bluuebunny/crossref_metadata_2025_split huggingface dataset:
The results of real‐time brachytherapy for the management of low‐ and intermediate‐risk prostate cancer in patients with prostate volumes up to 100 mL
Authors: Dallas Nicola L. , Malone Peter R. , Jones Adam , Doggart Andrew J. , McConway Kevin J. , Rogers Paul B. 
Published: February 2012

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Historically, the majority of centres in the UK practise a pre‐plan brachytherapy technique which is limited to prostate volumes <50 ml. This study provides further evidence that it is technically possible to deliver a quality implant in a large prostate using real‐time brachytherapy and that the treatment is well tolerated. It has emphasized the value of functional parameters in selecting appropriate patients and concluded that prostate volumes up to 100 ml should not exclude patients from brachytherapy.OBJECTIVES
To report the results of real‐time brachytherapy in the management of low‐risk and intermediate‐risk prostate cancer in patients with prostate volumes up to 100 mL, over a 6‐year period.
To prospectively determine whether prostate volume influences the ability to achieve a quality implant and therefore impact upon prostate‐specific antigen (PSA) relapse‐free survival, and urinary and rectal toxicity.
SUBJECTS AND METHODS
In all, 216 men with localized prostate cancer were treated with real‐time prostate brachytherapy using 125I implants between November 2003 and December 2009.
Patient selection was based upon functional parameters; International Prostate Symptom Score (IPSS) and flowmetry.
Patients had computed tomography imaging at 1 month to assess post‐implant dosimetry. PSA, IPSS and Radiation Therapy Oncology Group rectal toxicity scores were recorded prospectively over the follow‐up period.
Patients with prostate volumes ≤50 mL and those with volumes >50 mL were compared.
RESULTS
Overall PSA relapse‐free survival was 98.8%; 97.0% for intermediate‐risk patients and 100.0% for low‐risk patients. By volume, 98.5% of men with standard prostates were free from PSA relapse compared with 100.0% of men with large prostates.
The mean post‐implant D90 was 177.0 Gy; 175.5 Gy in standard prostates and 183.5 Gy in large prostates.
The overall acute urinary retention rate was 1.9%; 1.7% in standard prostates and 2.4% in large prostates. There were three urethral strictures, all in the standard prostate group. The mean IPSS increased to 11 and 14 at 3 months for the standard and large prostate groups, respectively, before settling to 2 above baseline for both groups at 12 months.
There were no rectovesical fistulae. Persistent rectal bleeding was reported by one (0.5%) patient in the standard prostate group.
CONCLUSIONS
Prostate brachytherapy is effective in the treatment of low‐risk and intermediate‐risk prostate cancer.
It is technically possible to deliver a quality implant in a large prostate using real‐time brachytherapy.
The treatment itself is well tolerated. Prostate volumes up to 100 mL should not exclude patients from brachytherapy providing either flow rate ≥14 mL/s or symptom score (IPSS) ≤ 10.
Laparoscopic partial nephrectomy: beyond the straightforward T1a
Authors: Tsivian Alexander , Tsivian Matvey , Stanevsky Yury , Benjamin Shalva , Sidi A. Ami 
Published: February 2012

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Complex tumour features (e.g. size, hilar location, multifocality) are generally considered contraindicative for LPN and only a handful of studies reporting encouraging outcomes with more complex tumours. Herein we suggest that in experience hands the benefits of minimally‐invasive surgery may be safely extended to patients with more complex renal masses.OBJECTIVE
To report on our experience in extending the indications for LPN beyond the single, T1a renal mass assessing the perioperative outcomes in a comparative fashion.
PATIENTS AND METHODS
Retrospective review of consecutive patients undergoing LPN for a renal mass in an academic centre between 2005–2010.
150 patients were divided into two groups based on tumours characteristics: straightforward T1a (group 1: single, <4 cm, n = 84) and complex (group 2: multiple and/or hilar and/or ≥4 cm, n = 66).
Comparison of demographic, clinical, radiographic and perioperative outcomes (operative times, blood loss, warm ischemia times, intra‐ and postoperative complications).
RESULTS
In group 2, 19 tumours were hilar, 15 were multifocal and 44 measured ≥4 cm; 2 of these criteria were present in 7, and all three in 3 cases.
Warm ischemia times and blood loss were comparable (medians of 21 vs 20 min, and 100 vs 100 mL).
Operative times were longer in group 2 (190 vs 140min, P < 0.001).
Complications occurred in 11.9% and 12.1% of patients in group 1 and 2, with Clavien grade 3 events in 8.3 and 10.9%, respectively (P = 1.00 and P = 0.547).
There were 4 conversions to laparoscopic radical nephrectomy (1 in group 1, 3 in group 2).
CONCLUSION
With adequate laparoscopic expertise, the indications for LPN can be safely extended beyond the single, small, peripheral T1a renal mass. In this series, more complex masses were effectively treated with LPN combining the advantages of minimally‐invasive surgery to those of nephron‐sparing approach.
Does severe hypoglycaemia influence microvascular complications in Type 1 diabetes? An analysis of the Diabetes Control and Complications Trial database
Authors: Kilpatrick E. S. , Rigby A. S. , Atkin S. L. , Frier B. M. 
Published: February 2012

