bluuebunny/crossref_metadata_2025_split huggingface dataset:
The University of Pennsylvania/Walter Reed Army Medical Center Proton Therapy Program
Authors: McDonough James , Tinnel Brent 
Published: October 2014

The design of the proton therapy center being constructed at the University of Pennsylvania is based on several principles that distinguish it from other proton facilities. Among these principles is the recognition that advances in imaging, and particularly in functional imaging, will have a large impact on radiotherapy in the near future and that the conformation of proton dose distributions can utilize that information to a larger degree than other treatment techniques. The facility will contain four-dimensional CT-simulators, an MR-simulator capable of spectroscopy, and a PET-CT scanner. A second principle applied to the facility design is to incorporate into proton radiotherapy the recent progress in conventional radiotherapy; including imaging and monitoring of patients during treatment, imaging of soft tissue, accounting for respiratory motion, and expanding the use of intensity-modulated treatments. A third principle is to understand that the facility must be operated efficiently. To that end the specifications for the equipment have included requirements for high beam intensity, fast switching times between treatment rooms, a multileaf collimator to permit multiple fields to be treated quickly, and plans for an intelligent beam scheduler to determine where the beam can be best used at any given time. We expect to use “universal” nozzles, which can switch rapidly from scattering mode to scanning mode, and there will be a set-up room used for the first day of treatment to verify alignment rather than spend valuable time in a gantry room. Many of these ideas require development, including the applications of existing radiotherapy techniques to proton gantries, so a series of research and development projects have started to address these issues. Walter Reed Army Medical Center, which will provide a portal through which military personnel and their dependants can receive proton radiotherapy, is involved in several of these development projects as well as the creation of process to remotely perform treatment planning for the military patients under treatment at the proton facility.
Effect of Continuous High Intensity Focused Ultrasound in a Squamous Cell Carcinoma Tumor Model Compared to Muscle Tissue Evaluated by MRI, Histology, and Gene Expression
Authors: Hundt Walter , Yuh Esther L. , Steinbach Silke , Bednarski Mark D. 
Published: October 2014

The purpose of this study was to investigate the effect of the continuous mode of high intensity focused ultrasound (HIFU) in a mouse head and neck cancer model (SCCVII) compared to muscle tissue. HIFU was applied to SCCVII tumors and to muscle tissue in C3H/Km mice using a dual ultrasound system (imaging 6 MHz/therapeutic 1 MHz). A continuous HIFU mode (total time 20 sec, intensity 6730.6 W/cm2) was applied. Three hours after HIFU treatment pre- and post-contrast T1-wt, T2-wt images, and a diffusion-wt STEAM sequence were obtained. After MR imaging, the animals were euthenized and the treated tumor and muscle tissue was taken out for histology and functional genomic analysis. T2 images showed increased signal intensity, post-contrast T1 showed a decreased contrast uptake in the central parts in the tumor tissue as well as in the muscle tissue. In addition a significant higher diffusion coefficient was found in both tissue types. Histological evaluation (H&E, Immunohistochemistry) of the tumors and the muscle tissue revealed areas of significant necrosis. In the tumor tissue 23 genes were up-regulated (> 2 fold change) and 4 genes were down-regulated (< −2 fold change). In the muscle tissue 29 genes were up-regulated and 17 genes down-regulated. Thirteen genes were up-regulated in both tissue types, 8 genes only in the SCCVII tissue, and 11 genes only in the muscle tissue. The use of HIFU treatment on tumor and muscle tissue results in dramatic changes in gene expression. The expression of some genes are tissue specific, the expression of other genes are independent of the tissue type.
Dosimetric Comparisons of Three-dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and Helical Tomotherapy in Whole Abdominopelvic Radiotherapy for Gynecologic Malignancy
Authors: Kim Yong Bae , Kim Joo Ho , Jeong Kyung Keun , Seong Jinsil , Suh Chang Ok , Kim Gwi Eon 
Published: October 2014

