heterogeneity between each study. To merge the odds ratio (OR) and 95% confidence interval, we utilized the fixed-effects model during the analyses. Results: The present study included 1612 patients with lung cancer and 1442 cancer-free control subjects. By meta-analysis, we did not find any association between the ACE gene I/D polymorphism and lung cancer in either genotype or allele distribution (DD vs. (ID+II): OR = 0.96, 95% CI (0.80–1.14), p = 0. 61; D allele vs. I allele: OR = 1.01, 95% CI (0.91–1.13), p = 0.79). Conclusion: We concluded that the ACE gene I/D polymorphism was not associated with lung cancer.
Overcoming recruitment challenges in patients with multiple sclerosis: Results from an Italian survey
Authors: Maida Simona , Dalla Costa Gloria , Rodegher Mariaemma , Falautano Monica , Comi Giancarlo , Martinelli Vittorio 
Published: August 2014

Background: Recruiting patients for randomized clinical trials is still extremely difficult. While there has been much research in oncology patients, no previous studies have consistently addressed specific factors affecting the willingness to enroll in multiple sclerosis trials from the patient’s perspective. To this end, we conducted an exploratory study to assess the related factors and to find ways to improve recruitment. Methods: This is a single-center, observational study involving 352 consecutive outpatients followed at one site in Italy. Patients completed the Enrollment Problems Questionnaire and Beck Depression Inventory. Results: Over 50% of the patients would consider participating in a randomized trial. Willing patients are frequently older, with no children, have a diagnosis of secondary progressive multiple sclerosis, and have already participated in clinical trials. Patients’ choices were positively influenced by expectations of having (a) a greater chance of cure, (b) an unavailable drug, (c) a specialist’s care, and (d) the chance to contribute to medical research. Willingness was significantly increased by the use of optimistic language and practical/psychological assistance during the decision-making process. Conclusion: Multiple sclerosis patients’ willingness to participate in a randomized trial is mainly related to both altruistic and individual considerations, as well as to a greater chance of specialist/improved care. More effective information flow and an effective, long-standing patient–physician relationship may improve recruitment overall.
Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?
Authors: Kim Taeryung , Park Heung Kyu , Lee Kyung Hee , Kim Kwan Il , Lee Kyu Chan , Ahn Jeong Suk , Ko Kwang-Pil 
Published: August 2014

Abstract
Identifying ductal carcinoma in situ (DCIS) patients at highest risk for recurrence after breast conserving surgery (BCS) remains a clinical concern. Subjecting all such patients to radiotherapy may be unnecessary. The Van Nuys Prognostic Index (VNPI) is a simple scoring system for predicting the risk of local recurrence in patients with DCIS. We reviewed patients with DCIS applying the VNPI score system. A total of 184 DCIS patients who underwent surgery at our institution between January 2003 and December 2011 were identified. Patients were not treated according to VNPI guidelines; rather, radiation therapy was applied at each surgeon’s discretion. All patients with hormonal receptor positive tumors were treated with hormonal therapy. Pathology reports were reviewed and VNPI scores of each DCIS calculated. Of the 184 patients, 52 (28.3%), 115 (62.5%) and 17 (9.2%) had low, intermediate and high VNPI scores, respectively. Six of the 184 patients (3.3%) developed ipsilateral local recurrence, five in the intermediate and one in the high VNPI score group. Of the five in the intermediate group, three (60%) were in patients with ER-negative tumors. VNPI score itself was not associated with recurrence (P = 0.145). Factors associated with recurrence included tumor size (hazard ratio [HR] 6.88), grade (HR 9.07) and hormone receptor status (HR 11.75). Radiotherapy did not significantly improve recurrence rates in patients with low and intermediate risk DCIS, especially in those with ER-positive tumors. Radiotherapy can be omitted in patients with ER-positive intermediate score DCIS and in patients with low score DCIS.
Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation
Authors: Fujiwara Atsushi , Komasawa Nobuyasu , Minami Toshiaki 
Published: August 2014

Abstract
A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered risky, monitored anesthesia care utilizing peripheral nerve block and slight sedation was scheduled. Pectoral nerves (PECS) block and intercostal block was performed under ultrasonography with ropivacaine. For sedation during the procedure, continuous infusion of dexmedetomidine without a loading dose was performed. The procedure lasted about 3 hours, but the patient showed no pain or restlessness. Combination of PECS block and intercostal block may provide effective analgesia for CRTD implantation.
Life threatening illness in popular movies-a first descriptive analysis
Authors: Drukarczyk Laura , Klein Carsten , Ostgathe Christoph , Stiel Stephanie 
Published: August 2014

