bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oxygen supplementation facilitating successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease following trans-tibial amputation: a case report
Authors: Sohal Jasdeep , Arneja Amarjit , Sharma Sat 
Published: January 2011

Abstract

Introduction
Dysvascular amputations are increasingly performed in patients with underlying cardiac and pulmonary disorders. A limb prosthesis is rarely offered to patients with severe chronic obstructive pulmonary disease because of their inability to achieve the high energy expenditure required for prosthetic ambulation. We describe a case of successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease with the aid of oxygen supplementation.

Case presentation
A 67-year-old aboriginal woman with severe chronic obstructive pulmonary disease and hypercapnic respiratory failure underwent right trans-tibial (below the knee) amputation for severe foot gangrene. An aggressive rehabilitation program of conditioning exercises and gait training utilizing oxygen therapy was initiated. She was custom-fitted with a right trans-tibial prosthesis. A rehabilitation program improved her strength, endurance and stump contracture, and she was able to walk for short distances with the prosthesis. The motion analysis studies showed a cadence of 73.5 steps per minute, a velocity of 0.29 meters per second and no difference in right and left step time and step length.

Conclusion
This case report illustrates that patients with significant severe chronic obstructive pulmonary disease can be successfully fitted with limb prostheses and undergo rehabilitation using supplemental oxygen along with optimization of their underlying comorbidities. Despite the paucity of published information in this area, prosthesis fitting and rehabilitation should be considered in patients who have undergone amputation and have severe chronic obstructive disease.
Spontaneous biloma managed with endoscopic retrograde cholangiopancreatography and percutaneous drainage: a case report
Authors: Bas Gurhan , Okan Ismail , Sahin Mustafa , Eryılmaz Ramazan , Isık Arda 
Published: January 2011

Abstract

Introduction
Spontaneous biloma formation is a very rare condition, which mandates immediate treatment.

Case presentation
An 80-year-old Caucasian man was referred to our department with a diagnosis of intra-abdominal collection located in his right upper quadrant. Further radiological examination demonstrated multiple calculi in his gallbladder and common bile duct. Our patient underwent endoscopic retrograde cholangiopancreatography and the stones in the common bile duct were extracted. Percutaneous drainage of the abdominal collection revealed a spontaneous biloma formation. Continuous drainage of bile persisted for one week, so endoscopic retrograde cholangiopancreatography was repeated and a 10Fr stent was placed; subsequently the biliary leak ceased and our patient was discharged. A control abdominal computed tomography did not show any residual fluid collection.

Conclusion
Spontaneous biloma formation is a very rare incidence; awareness is necessary for prompt recognition and treatment.
Expression and prognostic significance of cancer-testis antigens (CTA) in intrahepatic cholagiocarcinoma
Authors: Zhou Jin-xue , Li Yin , Chen Sun-xiao , Deng An-mei 
Published: January 2011

Abstract

Background
Cancer-testis antigens (CTAs) are suitable targets for cancer-specific immunotherapy. The aim of the study is to investigate the expression of CTAs in intrahepatic cholagiocarcinoma (IHCC) and evaluate their potential therapeutic values.

Methods
Eighty-nine IHCC patients were retrospectively assessed for their expression of CTAs and HLA Class I by immunohistochemistry using the following antibodies: MA454 recognizing MAGE-A1, 57B recognizing multiple MAGE-A (MAGE-A3/A4), E978 recognizing NY-ESO-1, and EMR8-5 recognizing HLA class I. The clinicopathological and prognostic significance of individual CTA markers and their combination were further evaluated.

Results
The expression rates of MAGE-A1, MAGE-A3/4 and NY-ESO-1 were 29.2%, 27.0% and 22.5%, respectively. The concomitant expression of CTAs and HLA class I antigen was observed in 33.7% of the IHCC tumors. We found that positive MAGE-3/4 expression correlated with larger tumor size (≥ 5 cm), tumor recurrence and poor prognosis. Moreover, we identified 52 cases (58.4%) of IHCC patients with at least one CTA marker expression, and this subgroup displayed a higher frequency of larger tumor size and a shorter survival than the other cases. Furthermore, expression of at least one CTA marker was also an independent prognostic factor in patients with IHCC.