Objectives The goal of this study was to dosimetrically compare 3-dimensional radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and helical tomotherapy (TOMO) plans for whole abdominopelvic radiotherapy (WART) in patients with gynecologic cancer. Methods Ten patients were selected for WART planning. Doses were prescribed to planning target volumes (PTVs) as the followings: 30 Gy to PTV-whole abdominopelvis (PTV-WA), 40 Gy to PTV-para-aortic lymph node (PTV-PALN), 44 Gy to PTV-pelvis, and 50 Gy to gross target volume (GTV) in 20 fractions. Dose to whole liver, both kidneys, and spinal cord were constrained below each tissue tolerance, and bone marrow (BM)-sparing technique was adopted in IMRT and TOMO. Dosimetric parameters and treatment times were compared among plans. Results Calculated doses in TOMO came most closely to the prescribed dose for coverage of PTV-WA, PTV-PALN, PTV-pelvis, and GTV compared to 3DCRT, and IMRT. In normal organs, TOMO had significantly better dosimetric profiles compared to IMRT and 3DCRT. TOMO significantly reduced V20Gy, and mean dose of whole liver, both kidneys, and spinal cord. The use of BM-sparing technique (BMS) did not impair coverage of target volume in IMRT and TOMO. While IMRT showed no differences of irradiated BM dose using BMS, TOMO with BMS reduced half V20Gy of BM compared to TOMO without BMS. Conclusions TOMO showed dosimetric superiority in target coverage, sparing BM, and other normal organs compared to 3DCRT and IMRT. Clinical experiences will be needed for evaluation of feasibility of WART using TOMO in patients with gynecologic cancer.
Muscular Activation During Plyometric Exercises in 90° of Glenohumeral Joint Abduction
Authors: Ellenbecker Todd S. , Sueyoshi Tetsuro , Bailie David S. 
Published: October 2014

Background: Plyometric exercises are frequently used to increase posterior rotator cuff and periscapular muscle strength and simulate demands and positional stresses in overhead athletes. The purpose of this study was to provide descriptive data on posterior rotator cuff and scapular muscle activation during upper extremity plyometric exercises in 90° of glenohumeral joint abduction. Hypothesis: Levels of muscular activity in the posterior rotator cuff and scapular stabilizers will be high during plyometric shoulder exercises similar to previously reported electromyographic (EMG) levels of shoulder rehabilitation exercises. Study Design: Descriptive laboratory study. Methods: Twenty healthy subjects were tested using surface EMG during the performance of 2 plyometric shoulder exercises: prone external rotation (PERP) and reverse catch external rotation (RCP) using a handheld medicine ball. Electrode application included the upper and lower trapezius (UT and LT, respectively), serratus anterior (SA), infraspinatus (IN), and the middle and posterior deltoid (MD and PD, respectively) muscles. A 10-second interval of repetitive plyometric exercise (PERP) and 3 repetitions of RCP were sampled. Peak and average normalized EMG data were generated. Results: Normalized peak and average IN activity ranged between 73% and 102% and between 28% and 52% during the plyometric exercises, respectively, with peak and average LT activity measured between 79% and 131% and between 31% and 61%. SA activity ranged between 76% and 86% for peak and between 35% and 37% for average activity. Muscular activity levels in the MD and PD ranged between 49% and 72% and between 12% and 33% for peak and average, respectively. Conclusion: Moderate to high levels of muscular activity were measured in the rotator cuff and scapular stabilizers during these plyometric exercises with the glenohumeral joint abducted 90°.
Differential impact of allelic ratio and insertion site in FLT3-ITD–positive AML with respect to allogeneic transplantation
Authors: Schlenk Richard F. , Kayser Sabine , Bullinger Lars , Kobbe Guido , Casper Jochen , Ringhoffer Mark , Held Gerhard , Brossart Peter , Lübbert Michael , Salih Helmut R. , Kindler Thomas , Horst Heinz A. , Wulf Gerald , Nachbaur David , Götze Katharina , Lamparter Alexander , Paschka Peter , Gaidzik Verena I. , Teleanu Veronica , Späth Daniela , Benner Axel , Krauter Jürgen , Ganser Arnold , Döhner Hartmut , Döhner Konstanze 
Published: October 2014

