bluuebunny/crossref_metadata_2025_split huggingface dataset:
Statin use and risk of liver cancer: an update meta-analysis
Authors: Shi Meng , Zheng Huiling , Nie Biao , Gong Wei , Cui Xiaobing 
Published: September 2014

ObjectiveStatins are commonly prescribed cholesterol-lowering drugs. Preclinical studies suggest that statins may possess cancer preventive properties. The primary objective of this meta-analysis was to determine the association between statin use and risk of liver cancer.DesignMeta-analysis.SettingInternational.ParticipantsA comprehensive literature search of PubMed, BIOSIS Previews, Web of Science, EMBASE, EBSCO and Cochrane Library was conducted through March 2014. The effect estimate was reported as pooled relative risk (RR) with 95% CIs, using the random-effects model.ResultsA total of 12 studies (1 individual patient data analysis of 22 randomised controlled trials, 5 cohorts and 6 case–controls) were qualified for this meta-analysis, involving 5 640 313 participants including 35 756 liver cancer cases. Our results indicated a significant risk reduction of liver cancer among all statin users (RR=0.58, 95% CIs 0.51 to 0.67). The difference of the study designs can partly explain the significant heterogeneity found in the overall analysis (I2=65%, p=0.0006). No evidence of publication bias was observed in this meta-analysis. Similar risk reductions were found in the subgroups analysis of Western and Asian countries, lipophilic and hydrophilia statins. There was a trend towards more risk reductions in subgroups with higher baseline risk, inadequate adjustment and higher cumulative dosage of statin use.ConclusionsThis meta-analysis suggests that statin is associated with a significant risk reduction of liver cancer when taken daily for cardiovascular event prevention. However, this preventive effect might be overestimated due to the exposure period, the indication and contraindication of statins and other confounders. Statins might be considered as an adjuvant in the treatment of liver cancer.
Acupuncture for neurogenic bladder due to spinal cord injury: a systematic review protocol
Authors: Zhang Tao , Liu Huilin , Liu Zhishun , Wang Linpeng 
Published: September 2014

IntroductionNeurogenic bladder is one of the most common complications following spinal cord injury (SCI). In China, acupuncture therapy is a common treatment for neurogenic bladder due to SCI, but its effects and safety remain uncertain. A protocol is described for a systematic review to investigate the beneficial effects and safety of acupuncture for neurogenic bladder due to SCI.Methods and analysisEight databases will be searched from their inception: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, the China National Knowledge Infrastructure (CNKI), the VIP database, the Wanfang database, the China Doctoral Dissertations Full-text Database (CDFD) and the China Master's Theses Full-text Database (CMFD). Any clinical randomised controlled trials (RCTs) and the first period of randomised cross-over studies related to acupuncture for neurogenic bladder due to SCI will be included. Outcomes will include change in urinary symptoms, urodynamic tests, clinical assessment and quality of life (QoL). The incidence of adverse events will be assessed as the safety outcome. Study selection, data extraction and quality assessment will be performed independently by two reviewers. Assessment of risk of bias, data synthesis and subgroup analysis will be carried out using Review Manager software.Ethics and disseminationEthics approval is not required as this is a protocol for a systematic review. The findings of this systematic review will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberPROSPERO (CRD42014010448).
Personalised physician learning intervention to improve hypertension and lipid control: randomised trial comparing two methods of physician profiling
Authors: O'Connor Patrick J , Magid David J , Sperl-Hillen JoAnn M , Price David W , Asche Stephen E , Rush William A , Ekstrom Heidi L , Brand David W , Tavel Heather M , Godlevsky Olga V , Johnson Paul E , Margolis Karen L 
Published: September 2014