Conclusion
Our data suggest that specific immunotherapy targeted CTAs might be a novel treatment option for IHCC patients.
Small airway remodeling in acute respiratory distress syndrome: a study in autopsy lung tissue
Authors: Morales Maina MB , Pires-Neto Ruy C , Inforsato Nicole , Lanças Tatiana , da Silva Luiz FF , Saldiva Paulo HN , Mauad Thais , Carvalho Carlos RR , Amato Marcelo BP , Dolhnikoff Marisa 
Published: January 2011

Abstract
Introduction
Airway dysfunction in patients with the Acute Respiratory Distress Syndrome (ARDS) is evidenced by expiratory flow limitation and dynamic hyperinflation. These functional alterations have been attributed to closure/obstruction of small airways. Airway morphological changes have been reported in experimental models of acute lung injury, characterized by epithelial necrosis and denudation in distal airways. To date, however, no study has focused on the morphological airway changes in lungs from human subjects with ARDS. The aim of this study is to evaluate structural and inflammatory changes in distal airways in ARDS patients.

Methods
We retrospectively studied autopsy lung tissue from subjects who died with ARDS and from control subjects who died of non pulmonary causes. Using image analysis, we quantified the extension of epithelial changes (normal, abnormal and denudated epithelium expressed as percentages of the total epithelium length), bronchiolar inflammation, airway wall thickness, and extracellular matrix (ECM) protein content in distal airways. The Student's t-test or the Mann-Whitney test was used to compare data between the ARDS and control groups. Bonferroni adjustments were used for multiple tests. The association between morphological and clinical data was analyzed by Pearson rank test.

Results
Thirty-one ARDS patients (A: PaO2/FiO2 ≤200, 45 ± 14 years, 16 males) and 11 controls (C: 52 ± 16 years, 7 males) were included in the study. ARDS airways showed a shorter extension of normal epithelium (A:32.9 ± 27.2%, C:76.7 ± 32.7%, P < 0.001), a larger extension of epithelium denudation (A:52.6 ± 35.2%, C:21.8 ± 32.1%, P < 0.01), increased airway inflammation (A:1(3), C:0(1), P = 0.03), higher airway wall thickness (A:138.7 ± 54.3 μm, C:86.4 ± 33.3 μm, P < 0.01), and higher airway content of collagen I, fibronectin, versican and matrix metalloproteinase-9 (MMP-9) compared to controls (P ≤0.03). The extension of normal epithelium showed a positive correlation with PaO2/FiO2 (r2 = 0.34; P = 0.02) and a negative correlation with plateau pressure (r2 = 0.27; P = 0.04). The extension of denuded epithelium showed a negative correlation with PaO2/FiO2 (r2 = 0.27; P = 0.04).

Conclusions
Structural changes in small airways of patients with ARDS were characterized by epithelial denudation, inflammation and airway wall thickening with ECM remodeling. These changes are likely to contribute to functional airway changes in patients with ARDS.
Clinical features of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic obstructive respiratory diseases: a prospective study
Authors: He Hangyong , Ding Lin , Li Fang , Zhan Qingyuan 
Published: January 2011

Abstract
Introduction
Critically ill patients with chronic obstructive respiratory diseases (CORD) who require intensive care unit (ICU) admission are at particular risk for invasive bronchial-pulmonary aspergillosis (IBPA). The purpose of this study is to investigate clinical features for rapid recognition of IBPA in critically ill patients with CORD.

Methods
We included 55 consecutive CORD patients in a respiratory ICU in a prospective, single-center, cohort study. In this study, IBPA combined two entities: ATB and IPA.