Diabet. Med. 29, 1195‐1198 (2012)AbstractAims Severe hypoglycaemia may have a role in aggravating micro‐ and macrovascular disease in diabetes. Data from the Diabetes Control and Complication Trial have been reanalysed to ascertain whether the frequency of severe hypoglycaemia exerted an influence on the development and progression of retinopathy or nephropathy in people with Type 1 diabetes.Methods Using binary longitudinal multiple logistic regression, HbA1cat study baseline, mean HbA1cthroughout the study and the number of severe hypoglycaemic episodes during the trial were compared to examine the risk of development/progression of retinopathy and nephropathy.Results Average HbA1cduring the study and/or HbA1cat baseline were independently predictive of retinopathy and nephropathy both in the intensively and the conventionally treated patients (allP ≤ 0.001). However, the number of hypoglycaemic episodes did not add to HbA1cin predicting retinopathy [odds ratio (95% CI) 0.99 (0.96–1.01),P = 0.51 in intensively treated patients, 0.94 (0.89–1.00),P = 0.05, conventional] or nephropathy [odds ratio (95% CI) 0.98 (0.95–1.01),P = 0.48 intensive, 1.03 (0.98–1.10),P = 0.17 conventional].Conclusions The frequency of exposure to severe hypoglycaemia did not predict a different risk of developing retinopathy or nephropathy in either treatment group of the Diabetes Control and Complications Trial at any given HbA1c.
Ethical review from the inside: repertoires of evaluation in Research Ethics Committee meetings
Authors: de Jong Jean Philippe , van Zwieten Myra C.B. , Willems Dick L. 
Published: February 2012

AbstractEvaluating the practice of ethical review by Research Ethics Committees (REC) could help protect the interests of human participants and promote scientific progress. To facilitate such evaluations, we conducted an ethnographic study of how an REC reviews research proposals during its meetings. We observed 13 meetings of a Dutch REC and studied REC documents. We coded this material inductively and categorised these codes in two repertoires of evaluation: a repertoire of rules and a repertoire of production. In the repertoire of rules the REC applies rules, weighs scientific value and burdens to the participants and makes a final judgment on a research proposal in a meeting. In the repertoire of production, REC members check documents and forms and advise researchers on how to improve their proposals and can use informal communication. Based on these findings, we think that evaluations of the practice of ethical review should take into account the fact that RECs can use a repertoire of rules and a repertoire of production to evaluate research proposals. Combining these two repertoires can be a viable option so that the REC gives researchers advice on how to improve their proposals to prevent rejection of valuable research.
Carers’ representations of affective mental disorders in British Chinese communities
Authors: Koo Kevin 
Published: February 2012

AbstractInfrequent use of and delayed presentation to professional services have increased the burden of mental illness in minority ethnic communities. Within the growing literature on informal carers, the Chinese remain relatively unstudied. This article reports a qualitative study of 14 carers to explore illness representations of affective disorders in British Chinese communities. Firstly, it places the study within a theoretical framework that permits an understanding of mental health and illness in different sociocultural belief systems. Next, it presents carers’ narrative accounts in conceptualising mental illness, including its causes, manifestations and impact on patients and carers, and contextualises the findings within the existing literature. Finally, the article examines how the caring role may be constructed from the broader social experience of carers and their relationships within a community structure that values the group over the individual. Coping mechanisms are discussed in the context of the practice of caring as a moral obligation and of policy implications for more culturally appropriate support services for both Chinese carers and mental health patients.
Pontine‐to‐midbrain ratio indexes ocular‐motor function and illness stage in adult Niemann–Pick disease type C
Authors: Walterfang M. , Macfarlane M. D. , Looi J. C. L. , Abel L. , Bowman E. , Fahey M. C. , Desmond P. , Velakoulis D. 
Published: February 2012