Key PointsIn FLT3-ITD–positive AML, high allelic ratio and ITD insertion site in TKD1 predict for low complete remission rates and poor survival. In FLT3-ITD–positive AML, allogeneic HSCT in first CR outweighs the negative impact of high allelic ratio on survival.
Increased expression of CYP17A1 indicates an effective targeting of the androgen receptor axis in castration resistant prostate cancer (CRPC)
Authors: Bremmer Felix , Jarry Hubertus , Strauß Arne , Behnes Carl Ludwig , Trojan Lutz , Thelen Paul 
Published: October 2014

Abstract
Recent breakthrough therapies targeting androgen receptor signalling in castration resistant prostate cancer (CRPC) involve multifunctional androgen receptor (AR) blockade and exhaustive androgen deprivation. Nevertheless, limitations to an enduring effectiveness of new drugs are anticipated in resistance mechanisms occurring under such treatments.
In this study we used CRPC cell models VCaP and LNCaP as well as AR-negative PC-3- and non-neoplastic epithelial BPH-1-cells treated with 5, 10 or 25 μmol/L abiraterone hydrolyzed from abiraterone acetate (AA). The origin of CYP17A1 up-regulation under AA treatment was investigated in CRPC cell models by qRT-PCR and western-blot procedures.
AA treatments of AR positive CRPC cell models led to decreased expression of androgen regulated genes such as PSA. In these cells diminished expression of androgen regulated genes was accompanied by an up-regulation of CYP17A1 expression within short-term treatments. No such effects became evident in AR-negative PC-3 cells. AR directed siRNA (siAR) used in VCaP cells significantly reduced mRNA expression and AR protein abundance. Such interference with AR signalling in the absence of abiraterone acetate also caused a marked up-regulation of CYP17A1 expression. Down-regulation of androgen regulated genes occurs in spite of an elevated expression of CYP17A1, the very target enzyme for this drug. CYP17A1 up-regulation already takes place within such short treatments with AA and does not require adaptation events over several cell cycles. CYP17A1 is also up-regulated in the absence of AA when AR signalling is physically eliminated by siAR.
These results reveal an immediate counter-regulation of CYP17A1 expression whenever AR-signalling is inhibited adequately but not a persisting adaptation yielding drug resistance.
FunSeq2: a framework for prioritizing noncoding regulatory variants in cancer
Authors: Fu Yao , Liu Zhu , Lou Shaoke , Bedford Jason , Mu Xinmeng Jasmine , Yip Kevin Y , Khurana Ekta , Gerstein Mark 
Published: October 2014

AbstractIdentification of noncoding drivers from thousands of somatic alterations in a typical tumor is a difficult and unsolved problem. We report a computational framework, FunSeq2, to annotate and prioritize these mutations. The framework combines an adjustable data context integrating large-scale genomics and cancer resources with a streamlined variant-prioritization pipeline. The pipeline has a weighted scoring system combining: inter- and intra-species conservation; loss- and gain-of-function events for transcription-factor binding; enhancer-gene linkages and network centrality; and per-element recurrence across samples. We further highlight putative drivers with information specific to a particular sample, such as differential expression. FunSeq2 is available from funseq2.gersteinlab.org.
The FES-assisted control for a lower limb rehabilitation robot: simulation and experiment
Authors: Chen Yixiong , Hu Jin , Peng Long , Hou Zeng-guang 
Published: October 2014