Results
Thirteen of 55 patients were diagnosed with IBPA. Before ICU admission, three variables were independent predictors of IBPA with statistical significance: more than three kinds of antibiotics used before the ICU admission, accumulated doses of corticosteroids (>350 mg) received before the ICU admission, and APACHE II scores >18 (OR, 1.208; P = 0.022; OR, 8.661; P = 0.038; and OR, 19.488; P = 0.008, respectively). After ICU admission, more IBPA patients had a high fever (>38.5°C) (46.2% versus 11.9%; P = 0.021), wheeze without exertion (84.6% versus 50.0%; P = 0.027), dry rales (84.6% versus 40.4%; P = 0.005), higher white blood cell counts (21 × 109/L versus 9.4 × 109/L; P = 0.012), lower mean arterial pressures (77.9 mm Hg versus 90.5 mm Hg; P = 0.019), and serum creatinine clearances (36.2 ml/min versus 68.8 ml/min; P < 0.001), and liver-function and coagulation abnormalities. Bronchospasm, sputum ropiness, and plaque formation were more common for IBPA patients during bronchoscopy (66.7% versus 14.3%; P = 0.082; 18% versus 0; P = 0.169; and 73% versus 13%; P = 0.003, respectively). More IBPA patients had nodules and patchiness on chest radiograph on day 1 of admission, which rapidly progressed to consolidation on day 7. IBPA mortality was higher than that of non-IBPA patients (69.2% versus 16.7%; P = 0.001).

Conclusions
IBPA may be suspected in critically ill CORD patients with respiratory failure and clinical and bronchoscopic manifestations of severe infection, bronchospasm, and rapid progression of radiologic lesions that are irresponsive to steroids and antibiotics. To avoid misdiagnosis and establish the microbiologic etiology, early bronchoscopy and tight radiologic follow-up should be performed.
Dissolving the Patient Bermuda Triangle
Authors: Ahgren Bengt 
Published: January 2011

Summary The differentiation of roles, tasks and responsibilities in health care has gradually increased because of efforts to decentralize, specialize and professionalize our health-care systems. These development approaches can on the one hand be regarded as successful, although there is also a negativeflipside. Increased differentiation has concurrently fragmented the delivery of health care, which, in turn, can be divided into structural, clinical and cultural fragmentation. Patients are lost as a result of these conditions of fragmentation. This phenomenon can metaphorically be described as a'Patient Bermuda Triangle’. Actions to dissolve the Patient Bermuda Triangles are commonly termed ‘Integrated health care’, a global buzzword that includes integrated care pathway as well as other integrated health-care strategies. Moreover, integrated care is a means to an end: improved patient outcome. To achieve this, it is crucial to have necessary prerequisites in place: both functional and interactional conditions. This procedure seems to be an organic process where the stakeholders go through gradual changes until the optimum level of integration, as well as mutualistic interactions, is established. If these conditions are concealed or impossible to achieve, developmental work should be ended to avoid the evolvement of antagonistic relations between the stakeholders concerned. This state will likely establish a Patient Bermuda Triangle or reinforce an existing one.
Management challenges in care pathways: Conclusions of a qualitative study within 57 health-care organizations
Authors: Van Gerven E , Vanhaecht K , Deneckere S , Vleugels A , Sermeus W 
Published: January 2011

Summary The objectives of this paper are to study the aim of care pathways, who has decisional power concerning pathways, the actual follow-up, challenges in cross-boundary development and the support provided by information and communication technology (ICT). The study design included a qualitative study using semi-structured interviews with 88 care pathway coordinators and members of the executive board in 57 health-care organizations enrolled in the Belgian- Dutch Clinical Pathway Network. The study revealed that the most important objectives for introducing care pathways are more standardization and quality of care. In 76% of the interviewed organizations, pathways are discussed in a committee. There is a lack of continuous follow-up when care pathways are implemented. Pathways can facilitate cross-boundary care, but are a challenge because of the fragmentation within primary care. There is a need for more ICT support for care pathways. In conclusion, the executive board members and pathway coordinators state that clearly formulated objectives, a special steering committee, a clear follow-up to keep pathways alive, cross-boundary collaboration and ICT support are among the main challenges for the management of an organization.
Why pathways cannot be taken from the shelf
Authors: Vleugels Arthur 
Published: January 2011