Background and purpose:  Niemann–Pick disease type C (NPC) is a progressive neurovisceral disorder associated with dystonia, ataxia and a characteristic gaze palsy. Neuropathological studies have demonstrated brainstem atrophy associated with neuronal inclusions and loss, and neurofibrillary tangles, although it is not known whether this pathology can be detected in vivo or how these changes relate to illness variables, particularly ocular‐motor changes. Our aim was to utilize a method for brainstem atrophy, validated in progressive supranuclear palsy (PSP), in a group of adult patients with NPC, and explore its relationship to illness variables and ocular‐motor functioning.Methods:  We calculated the midbrain and pontine area, and pontine‐to‐midbrain ratio (PMR) from midsagittal images of 10 adult patients with NPC and 27 age‐ and gender‐matched controls. Measures were correlated with illness variables, and measures of horizontal saccadic functioning.Results:  Pontine‐to‐midbrain ratio was 14% higher in the NPC group, but this difference was not significant. However, PMR showed a significant positive correlation with duration of illness and a measure of illness severity. Furthermore, PMR was significantly negatively correlated with saccadic peak velocity and gain, and self‐paced saccadic performance.Conclusions:  Pontine‐to‐midbrain ratio was increased in adult patients with NPC compared to controls, although not to the same degree as previously described in PSP, which also presents with significant gaze palsy. These changes were driven predominantly by progressive midbrain atrophy. The strong correlation with illness and ocular‐motor variables suggests that it may be a useful marker for illness progression in NPC.
Perceived relationships between severity of psoriasis symptoms, gender, stigmatization and quality of life
Authors: Böhm D. , Stock Gissendanner S. , Bangemann K. , Snitjer I. , Werfel T. , Weyergraf A. , Schulz W. , Jäger B. , Schmid‐Ott G. 
Published: February 2012

AbstractBackground  Psoriasis is a skin disease with negative physical, psychological and social repercussions for those affected, but we still lack knowledge of how somatic and non‐somatic factors directly and indirectly combine to affect patients’ quality of life (QoL).Objectives  This study seeks a better understanding of the relations between symptom severity, discomfort, stigmatization, gender and QoL among psoriasis patients.Methods  The sample comprised 381 psoriasis patients in inpatient care. Symptom severity and discomfort were measured subjectively with single items. Stigmatization was measured with the Questionnaire on Experience with Skin Complaints. QoL was measured using the Dermatology Life Quality Index (DLQI) and the Short Form‐8 Health Survey (SF‐8).Results  Symptom severity was associated with higher discomfort, stigmatization and lower skin‐related QoL. Symptom severity correlated weakly with more general aspects of QoL as measured by the SF‐8. Men and women reported different experiences with discomfort, stigmatization and mental aspects of QoL (SF‐8 mental component summary score). Some stigmatization parameters function as mediating variables between symptom severity and QoL.Conclusions  Our findings suggest that the effect of stigmatization on skin‐related QoL is driven by symptom severity and stigmatization combined, whereas its effect on mental health is driven mostly by stigmatization alone. Further, although women and men experience the social impact of psoriasis differently, the effect of stigmatization on QoL is similar for both genders.
Symbol and power: the Dalai Lama as a charismatic leader
Authors: Bentz Anne‐Sophie 
Published: February 2012

AbstractThis article originated in a brief but inspiring analysis by Margaret Nowak. Nowak used Sherry Ortner's concept of ‘summarising symbol’ to imply that, much the same way as the American flag was the epitome of the United States to each and every American, the Dalai Lama encompasses everything Tibetan to the Tibetan people. What does this comparison say about the Dalai Lama? I examine the relationship between symbol, power and charisma with Tenzin Gyatso, the current Dalai Lama, as a case in point. With exile, there has been a shift in the symbolic importance of the Dalai Lama, both as a man and as an institution, from a symbol of Tibet and Tibetan Buddhism to a symbol of the Tibetan cause and, more generally, to a symbol of Buddhism in the world. These changes have given Tenzin Gyatso a new authority in the Tibetan community: he is now the unique and unquestioned leader of the Tibetan cause in the world. I discuss the problems that occur when a symbol is also a man and a leader, as well as the solutions proposed, at a moment when the Tibetan community in exile is experiencing democratisation.
Differential effects of moderate alcohol consumption on motion and contrast processing
Authors: Weschke Sarah , Niedeggen Michael 
Published: February 2012