PurposeTo assess the impact of personalised physician learning (PPL) interventions using simulated learning cases on control of hypertension and dyslipidaemia in primary care settings.MethodsA total of 132 primary care physicians, 4568 eligible patients with uncontrolled hypertension, and 15 392 eligible patients with uncontrolled dyslipidaemia were cluster-randomised to one of three conditions: (a) no intervention, (b) PPL-electronic medical record (EMR) intervention in which 12 PPL cases were assigned to each physician based on observed patterns of care in the EMR in the previous year, or (c) PPL-ASSESS intervention in which 12 PPL cases were assigned to each physician based on their performance on four standardised assessment cases. General and generalised linear mixed models were used to account for clustering and to model differences in patient outcomes in the study arms.ResultsAmong patients with uncontrolled hypertension at baseline, 49.1%, 46.6% and 47.3% (p=0.43) achieved blood pressure (BP) targets at follow-up. Among patients with uncontrolled dyslipidaemia at baseline, 37.5%, 37.3% and 38.1% (p=0.72) achieved low density lipoprotein cholesterol targets at follow-up in PPL-EMR, PPL-ASSESS and the control group, respectively. Although systolic (BP) (p<0.001) and lipid (p<0.001) values significantly improved during the study, the group-by-time interaction term showed no differential change in systolic BP values (p=0.51) or lipid values (p=0.61) among the three study arms. No difference in intervention effect was noted when comparing the PPL-EMR with the PPL-ASSESS intervention (p=0.47).ConclusionsThe two PPL interventions tested in this study did not lead to improved control of hypertension or dyslipidaemia in primary care clinics during a mean 14-month follow-up period. This null result may have been due in part to substantial overall improvement in BP and lipid control at the study sites during the study.Trial registration numberNCT00903071.
Experience of propofol sedation in a UK ERCP practice: lessons for service provision
Authors: Joshi D , Paranandi B , El Sayed G , Down J , Johnson G J , Chapman M H , Pereira S P , Webster G J M 
Published: September 2014

ObjectiveEndoscopic retrograde cholangiopancreatography (ERCP) in the UK has been historically performed under conscious sedation. However, given the increasing complexity of cases, the role of propofol-assisted ERCP (propERCP) is increasing. We describe our experience of propERCP and highlight the importance of this service.DesignOur prospective ERCP database was interrogated between January 2013 and January 2014. Data collection included procedural information, patient demographics, American Association of Anaesthesiologists (ASA) status, Cotton grade of endoscopic difficulty and endoscopic and anaesthetic complications. Comparison was made with patients undergoing conscious sedation ERCP (sedERCP).Results744 ERCPs were performed in 629 patients (53% male). 161 ERCPs were performed under propofol. PropERCP patients were younger compared with the sedERCP group (54 vs 66 years, p<0.0001) but ASA grade 1–2 status was similar (84% vs 78%, p=0.6). An increased number of Cotton grade 3–4 ERCPs were performed in the propERCP group (64% vs 34%, p<0.0001). Indications for propERCP included sphincter of Oddi manometry (27%), previously poorly tolerated sedERCP (26%), cholangioscopy (21%) and patient request (8%). 77% of cases were elective, 12% were urgent day-case transfers and 11% were urgent inpatients. 59% of cases were tertiary referrals. ERCP was completed successfully in 95% of cases. Anaesthetic and endoscopic complications were comparable between the two groups (5% and 7% vs 3% and 5%). Where sedERCP had been unsuccessful due to patient intolerance, the procedure was completed successfully using propofol.ConclusionsPropERCP is safe and is associated with high endoscopic success. The need for propERCP is likely to increase given patient preference and the high proportion of complex procedures being undertaken. All endoscopy units should look to incorporate propofol-assisted endoscopy into aspects of their services.
Phase I Study of Intermittent Oral Dosing of the Insulin-like Growth Factor-1 and Insulin Receptors Inhibitor OSI-906 in Patients With Advanced Solid Tumors
Authors: Jones Robin L. , Kim Edward S. , Nava-Parada Pilar , Alam Salma , Johnson Faye M. , Stephens Andrew W. , Simantov Ronit , Poondru Srinivasu , Gedrich Rich , Lippman Scott M. , Kaye Stan B. , Carden Craig P. 
Published: September 2014