Summary Clinical pathways are our most valuable and performant tool in managing health-care processes. Sloppiness and inaccuracy, in both definition and implementation, threaten to erode the concept and, thus, to undermine its power. Back to basics is not a plea for nostalgia, but for continuing consistently to design care according to a patient's needs, to focus on desired clinical outcomes and to anchor the care processes into the daily life of the health-care organization.
Development of a health promotion care pathway for adult hospital-based patients
Authors: Sinclair Janet , Haynes Charlotte , Lee Deborah 
Published: January 2011

Summary UK health policy highlights the importance of hospital patients being assessed for smoking, alcohol and obesity, and delivered health promotion for these risk factors; yet there is a paucity of guidance and research on health promotion care pathways that can inform the development of effective and efficient hospital health promotion services. Consultation with health-care professionals and public health experts was undertaken in order to develop a health promotion care pathway for smoking, alcohol and obesity. Eight adult wards piloted the care pathway. An audit of case-notes was completed for patients discharged from the pilot wards over 13 weeks. Patients were also followed up by survey for service and behaviour change feedback four weeks after discharge. In all, 56% of patients were assessed for lifestyle risk factors, 43% of whom were identified as having a risk factor and 13% were referred to specialists in delivering brief interventions (key workers). Seventy percent of patients referred to as key workers reported a positive change in their lifestyle. In conclusion, involvement of staff is essential in the development of the care pathway, ensuring that timely efficient processes are in place in order to affect the optimal outcome for patients in changing lifestyle behaviours.
Quantitative evaluation trial for functions included in currently available electronic clinical pathways products
Authors: Wakamiya Shunji , Yamauchi Kazunobu 
Published: January 2011

Summary No quantitative method is available to evaluate the functions of electronic clinical pathways embedded in electronic medical records. Therefore, we developed new evaluation sheets. The standard functions of electronic clinical pathways published in 2007 were modified to facilitate their quantification, and functions requested at Kawasaki Medical School Hospital were added when electronic medical records were introduced. Electronic clinical pathways products by four vendors were evaluated quantitatively and each function was given a weight according to its importance. Moreover, we compared this quantitative evaluation with the subjective evaluation of four staff from the Committee of Clinical Pathways. The results indicated that the implementation of many functions differed among the four vendors, and the quantitative evaluations were comparable. The weights of each function may differ among hospitals due to differences in their medical background, and further studies regarding weighting are necessary. It can be concluded that the method described in this study will be useful for quantitative evaluation of electronic clinical pathways functions.
Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy
Authors: Karmisholt Jesper , Andersen Stig , Laurberg Peter 
Published: January 2011

Subclinical hypothyroidism (SCH) is a common condition that is often observed without therapy. However, no evidence-based recommendation exists with regards to how patients with untreated SCH should be monitored.Monitoring involves regular assessment of symptoms and signs of hypothyroidism (HYPO) and biochemical tests of thyroid function. An important question when repeated tests of thyroid function are performed is how large a difference in test results is needed to be confident that the change is real and not just due to chance variation.Recent data show that the least significant difference between two tests in SCH is 40% for TSH and 15% for free thyroxine and free triiodothyronine, with 90% confidence. Furthermore, monitoring has to be based on biochemical function testing because serial evaluation of symptoms and signs related to HYPO is rather insensitive in detecting worsening of thyroid insufficiency.When the presence of thyroid peroxidase auto-antibodies (TPO-Ab) in serum has been demonstrated, repeated measurements do not add much useful information in the monitoring of individual subclinical hypothyroid patients, as levels of TPO-Ab vary in parallel with TSH in these patients.Lastly, we discuss how differences in the monitoring procedure influence the diagnostic outcome, and we suggest a follow-up approach for untreated subclinical hypothyroid patients.
Isolation and Distribution of Bacterial Flora in Farmed Rainbow Trout from Mexico
Authors: Salgado-Miranda Celene , Palomares Elizabeth , Jurado Mirsam , Marín Aída , Vega Fernando , Soriano-Vargas Edgardo 
Published: January 2011

