bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluoroscopic Determination of the Tibial Insertion of the Posterior Cruciate Ligament in the Sagittal Plane
Authors: Salim Rodrigo , Salzler Matthew J. , Bergin Mark A. , Zheng Liying , Carey Robert E. , Kfuri Mauricio , Zhang Xudong , Harner Christopher D. 
Published: February 2015

Background: Currently, placement of the tibial tunnel for arthroscopic transtibial posterior cruciate ligament (PCL) reconstruction relies on a limited arthroscopic view of the native insertion or the use of intraoperative imaging. No widely accepted method exists for intraoperative determination of PCL tibial tunnel placement, and current descriptions are cumbersome. Purpose: To identify the center of the PCL’s anatomic tibial insertion site as a percentage of the PCL facet length on a lateral radiograph of the knee so that it may be reliably located in the sagittal plane during surgical reconstruction. Study Design: Descriptive laboratory study. Methods: Twenty fresh-frozen cadaveric knees were dissected and the tibial insertions of the PCL were digitized with an optical tracing system. The digitized PCL footprints were mapped onto 3-dimensional computed tomography–acquired tibial models, and their center points were determined. A K-wire was then inserted into the center of the PCL’s tibial insertion under direct visualization, a direct lateral radiograph was obtained, and the center point was measured. The center locations for both methods were defined as a percentage of PCL facet length from anterior and proximal to posterior and distal, and intraobserver and interobserver reliability was tested with 4 different observers. Results: The average location of the PCL center on the 3-dimensional bone model method was 71.7% ± 5.6% along the PCL facet from anterior/proximal to posterior/distal. In the lateral radiographic method, the center of the PCL was at an average of 69.7% ± 4.9% of the facet length. There was no significant difference between the percentage measurements of the 2 methods ( P = .13). Interobserver reliability (κ = 0.57) and intraobserver reliability (κ = 0.71) were moderate to strong. Conclusion: Locating the center of the tibial PCL insertion with fluoroscopy at a point that is 70% of the PCL tibial facet length on a true lateral radiograph is a reliable method for locating the PCL tibial insertion. Clinical Relevance: The method described in this study enables clinicians to identify the tibial location of the PCL insertion, which must be accurately determined during PCL reconstruction.
Identifying High-Risk Children in the Emergency Department
Authors: Nielsen Katie R. , Migita Russ , Batra Maneesh , Gennaro Jane L. Di , Roberts Joan S. , Weiss Noel S. 
Published: February 2015

Purpose: Early warning scores (EWS) identify high-risk hospitalized patients prior to clinical deterioration; however, their ability to identify high-risk pediatric patients in the emergency department (ED) has not been adequately evaluated. We sought to determine the association between modified pediatric EWS (MPEWS) in the ED and inpatient ward-to-pediatric intensive care unit (PICU) transfer within 24 hours of admission. Methods: This is a case–control study of 597 pediatric ED patients admitted to the inpatient ward at Seattle Children’s Hospital between July 1, 2010, and December 31, 2011. Cases were children subsequently transferred to the PICU within 24 hours, whereas controls remained hospitalized on the inpatient ward. The association between MPEWS in the ED and ward-to-PICU transfer was determined by chi-square analysis. Results: Fifty children experienced ward-to-PICU transfer within 24 hours of admission. The area under the receiver–operator characteristic curve was 0.691. Children with MPEWS > 7 in the ED were more likely to experience ward-to-PICU transfer (odds ratio 8.36, 95% confidence interval 2.98-22.08); however, the sensitivity was only 18.0% with a specificity of 97.4%. Using MPEWS >7 for direct PICU admission would have led to 167 unnecessary PICU admissions and identified only 9 of 50 patients who required PICU care. Conclusions: Elevated MPEWS in the ED is associated with increased risk of ward-to-PICU transfer within 24 hours of admission; however, an MPEWS threshold of 7 is not sufficient to identify more than a small proportion of ward-admitted children with subsequent clinical deterioration.
Spot urine protein/creatinine ratio is unreliable estimate of 24 h proteinuria in lupus nephritis when the histological scores of activity index are higher
Authors: Zhang Q , Sun L , Jin L 
Published: February 2015