Abstract
To design a control strategy for iLeg, an exoskeleton robot developed for lower limb rehabilitation aiming at investigating the feasibility of integrating functional electrical stimulation (FES) with robot-based rehabilitation training, an FES-assisted training strategy combined with impedance control, has been proposed in this paper. Through impedance control, an active compliance of the robot is established, and the patient’s voluntary effort to accomplish the training task is inspired. During the training process, the patient’s related muscles are applied with FES which provides an extra assistance to the patient. The intensity of the FES is properly chosen in order to induce a desired active torque which is proportional to the voluntary effort extracted from the electromyography signals of the related muscles using back propagation neural networks. This kind of enhancement serves as a positive feedback which reminds the patient of the correct attempt to fulfill the desired motion. FES control is conducted by a combination of neural network-based feedforward controller and a PD feedback controller. Simulation conducted using Matlab and the experiment with a spinal cord injury subject and a healthy subject have shown satisfactory results which verify the feasibility of this control strategy.
Using virtual worlds for role play simulation in child and adolescent psychiatry: an evaluation study
Authors: Vallance Aaron K. , Hemani Ashish , Fernandez Victoria , Livingstone Daniel , McCusker Kerri , Toro-Troconis Maria 
Published: October 2014

Aims and methodTo develop and evaluate a novel teaching session on clinical assessment using role play simulation. Teaching and research sessions occurred sequentially in computer laboratories. Ten medical students were divided into two online small-group teaching sessions. Students role-played as clinician avatars and the teacher played a suicidal adolescent avatar. Questionnaire and focus-group methodology evaluated participants' attitudes to the learning experience. Quantitative data were analysed using SPSS, qualitative data through nominal-group and thematic analyses.ResultsParticipants reported improvements in psychiatric skills/knowledge, expressing less anxiety and more enjoyment than role-playing face to face. Data demonstrated a positive relationship between simulator fidelity and perceived utility. Some participants expressed concern about added value over other learning methods and non-verbal communication.Clinical implicationsThe study shows that virtual worlds can successfully host role play simulation, valued by students as a useful learning method. The potential for distance learning would allow delivery irrespective of geographical distance and boundaries.
A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team
Authors: Munro Calum , Thomson Victoria , Corr Jean , Randell Louise , Davies Jennie E. , Gittoes Claire , Honeyman Vicky , Freeman Chris P. 
Published: October 2014

Aims and methodA community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described.ResultsPatients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced.Clinical implicationsThere is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission.
Phyllodes tumours of the breast: radiological presentation, management and follow-up
Authors: McCarthy E , Kavanagh J , O'Donoghue Y , McCormack E , D'Arcy C , O'Keeffe S A 
Published: October 2014

Objective:
Phyllodes tumours (PTs) are rare neoplasms accounting for &lt;1% of breast lesions. With increased breast awareness and screening programmes, smaller PTs are being detected. The purpose of this study was to determine the clinical, radiological and pathological presentation of PTs and to evaluate the role of imaging follow-up, for which there are no specific guidelines.

Methods:
A retrospective study of all patients diagnosed with PT in a symptomatic unit between January 2006 and March 2013 was carried out. Patients were identified using breast care and electronic patient record databases.

Results:
53 patients with 54 lesions were diagnosed as having a PT. The median age was 27.5, 35.0 and 38.5 years for benign, borderline and malignant PT, respectively. Borderline and malignant PTs were larger than benign PTs, with mean sizes of 33 and 42 mm compared with 29 mm. 38% of PTs were labelled by the reporting radiologist as fibroadenomas, including two borderline PTs and one malignant PT. In 24% of cases, the radiologist raised the possibility of PT in the report. 17 patients (40%) developed a new fibroepithelial breast lesion during follow-up of which 4 were recurrent PTs.

Conclusion:
Despite adequate surgical management, the development of further fibroepithelial lesions in the ipsilateral breast is common. 3-year clinical surveillance, with the addition of 6-monthly ultrasound is advised for females with initial borderline or malignant PT histology.