Abstract
Trout farming is a growing aquaculture industry in Mexico, with stock mainly supplied by the importation of eyed eggs. The aim of the present study was to determine the frequency of bacterial isolations in farmed rainbow trout Oncorhynchus mykiss from Mexico. Sixty-five farms distributed among seven states of Mexico were included in the study. Individual samples from gills, liver, spleen, intestine, and kidney were obtained from 563 apparently healthy fish. In total, 371 bacterial isolates were recovered from sampled fish; isolates of the genera Aeromonas, Edwardsiella, Enterobacter, Escherichia, Klebsiella, Plesiomonas, Pseudomonas, and Yersinia were identified. Aeromonads were the most frequently isolated bacteria. Renibacterium salmoninarum was not isolated from any of the sampled fish. Our results showed the presence of bacteria that are potential pathogens of both rainbow trout and humans.
Asian Fish Tapeworm Bothriocephalus acheilognathi in the Desert Southwestern United States
Authors: Archdeacon Thomas P. , Iles Alison , Kline Jason S. , Bonar Scott A. 
Published: January 2011

Abstract
The Asian fish tapeworm Bothriocephalus acheilognathi (Cestoda: Bothriocephalidea) is an introduced fish parasite in the southwestern United States and is often considered a serious threat to native desert fishes. Determining the geographic distribution of nonnative fish parasites is important for recovery efforts of native fishes. We examined 1,140 individuals belonging to nine fish species from southwestern U.S. streams and springs between January 2005 and April 2007. The Asian fish tapeworm was present in the Gila River, Salt River, Verde River, San Pedro River, Aravaipa Creek, and Fossil Creek, Arizona, and in Lake Tuendae at Zzyzx Springs and Afton Canyon of the Mojave River, California. Overall prevalence of the Asian fish tapeworm in Arizona fish populations was 19% (range = 0–100%) and varied by location, time, and fish species. In California, the prevalence, abundance, and intensity of the Asian fish tapeworm in Mohave tui chub Gila bicolor mohavensis were higher during warmer months than during cooler months. Three new definitive host species—Yaqui chub G. purpurea, headwater chub G. nigra, and longfin dace Agosia chrysogaster—were identified. Widespread occurrence of the Asian fish tapeworm in southwestern U.S. waters suggests that the lack of detection in other systems where nonnative fishes occur is due to a lack of effort as opposed to true absence of the parasite. To limit further spread of diseases to small, isolated systems, we recommend treatment for both endo- and exoparasites when management actions include translocation of fishes.
Effectiveness of Aquaflor (50% Florfenicol) to Control Mortality Associated with Streptococcus iniae in Freshwater-Reared Subadult Sunshine Bass
Authors: Bowker James D. , Ostland Vaughn E. , Carty Daniel , Bowman Molly P. 
Published: January 2011

Abstract
We conducted a field trial to evaluate the effectiveness of Aquaflor (50% florfenicol) for controlling mortality associated with Streptococcus iniae in freshwater-reared subadult sunshine bass (female white bass Morone chrysops × male striped bass M. saxatilis). Bacterial samples collected from moribund fish representing a reference population were presumptively identified microbiologically and were later confirmed to be S. iniae by biochemical characterization and polymerase chain reaction. The trial comprised a 1-d acclimation period, 10-d treatment period, and 14-d posttreatment period. During the treatment period, Aquaflor-medicated feed was administered to treated tanks (N = 3) at a target dose of 10 mg of florfenicol·kg of fish−1·d−1, and nonmedicated feed was administered to control tanks (N = 3). At the end of the posttreatment period, mean (±SD) cumulative mortality in treated tanks (9 ± 11%) was significantly (P = 0.040) less than that in control tanks (52 ± 13%). Analysis of medicated feed samples revealed that treated tanks had received an actual dose of 8.3 mg florfenicol·kg fish−1·d−1 (83% of target). No florfenicol was detected in control feed samples. Although the actual florfenicol dose administered to treated tanks was less than the target dose, the trial was accepted by the U.S. Food and Drug Administration Center for Veterinary Medicine as demonstrating the efficacy of Aquaflor to control mortality associated with S. iniae in cultured sunshine bass populations.