Objectives The aim of this study was to evaluate the correlation and agreement of spot urine protein/creatinine (P/C) ratio with 24 h proteinuria in patients with lupus nephritis (LN) under different scores of activity index (AI). Methods In total, 90 pairs of 24 h urine and spot urine samples from 90 patients with biopsy-proven LN were analyzed. The correlation and agreement between the two sample types were assessed by Pearson correlation and intra-class correlation coefficient (ICC) using mixed model for repeated measurements, respectively. Results and conclusions Overall, 24 h proteinuria correlated strongly with the spot urine P/C ratio ( r = 0.671, p < 0.001) with a good agreement (ICC = 0.656, 95% confidence interval (CI): 0.52–0.76). Subgroup analyses revealed that the correlation remained high in all groups ( r = 0.825, p < 0.001; r = 0.567, p = 0.001; r = 0.686, p = 0.020), the agreement in group A (low AI) was good (ICC = 0.824, 95% CI: 0.70–0.89), but in group B (middle AI) and group C (high AI), the agreements were weak (ICC = 0.503, 95% CI: 0.19–0.72; ICC = 0.532, 95% CI: 0.06–0.84). Our work suggests that over the range of a higher AI, however, correlation was present but agreement was poor.
Ethical competence
Authors: Kulju Kati , Stolt Minna , Suhonen Riitta , Leino-Kilpi Helena 
Published: February 2015

Background: Exploring the concept of ethical competence in the context of healthcare is essential as it pertains to better quality of care. The concept still lacks a comprehensive definition covering the aspects of ethical expertise, ethical knowledge and action of a health professional. Objective: This article aims to report an analysis of the concept of ethical competence. Method: A modified strategy suggested by Walker and Avant was used to analyse the concept. Results: As a result, the concept of ethical competence can be defined in terms of character strength, ethical awareness, moral judgement skills and willingness to do good. Virtuous professional, experience of a professional, human communication, ethical knowledge and supporting surroundings in the organisation can be seen as prerequisites for ethical competence. Ethical competence results in the best possible solutions for the patient, reduced moral distress at work and development and democratisation of society. Conclusion: The results of the analysis establish a basis for an instrument to evaluate health professionals’ ethical competence. It will guide educators, as well as managers in healthcare, to support the development of ethical conduct in healthcare.
Itraconazole therapy in a pancreatic adenocarcinoma patient: A case report
Authors: Lockhart Nicholas R , Waddell James Aubrey , Schrock Nathan Eric 
Published: February 2015

Objective To report the case of a patient receiving itraconazole for the treatment of histoplasmosis and his subsequent reduction in pancreatic tumor size. Case summary A 64-year-old male was diagnosed with Stage III locally advanced unresectable pancreatic adenocarcinoma. The patient was administered radiation plus chemotherapy, which included cisplatin and capecitabine. Upon restaging, the patient’s tumor was again determined to be unresectable; therefore, palliative chemotherapy treatments were initiated, which included gemcitabine and erlotinib. After two gemcitabine cycles, he was admitted to the hospital because of loss of motor function due to spinal cord hemisection. After the surgery, the patient became neutropenic because of previous chemotherapy cycle and developed disseminated histoplasmosis. After he received his nine-month course of itraconazole, the pancreatic cancer was readdressed and he was then deemed to be resectable and had a Whipple procedure. Over the next several years, he showed no evidence of pancreatic metastases or relapse. Discussion Itraconazole has been shown to have many mechanisms by which it could potentially suppress tumor cell growth, which includes inhibition of the Hedgehog pathway, vascular endothelial growth factor receptor-2, and P-glycoprotein efflux pump. This azole antifungal has been studied in small patient populations with various types of cancers. Studies of basal cell carcinoma, nonsmall cell lung cancer, ovarian cancer, and malignant pleural mesothelioma have shown favorable results suggesting that more study of itraconazole is warranted to decide its clinical utility. Conclusion There would need to be much more research performed to determine if this agent had a role as a chemotherapy agent; however, health care professionals should be aware of itraconazole’s potential antineoplastic mechanisms.
Efficacy of telemedicine for thrombolytic therapy in acute ischemic stroke: a meta-analysis
Authors: Zhai Yun-kai , Zhu Wei-jun , Hou Hong-li , Sun Dong-xu , Zhao Jie 
Published: February 2015