AbstractIn the last two decades, public attention towards illness, dying and death has evolved. In particular, advance care planning, living wills, end-of-life care, and autonomy are increasingly discussed. How this change in public awareness has influenced the presentation of dying and death in cinema needs clarification. Over a one year period, November 2011 until October 2012, a systematic search was conducted to identify movies dealing with incurable diseases produced in 1991–2010 35 movies could be identified and were analyzed in detail and investigated the presentation of illness and death. The number of movies focusing on terminal illness, dying, and death has increased since 1991. The total number of movies that made the yearly German Federal Film Board (FFA) hit list and included a focus on terminal illness, dying, and death increased from 1991 (1 movie) to 2011 (6 movies). The gender of the main characters suffering from terminal illness was distributed equally; three movies portrayed terminally ill children. More than one third of the terminally ill characters died in hospital. The terms “palliative” or “hospice care” were not mentioned once in any films. The number of movies dealing with terminal illness continues to increase and a considerable audience has shown interest in these films. Due to a limited true-to-life performance in the films, a presentation closer to reality could be a major public educational resource.
Identification of a novel AMPK-PEA15 axis in the anoikis-resistant growth of mammary cells
Authors: Hindupur Sravanth K , Balaji Sai A , Saxena Meera , Pandey Shubham , Sravan Gopalkrishnashetty Sreenivasmurthy , Heda Namrata , Kumar M Vijaya , Mukherjee Geetashree , Dey Devaveena , Rangarajan Annapoorni 
Published: August 2014

Abstract
Introduction
Matrix detachment triggers anoikis, a form of apoptosis, in most normal epithelial cells, while acquisition of anoikis resistance is a prime requisite for solid tumor growth. Of note, recent studies have revealed that a small population of normal human mammary epithelial cells (HMECs) survive in suspension and generate multicellular spheroids termed ‘mammospheres’. Therefore, understanding how normal HMECs overcome anoikis may provide insights into breast cancer initiation and progression.

Methods
Primary breast tissue-derived normal HMECs were grown as adherent monolayers or mammospheres. The status of AMP-activated protein kinase (AMPK) and PEA15 signaling was investigated by immunoblotting. Pharmacological agents and an RNA interference (RNAi) approach were employed to gauge their roles in mammosphere formation. Immunoprecipitation and in vitro kinase assays were undertaken to evaluate interactions between AMPK and PEA15. In vitro sphere formation and tumor xenograft assays were performed to understand their roles in tumorigenicity.

Results
In this study, we show that mammosphere formation by normal HMECs is accompanied with an increase in AMPK activity. Inhibition or knockdown of AMPK impaired mammosphere formation. Concomitant with AMPK activation, we detected increased Ser116 phosphorylation of PEA15, which promotes its anti-apoptotic functions. Inhibition or knockdown of AMPK impaired PEA15 Ser116 phosphorylation and increased apoptosis. Knockdown of PEA15, or overexpression of the nonphosphorylatable S116A mutant of PEA15, also abrogated mammosphere formation. We further demonstrate that AMPK directly interacts with and phosphorylates PEA15 at Ser116 residue, thus identifying PEA15 as a novel AMPK substrate. Together, these data revealed that AMPK activation facilitates mammosphere formation by inhibition of apoptosis, at least in part, through Ser116 phosphorylation of PEA15. Since anoikis resistance plays a critical role in solid tumor growth, we investigated the relevance of these findings in the context of breast cancer. Significantly, we show that the AMPK-PEA15 axis plays an important role in the anchorage-independent growth of breast cancer cells both in vitro and in vivo.

Conclusions
Our study identifies a novel AMPK-PEA15 signaling axis in the anchorage-independent growth of both normal and cancerous mammary epithelial cells, suggesting that breast cancer cells may employ mechanisms of anoikis resistance already inherent within a subset of normal HMECs. Thus, targeting the AMPK-PEA15 axis might prevent breast cancer dissemination and metastasis.
Effects of dust storm events on emergency admissions for cardiovascular and respiratory diseases in Sanandaj, Iran
Authors: Ebrahimi Seyyed Jamal Aldin , Ebrahimzadeh Leila , Eslami Akbar , Bidarpoor Farzam 
Published: August 2014

Abstract

Background
In recent years, increasing dust storms from western neighboring countries of Iran influenced western and central parts of the country. In this case, level of concentration of atmospheric particulate matter greater than 10 μm (PM10) remained higher for several days compared to the levels before the event. Accordingly, Suspended particulate matters of dust storms in western Iran have caused PM10 pollution in Sanandaj (capital of the Iranian province of Kurdistan) and other Iranian cities. The present study aimed to evaluate possible effects of dust storms on incidence of cardiovascular and respiratory diseases among residents of Sanandaj.

Materials and methods
Dust storm events defined based on the Environmental Protection Administration and Meteorological Announcements, 21 March 2009 to 21 June 2010. Data related to the dust events associated with cardiovascular and respiratory diseases were obtained from the Center for Disaster and Emergency Medicine of Sanandaj, Iran. PM10 concentration and air quality data were obtained from air quality monitoring agency of Kurdistan Provincial Directorate of Environment Protection. Daily PM10 measurements were performed automatically according to β-ray absorption. Data were statistically analyzed using SPSS and Pearson's correlation coefficient. Also, linear regression model was used to investigate the relationship between variables.

Results
The average PM10 levels during dust episodes (187 μg/m3) were significantly higher than the other days (48.7 μg/m3). In addition, correlation coefficient between PM10 level and number of cardiovascular and emergency service during dust events were equal to 0.48 (P <0.05) and 0.19 (P >0.05) respectively.

Conclusion
Our findings showed significant increase in emergency admissions for cardiovascular and respiratory diseases during dust storms episode in Sanandaj. Although correlation between respiratory diseases and dust storm events were statistically insignificant (0.19), numbers of cardiovascular diseases were significantly correlated with dust storm events (0.48).