Abstract
Purpose: We determined the maximum tolerated dose (MTD), safety, pharmacokinetics, pharmacodynamics, and preliminary activity of OSI-906, a potent, oral, dual inhibitor of insulin-like growth factor-1 receptor (IGF1R) and insulin receptor (IR), in patients with advanced solid tumors.
Experimental Design: This was a multicenter, open-label, dose escalation phase I study evaluating three intermittent dosing schedules of once-daily OSI-906 [schedule (S) 1, days 1–3 every 14 days; S2, days 1–5 every 14 days; S3, days 1–7 every 14 days]. A fed-fasting expansion cohort was included in the study.
Results: Seventy-nine patients were enrolled: 62 in S1, 4 in S2, and 13 in S3. S2 was discontinued. Dose-limiting toxicity comprised grade 3–4 hyperglycemia, vomiting, fatigue, and prolonged QTc interval. The MTD and recommended phase II dose of OSI-906 was 600 mg for both S1 and S3 schedules. Other common adverse events were grade 1–2 nausea, vomiting, fatigue, and diarrhea. The pharmacokinetics of OSI-906 was dose linear, and the terminal half-life ranged between 2 and 6 hours. High-fat meals had a moderate effect on the pharmacokinetics of OSI-906. At the MTD, inhibition of IGF1R and IR was observed in peripheral blood mononuclear cells. An increase in plasma IGF1 concentrations, an indirect measure of IGF1R signaling inhibition, was seen at doses ≥ 450 mg. Two patients with adrenocortical carcinoma achieved partial responses.
Conclusion: The MTD of 600 mg was well tolerated and associated with preliminary antitumor activity. These data support further evaluation of OSI-906 in solid tumors. Clin Cancer Res; 21(4); 693–700. ©2014 AACR.
See related commentary by Yee, p. 667
Immune functions of platelets
Authors: Bode Christoph , Ahrens Ingo , Duerschmied Daniel 
Published: September 2014

SummaryThis review collects evidence about immune and inflammatory functions of platelets from a clinician’s point of view. A focus on clinically relevant immune functions aims at stimulating further research, because the complexity of platelet immunity is incompletely understood and not yet translated into patient care. Platelets promote chronic inflammatory reactions (e.g. in atherosclerosis), modulate acute inflammatory disorders such as sepsis and other infections (participating in the host defense against pathogens), and contribute to exacerbations of autoimmune conditions (like asthma or arthritis). It would hence be obsolete to restrict a description of platelet functions to thrombosis and haemostasis – platelets clearly are the most abundant cells with immune functions in the circulation.
Ectosomes released by platelets induce differentiation of CD4+ T cells into T regulatory cells
Authors: Eken Ceylan , Sadallah Salima , Amicarella Francesca , Iezzi Giandomenica , Schifferli Jürg 
Published: September 2014

SummaryAccumulating evidence suggests an immune-modulatory role for platelets (PLT) and PLT-derived microvesicles. In particular, ectosomes, i.e. vesicles budding from PLT surface, have been shown to exert immunosuppressive activities on phagocytes. Here we investigated the effects mediated by PLT-derived ectosomes (PLT-Ecto) on CD4+ T cells. Exposure of activated CD4+ T cells to PLT-Ecto decreased their release of IFNγ, TNFα and IL-6, and increased the production of TGF-β1. Concomitantly, PLT-Ecto-exposed CD4+ T cells displayed increased frequencies of CD25high Foxp3+ cells. These phenomena were dose-dependent and PLT-Ecto specific, since they were not observed in the presence of polymorphonuclear- and erythrocyte-derived ectosomes. Analysis of specific T cell subsets revealed that PLT-Ecto induced differentiation of naïve T cells into Foxp3+ cells, but had no effect on predifferentiated Foxp3+ regulatory T cells (Tregs). Importantly, PLT-Ectoinduced Foxp3+ cells were as effective as peripheral blood Tregs in suppressing CD8+ T cell proliferation. PLT-Ecto-mediated effects were partly dependent on PLT-derived TGF-β1, as they were to some extent inhibited by PLT-Ecto pretreatment with TGF-β1-neutralising antibodies. Interestingly, ectosome-derived TGF-β1 levels correlated with Foxp3+ T cell frequencies in blood of healthy donors. In conclusion, PLT-Ecto induce differentiation of CD4+ T cells towards functional Tregs. This may represent a mechanism by which PLT-Ecto enhance peripheral tolerance.
Effects of dark chocolate consumption on the prothrombotic response to acute psychosocial stress in healthy men
Authors: Känel Roland von , Meister Rebecca , Stutz Monika , Kummer Petra , Arpagaus Angela , Huber Susanne , Ehlert Ulrike , Wirtz Petra 
Published: September 2014