Summary The aim of this study was to assess the benefits of telemedicine in the delivery of thrombolytic therapy for patients with acute ischemic stroke. We performed a meta-analysis using combinations of the following terms: telestroke, telemedicine, tissue plasminogen activator/t-PA, and acute ischemic stroke. The primary outcome was favorable outcome based on the modified Rankin score. Secondary outcomes were incidence of symptomatic intracranial hemorrhage and overall mortality. We found no significant difference in favorable outcome between the telemedicine and control groups, and no significant difference was found between these groups in the rate of symptomatic intracranial hemorrhage or overall mortality. Patients with acute ischemic stroke who were treated with intravenous thrombolysis had similar outcomes regardless of whether telemedicine was used or they were treated in-person at a medical facility. Telemedicine can be used to support hospitals with limited experience in administering thrombolytic therapy for stroke.
Impact of diabetes and diastolic dysfunction on exercise capacity in normotensive patients without coronary artery disease
Authors: Gürdal Ahmet , Kasikcioglu Erdem , Yakal Sertac , Bugra Zehra 
Published: February 2015

Objective: The aim of this study was to determine the impact of diabetes and diastolic dysfunction on exercise capacity in asymptomatic, normotensive patients with type 2 diabetes without coronary artery disease. Methods: A total of 43 type 2 diabetes patients (age: 50 ± 5 years) and 20 healthy controls (age: 48 ± 4 years) were enrolled. Diastolic function was investigated by conventional pulsed-wave (PW) Doppler and tissue Doppler imaging (TDI). Exercise capacity was evaluated with cardiopulmonary exercise testing (CPET). Results: In patients with type 2 diabetes, increase in resting heart rate (HR-rest) ( p = 0.013), decrease in maximum heart rate during exercise (HR-max) ( p < 0.001) and exercise time ( p < 0.001) compared with controls were significant. Patients had significantly increased minute ventilation volume (VE)/maximum carbon dioxide discharge (VCO2) ratio ( p < 0.001), decreased maximum oxygen consumption (VO2-max) ( p < 0.001), oxygen consumption at anaerobic threshold (VO2-an) ( p < 0.001) and maximum carbon dioxide discharge (VCO2) ( p < 0.001) compared to controls indicating significantly reduced exercise capacity. HbA1c was inversely correlated with VO2-max ( r = −0.456, p < 0.01) independent of the absence or presence of mild diastolic dysfunction. Conclusion: Exercise capacity was found to be significantly decreased in normotensive patients with type 2 diabetes without coronary artery disease, and this decrease was independent of diastolic dysfunction.
The leadership shadow: How to recognise and avoid derailment, hubris and overdrive
Authors: de Haan Erik 
Published: February 2015

In his influential book Capital in the 21st Century Thomas Piketty (2014) shows that the present rate of return on capital being higher than economic growth is leading to increasing wealth and income inequality, which ultimately stifles our growth and prosperity. For some time I have noticed a similar pattern applying to top leadership in corporates, where current growth rates of managerial discretion and remuneration topple increases in leadership effectiveness, which is leading to organisational inequalities that are stifling our economy’s development, agility and growth. In this article I look at the immense pressures on the function of leadership, on leaders and their followers, from an organisational, ontological and personal perspective. I try to demonstrate that there are three areas of conflict: the projections and expectations put upon leaders, the confusion of misleading definitions of leadership, and an internal conflict which always emerges when taking up a leadership role. I describe and explore the emergence of a splitting phenomenon called the leadership shadow which is a common consequence of these pressures, and suggest a few local solutions to this great societal leadership predicament.
Squamous Cell Carcinoma With Chronic Osteomyelitis
Authors: Monaco Spencer J. , Pearson Kyle , Wukich Dane K. 
Published: February 2015

Squamous cell carcinoma is one of the most common human malignancies; however, it is uncommon in the lower extremity. These lesions require prompt surgical attention and a delay in diagnosis can be harmful to the patient. We present a case report of squamous cell carcinoma with chronic osteomyelitis in a patient without diabetes. Definitive treatment included a transtibial amputation and metastatic workup was negative for active malignancy. Surgeons who treat chronic wounds should be cognizant of the potential for malignant degeneration. Level of Evidence: Therapeutic, Level IV: Case report
Aurora kinase A is required for hematopoiesis but is dispensable for murine megakaryocyte endomitosis and differentiation
Authors: Goldenson Benjamin , Kirsammer Gina , Stankiewicz Monika J. , Wen Qiang Jeremy , Crispino John D. 
Published: February 2015