Advances in knowledge:
We propose a follow-up protocol with ultrasound based on the grade of the PT diagnosed for 3 years to detect recurrence.
Heart2Heart: An integrated approach to cardiac rehabilitation and CBT
Authors: Elliot Marion , Salt Heather , Dent June , Stafford Clare , Schiza Angeliki 
Published: October 2014

Background: Heart2Heart is a service that integrates cardiac rehabilitation and psychological therapy for patients following myocardial infarction, as well as for those with other cardiac diseases such as heart failure, cardiomyopathy and arrhythmias. Psychosocial support within cardiac rehabilitation programmes has typically been delivered by a specialist psychologist embedded within the cardiac rehabilitation team. Heart2Heart has provided an alternative to this model by developing a more extensive service, which includes primary and secondary care psychological therapists working in a stepped-care way using the Improving Access to Psychological Therapies (IAPT) stepped-care approach. Stepped care is the provision of the simplest care possible to achieve the intended aims. The service was one of 15 Department of Health long-term condition pathfinder sites evaluating the feasibility of such a service and was subject to a national evaluation. Objectives: To provide an acceptable and accessible psychological assessment and treatment service to patients as part of integrated cardiac care. Methods: This project was designed as a feasibility study to develop an innovative service across organisational boundaries. A selection of validated tools was used to measure anxiety, depression and quality of life outcomes. An economic analysis of primary and secondary care service use was also carried out. Conclusions: The project provided timely and cost-effective cognitive behavioural therapy with high levels of patient satisfaction. Preliminary evidence suggests clinically significant improvements in levels of anxiety, depression and quality of life. Further work is ongoing to explore the economic impact on reducing hospital use and GP attendance.
The role of inter-prosthetic distance, cortical thickness and bone mineral density in the development of inter-prosthetic fractures of the femur
Authors: Weiser L. , Korecki M. A. , Sellenschloh K. , Fensky F. , Püschel K. , Morlock M. M. , Rueger J. M. , Lehmann W. 
Published: October 2014

It is becoming increasingly common for a patient to have ipsilateral hip and knee replacements. The inter-prosthetic (IP) distance, the distance between the tips of hip and knee prostheses, has been thought to be associated with an increased risk of IP fracture. Small gap distances are generally assumed to act as stress risers, although there is no real biomechanical evidence to support this. The purpose of this study was to evaluate the influence of IP distance, cortical thickness and bone mineral density on the likelihood of an IP femoral fracture. A total of 18 human femur specimens were randomised into three groups by bone density and cortical thickness. For each group, a defined IP distance of 35 mm, 80 mm or 160 mm was created by choosing the appropriate lengths of component. The maximum fracture strength was determined using a four-point bending test. The fracture force of all three groups was similar (p = 0.498). There was a highly significant correlation between the cortical area and the fracture strength (r = 0.804, p < 0.001), whereas bone density showed no influence. This study suggests that the IP distance has little influence on fracture strength in IP femoral fractures: the thickness of the cortex seems to be the decisive factor. Cite this article: Bone Joint J 2014;96-B:1378–84.
The identification and quantification of instability in a primary total knee replacement prior to revision
Authors: Hamilton D. F. , Burnett R. , Patton J. T. , Howie C. R. , Simpson A. H. R. W. 
Published: October 2014

Instability is the reason for revision of a primary total knee replacement (TKR) in 20% of patients. To date, the diagnosis of instability has been based on the patient’s symptoms and a subjective clinical assessment. We assessed whether a measured standardised forced leg extension could be used to quantify instability. A total of 25 patients (11 male/14 female, mean age 70 years; 49 to 85) who were to undergo a revision TKR for instability of a primary implant were assessed with a Nottingham rig pre-operatively and then at six and 26 weeks post-operatively. Output was quantified (in revolutions per minute (rpm)) by accelerating a stationary flywheel. A control group of 183 patients (71 male/112 female, mean age 69 years) who had undergone primary TKR were evaluated for comparison. Pre-operatively, all 25 patients with instability exhibited a distinctive pattern of reduction in ‘mid-push’ speed. The mean reduction was 55 rpm (sd 33.2). Post-operatively, no patient exhibited this pattern and the reduction in ‘mid-push’ speed was 0 rpm. The change between pre- and post-operative assessment was significant (p < 0.001). No patients in the control group exhibited this pattern at any of the intervals assessed. The between-groups difference was also significant (p < 0.001). This suggests that a quantitative diagnostic test to assess the unstable primary TKR could be developed. Cite this article: Bone Joint J 2014;96-B:1339–43.