SummaryFlavanoid-rich dark chocolate consumption benefits cardiovascular health, but underlying mechanisms are elusive. We investigated the acute effect of dark chocolate on the reactivity of prothrombotic measures to psychosocial stress. Healthy men aged 20–50 years (mean ± SD: 35.7 ± 8.8) were assigned to a single serving of either 50 g of flavonoid-rich dark chocolate (n=31) or 50 g of optically identical flavonoid-free placebo chocolate (n=34). Two hours after chocolate consumption, both groups underwent an acute standardised psychosocial stress task combining public speaking and mental arithmetic. We determined plasma levels of four stress-responsive prothrombotic measures (i. e., fibrinogen, clotting factor VIII activity, von Willebrand Factor antigen, fibrin D-dimer) prior to chocolate consumption, immediately before and after stress, and at 10 minutes and 20 minutes after stress cessation. We also measured the flavonoid epicatechin, and the catecholamines epinephrine and norepinephrine in plasma. The dark chocolate group showed a significantly attenuated stress reactivity of the hypercoagulability marker D-dimer (F=3.87, p=0.017) relative to the placebo chocolate group. Moreover, the blunted D-dimer stress reactivity related to higher plasma levels of the flavonoid epicatechin assessed before stress (F=3.32, p = 0.031) but not to stress-induced changes in catecholamines (p’s=0.35). There were no significant group differences in the other coagulation measures (p’s≥0.87). Adjustments for covariates did not alter these findings. In conclusion, our findings indicate that a single consumption of flavonoid- rich dark chocolate blunted the acute prothrombotic response to psychosocial stress, thereby perhaps mitigating the risk of acute coronary syndromes triggered by emotional stress.
Impact of an Expanded Hospital Recognition Program for Heart Failure Quality of Care
Authors: Heidenreich Paul A. , Zhao Xin , Hernandez Adrian F. , Yancy Clyde W. , Schwamm Lee H. , Albert Nancy M. , Fonarow Gregg C. 
Published: September 2014

Background
In 2009, the Get With The Guidelines–Heart Failure program enhanced the standard recognition of hospitals by offering additional recognition if hospitals performed well on certain quality measures. We sought to determine whether initiation of this enhanced recognition opportunity led to acceleration in quality of care for all hospitals participating in the program.

Methods and Results

We examined hospital‐level performance on 9 quality‐of‐care (process) measures that were added to an existing recognition program (based on existing published performance measures). The rate of increase in use over time 6 months to 2 years after the start of the program was compared with the rate of increase in use for the measures during the 18‐month period prior to the start of the program. Use increased for all 9 new quality measures from 2008 to 2011. Among 4 measures with baseline use near or lower than 50%, a statistically significant greater increase in use during the program was seen for implantable cardioverter defibrillator use (program versus preprogram use: odds ratio 1.14, 95%
CI
1.06 to 1.23). Among the 5 measures for which baseline use was 50% or higher, the increase in influenza vaccination rates actually slowed. There was no evidence of adverse impact on the 4 established quality measures, a composite of which actually increased faster during the expanded program (adjusted odds ratio 1.08, 95%
CI
1.01 to 1.15).

Conclusions
A program providing expanded hospital recognition for heart failure had mixed results in accelerating the use of 9 quality measures.
Roman Gardens, Imagination, and Cognitive Structure
Authors: Jones F.M.A. 
Published: September 2014

The article deals with the Roman garden and sets it in the context of identity, imagination, and cognitive development. Although the implications of the argument are empire-wide, the focus here is primarily on the urban gardens of the city of Rome ca. 60 b.c.-a.d. 60.
The person experiencing one garden sees through it other gardens, real, historical, or poetic. ‘The garden’ and representations of the garden become places for thinking about literature, history, and identity. Our evidence for this ‘thinking’ is a lateral or synchronic layer in the sense that the thinking for which we have textual evidence is all done by fully developed adults. However, there is another, vertical or diachronic, aspect to the process which involves the cognitive development from childhood of the garden-user and the role of the garden in structuring the prospective citizen’s understanding of the world. The garden is a central feature of the urban residence, where the Roman citizen lives and moves through the course of his cognitive development. It is inside the house, and the house is inside the city, which is inside Italy. The concluding part of the article investigates how the core notion of the garden as enclosed space maps on to larger sets of inside-outside dyads in the Roman world: the garden is a secluded interior, but on a larger scale Rome is a safe interior surrounded by more perilous environment; again, Italy is a civilised interior surrounded by a more dangerous outer world. The garden is experienced by the child largely through play, and this also feeds into the garden-related imaginative acts described in the first part of the paper.1
Nesting ecology of the exotic Trachemys scripta elegans in an area of Southern Italy (Angitola Lake, Calabria)
Authors: Crescente Antonio , Sperone Emilio , Paolillo Giuseppe , Bernabò Ilaria , Brunelli Elvira , Tripepi Sandro 
Published: September 2014