Key Points
AURKA is essential for adult hematopoiesis. AURKA is dispensable for megakaryocyte polyploidization and differentiation.
Thermochemically activated carbon as an electrode material for supercapacitors
Authors: Ostafiychuk Bogdan K , Budzulyak Ivan M , Rachiy Bogdan I , Vashchynsky Vitalii M , Mandzyuk Volodymyr I , Lisovsky Roman P , Shyyko Lyudmyla O 
Published: February 2015

Abstract
The results of electrochemical studies of nanoporous carbon as electrode material for electrochemical capacitors (EC) are presented in this work. Nanoporous carbon material (NCM) was obtained from the raw materials of plant origin by carbonization and subsequent activation in potassium hydroxide. It is established that there is an optimal ratio of 1:1 between content of KOH and carbon material at chemical activation, while the maximum specific capacity of NCM is 180 F/g. An equivalent electrical circuit, which allows modeling of the impedance spectra in the frequency range of 10−2 to 105 Hz, is proposed, and a physical interpretation of each element of the electrical circuit is presented.
Types of Skin Afferent Fibers and Spinal Opioid Receptors that Contribute to Touch-Induced Inhibition of Heart Rate Changes Evoked by Noxious Cutaneous Heat Stimulation
Authors: Watanabe Nobuhiro , Piché Mathieu , Hotta Harumi 
Published: February 2015

Background In anesthetized rats and conscious humans, a gentle touch using a soft disc covered with microcones (with a texture similar to that of a finger), but not with a flat disc, inhibits nociceptive somatocardiac reflexes. Such an inhibitory effect is most reliably evoked when touch is applied to the skin ipsilateral and closest to nociceptive inputs. However, the mechanism of this inhibition is not completely elucidated. We aimed to clarify the types of cutaneous afferent fibers and spinal opioid receptors that contribute to antinociceptive effects of microcone touch. Results The present study comprised two experiments with urethane-anesthetized rats. In the first experiment, unitary activity of skin afferent fibers was recorded from the saphenous nerve, and responses to a 10-min touch using a microcone disc and a flat disc (control) were compared. Greater discharge rate during microcone touch was observed in low-threshold mechanoreceptive Aδ and C afferent units, whereas many Aβ afferents responded similarly to the two types of touch. In the second experiment, the effect of an intrathecal injection of opioid receptor antagonists on the inhibitory effects of microcone touch on heart rate responses to noxious heat stimulation was examined. The magnitude of the heart rate response was significantly reduced by microcone touch in rats that received saline or naltrindole (δ-opioid receptor antagonist) injections. However, such an inhibition was not observed in rats that received naloxone (non-selective opioid receptor antagonist) or Phe-Cys-Tyr-Trp-Orn-Thr-Pen-Thr-NH2 (CTOP; μ-opioid receptor antagonist) injections. Conclusions Microcone touch induced greater responses of low-threshold mechanoreceptive Aδ and C afferent units than control touch. The antinociceptive effect of microcone touch was abolished by intrathecal injection of μ-opioid receptor antagonist. These results suggest that excitation of low-threshold mechanoreceptive Aδ and C afferents produces the release of endogenous μ-opioid ligands in the spinal cord, resulting in the inhibition of nociceptive transmission that contributes to somatocardiac reflexes.
High-depth sequencing of over 750 genes supports linear progression of primary tumors and metastases in most patients with liver-limited metastatic colorectal cancer
Authors: Tan Iain Beehuat , Malik Simeen , Ramnarayanan Kalpana , McPherson John R , Ho Dan Liang , Suzuki Yuka , Ng Sarah Boonhsui , Yan Su , Lim Kiat Hon , Koh Dennis , Hoe Chew Min , Chan Chung Yip , Ten Rachel , Goh Brian KP , Chung Alexander YF , Tan Joanna , Chan Cheryl Xueli , Tay Su Ting , Alexander Lezhava , Nagarajan Niranjan , Hillmer Axel M , Tang Choon Leong , Chua Clarinda , Teh Bin Tean , Rozen Steve , Tan Patrick 
Published: February 2015

Abstract
Background
Colorectal cancer with metastases limited to the liver (liver-limited mCRC) is a distinct clinical subset characterized by possible cure with surgery. We performed high-depth sequencing of over 750 cancer-associated genes and copy number profiling in matched primary, metastasis and normal tissues to characterize genomic progression in 18 patients with liver-limited mCRC.

Results
High depth Illumina sequencing and use of three different variant callers enable comprehensive and accurate identification of somatic variants down to 2.5% variant allele frequency. We identify a median of 11 somatic single nucleotide variants (SNVs) per tumor. Across patients, a median of 79.3% of somatic SNVs present in the primary are present in the metastasis and 81.7% of all alterations present in the metastasis are present in the primary. Private alterations are found at lower allele frequencies; a different mutational signature characterized shared and private variants, suggesting distinct mutational processes. Using B-allele frequencies of heterozygous germline SNPs and copy number profiling, we find that broad regions of allelic imbalance and focal copy number changes, respectively, are generally shared between the primary tumor and metastasis.

Conclusions
Our analyses point to high genomic concordance of primary tumor and metastasis, with a thick common trunk and smaller genomic branches in general support of the linear progression model in most patients with liver-limited mCRC. More extensive studies are warranted to further characterize genomic progression in this important clinical population.
The effects of land use types, management practices and slope classes on selected soil physico-chemical properties in Zikre watershed, North-Western Ethiopia
Authors: Selassie Yihenew G , Anemut Fentanesh , Addisu Solomon 
Published: February 2015

AbstractBackgroundLand degradation is one of the major threats to food security and natural resources conservation Zikre watershed. The objective of the study was to investigate the effects of land use types, management practices and slope classes on soil physico-chemical properties.ResultsResults of the experiment indicated highest mean values of total nitrogen (0.23%), organic matter (5.01%) and cation exchange capacity (35.44 cmol(+)kg−1) were recorded under the natural forest and the lowest values of the same (0.12%, 2.57% and 26.08 cmol(+)kg−1, respectively) were registered in crop lands. Available phosphorus content was the highest (6.18 mg kg1) in crop lands and the lowest (1.33 mg kg−1) in grazing lands. Comparing management practices the highest mean values of available phosphorus (18.41 mg kg−1), organic matter (5.88%) and total nitrogen (0.29%) were recorded from the cultivated land treated with both manure and soil bund compared to sole soil bund, sole manure and the control plots. Considering the slope classes, the higher mean values of total nitrogen (0.19%), organic matter (4.49%) and cation exchange capacity (33.09 cmol(+)kg1) were recorded in the lower slope classes followed by middle (0.17%, 3.39% and 30.58 cmol(+)kg−1, respectively) and upper slope classes (0.14%, 2.65% and 27.36 cmol(+)kg−1, respectively).ConclusionsTo conclude, conversion of forest lands to cultivated and grazing lands had detrimental effects on the soil physico-chemical properties; whereas construction of soil bunds on farm fields and application of manure improve the same under subsistence farming systems.
Effect of vitamin D supplementation on glycemic control in patients with type 2 diabetes: a systematic review of interventional studies
Authors: Nigil Haroon Nisha , Anton Ammepa , John Jisha , Mittal Madhukar 
Published: February 2015

AbstractBackgroundDiabetes and vitamin D deficiency are global epidemics. Researchers have long been exploring the role of potentially modifiable factors to manage type 2 diabetes. We conducted a systematic review of prospective studies and randomized controlled trials that involved vitamin D supplementation and specifically intended to study glycemic outcomes related to type 2 diabetes.MethodsTwo authors independently searched Medline and PubMed for longitudinal studies that had assessed the effect of vitamin D supplements on glycemic control, insulin resistance and beta-cell dysfunction in patients with diabetes.ResultsSeventeen randomized control trials and seven longitudinal studies with a minimum follow-up of one month were included.Results of the various short-term studies (follow up ≤ 3 months) suggested that vitamin D supplementation had a positive impact on glycemic control and metabolic parameters such as insulin resistance and beta cell dysfunction. However, the evidence was weak due to the low methodological quality of the studies. There was no significant effect on HbA1c, beta cell function and insulin resistance in the long-term studies (follow up > 3 months). There existed heterogeneity in the methodology of the studies, inclusion criteria, mode of supplementation of vitamin D and the duration of follow up.ConclusionsCurrent evidence based on randomized controlled trials and longitudinal studies do not support the notion that vitamin D supplementation can improve hyperglycemia, beta cell secretion or insulin sensitivity in patients with type 2 diabetes. Large-scale trials with proper study design, optimal vitamin D supplementation and longer follow up need to be conducted.