The nesting ecology of the slider turtle Trachemys scripta elegans was studied in Angitola Lake, a natural protected area in Calabria (Southern Italy). During 2008-2010, data were collected based on 1081 egg shells from 250 nests. The average number of egg shells per nest was 4.3 (min-max = 1-16) and the clutch size increased from 2008 to 2010. Two main hatching periods were identified: one in July and another in September. There were significant correlations between nest diameter and nest depth, between nest diameter and egg shell number, and between nest depth and egg shell number.
Clinical embryology: is there still a place in medical schools today?
Authors: Hamilton J , Carachi R 
Published: September 2014

Background and aims Embryology remains an important tool in medicine and surgery for the management of many clinical conditions. As a subject, it is neither straightforward nor easy to learn and teach in a busy modern medical school curriculum and can be easily overlooked. The aim of this study was to assess medical students’ confidence in, and attitudes towards, the learning and teaching of clinical embryology. Method and results Medical students from all years of the course were asked to complete an online questionnaire in 2014. The questionnaire focused on confidence levels in learning embryology, methods of teaching, clinical embryology and it also allowed comments. In total, 146 students completed the questionnaire. The majority of students were not confident in learning and applying embryology and were unhappy with current teaching. Despite this, they felt that embryology should be included in the medical school curriculum, in particular clinical embryology with relevant clinical scenarios. Conclusion Students remain confident that embryology should remain in the medical school curriculum. Embryology should be taught at the right level, depth and through various methods, including basic concepts in the lower years of medical school and moving into clinical embryology later on. As a result, junior doctors and trainees will have a good foundation of knowledge.
Primary breast osteosarcoma: a case report and review of literature
Authors: Al Samaraee Ahmad , Angamuthu Nithia , Fasih Tarannum 
Published: September 2014

Background Primary soft tissue sarcomas are uncommon. We report a case of primary breast osteosarcoma which was treated successfully. This case report is combined with a literature review of this rare breast malignancy. Methods Electronic literature search of databases: Pubmed/Medline, Ovid and EMBASE, in addition to the search engines Google/Google Scholar and Bing. The keywords used were breast osteosarcoma, soft tissue sarcoma and breast cancer. Searches were screened and those studies thought to be relevant had full text versions retrieved. The references to all retrieved texts were searched for further relevant studies. Conclusion Primary breast osteosarcoma is a rare breast malignancy that affects elderly patients. Diagnosis is often challenging and can be debatable due to its rarity, non-specific radiological findings and the complicated histopathological subtypes. Surgery is the treatment of choice.
Prospective Randomized Study of Chevron Osteotomy Versus Mitchell’s Osteotomy in Hallux Valgus
Authors: Buciuto Robert 
Published: September 2014

Background: We conducted a prospective randomized trial to compare the most popular osteotomy types of operative treatment of hallux valgus (HV) used in Norway, Mitchell’s osteotomy (MO) and chevron osteotomy (CO). Methods: One hundred twenty adult female patients were prospectively randomized to treatment with either MO or CO. All operative procedures were performed with ankle block and with tourniquet applied. None of the patients received any antibiotic or antithrombotic prophylaxis. The follow-up period was 3 years. Clinical results were rated according to the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System (CRS). Results: HV in the MO group was reduced from 30 (range, 20 to 44) to 15 (range, 8 to 24) degrees and IM angle from 11 (range, 6 to 14) to 7 (range, 4 to 11) degrees. HV in the CO group was reduced from 31 (range, 22 to 42) to 16 (range, 6 to 24) degrees and IM angle from 14 (range, 8 to 20) to 6 (range, 2 to 10) degrees. Transfer metatarsalgia occurred in 36 (60%) patients and hammertoe in 6 (10%) patients in the MO group. In the CO group, metatarsalgia occurred in 5 patients. The median loss of postoperative HV correction was 4 (range, 2 to 10) degrees in mild deformity and 6 (6 to 10) degrees in moderate deformity. Conclusion: Patients treated with CO had significantly better results for AOFAS CRS, number of postoperative complications, patient satisfaction, and length of sick leave for the employed patients. Based on our results, we consider that in female patients CO should be regarded as the first-line procedure for treatment of mild and moderate HV. Level of Evidence: Level I, prospective randomized study.