AbstractAlthough a moderate blood alcohol concentration already affects attention, an effect on early visual processing is still questionable. Using psychophysical measures and visually evoked potentials (VEP), we examined the effects of alcohol on the processing of contrast and motion features. In our tasks, two lateralized stimuli were briefly presented, and participants had to identify either the stimulus of higher contrast or motion coherence. In the contrast task, alcohol was found to decrease the discrimination ability and induced a global attenuation of VEP amplitudes. In the motion task, discrimination was not impaired. VEP amplitudes were reduced contralateral to the target position, indicating an effect of alcohol on the deployment of visuospatial attention. In sum, our data suggest that specialized areas for motion and contrast processing within the visual cortex are differently sensitive to moderate alcohol exposure.
Learning to fear suffocation: A new paradigm for interoceptive fear conditioning
Authors: Pappens Meike , Smets Elyn , Vansteenwegen Debora , Van Den Bergh Omer , Van Diest Ilse 
Published: February 2012

AbstractThe present study aimed to establish a new interoceptive fear conditioning paradigm. The conditioned stimulus (CS) was a flow resistor that slightly obstructs breathing; the unconditional stimulus (US) was a breathing occlusion. The paired group (N = 21) received 6 acquisition trials with paired CS–US presentations. The unpaired group (N = 19) received 6 trials of unpaired CS–US presentations. In the extinction phase, both groups were administered 6 CS‐only trials. Measurements included startle eyeblink response, electrodermal responses, and self‐reported US expectancy. In the paired group, startle blink responses were larger during CS compared to intertrial interval during acquisition and extinction. Electrodermal and US expectancies were larger for the paired than for the unpaired group during acquisition, but not during extinction. The present paradigm successfully established interoceptive fear conditioning with panic‐relevant stimuli.
The impact and management of symptoms experienced at midlife: a community‐based study of women in northeast Scotland
Authors: Duffy OK , Iversen L , Hannaford PC 
Published: February 2012

Please cite this paper as: Duffy O, Iversen L, Hannaford P. The impact and management of symptoms experienced at midlife: a community‐based study of women in northeast Scotland. BJOG 2012;119:554–564.Objectives  To determine the frequency and management of menopausal symptoms among community‐dwelling women.Design  Cross‐sectional study.Setting  Northeast Scotland.Population  Women aged 45–54 years registered with 16 general practices.Methods  In 2009, a self‐completed questionnaire enquiring about the frequency, associated level of bothersomeness and management of 23 symptoms experienced during the previous month was sent to 8206 women.Main outcome measures  The proportion (95% CI) of women reporting each symptom and management strategy.Results  Hot flushes, night sweats and vaginal dryness were reported by 46.7% (95% CI 45.2–48.2), 46.4% (95% CI 44.9–47.9) and 28.2% (95% CI 26.9–29.6) of women, respectively. Two‐fifths of women rated these symptoms as quite bothersome or extremely bothersome. More than 60% managed menopausal symptoms using social support by talking to friends and family. Avoidance or alleviating options were common. Herbal remedies were more commonly used than prescription drugs. Current hormone replacement therapy use was highest among surgically menopausal women (21%); 8% of postmenopausal and <2% of perimenopausal women with symptoms were using hormone replacement therapy. Many women had sought information about symptom management. More than one‐third of women wanted more support about menopausal symptoms from their general practitioner or practice nurse.Conclusion  Following the publication of the Women’s Health Initiative trial results, menopausal symptoms remain common and are often bothersome. Many women seek information about menopausal symptoms from healthcare professionals. Future studies should look beyond frequently researched management strategies, to consider other commonly used options, such as social support, strategies to reduce core body temperature and information about managing menopausal symptoms.
Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion‐based audit at two Tanzanian rural hospitals
Authors: Maaløe N , Sorensen BL , Onesmo R , Secher NJ , Bygbjerg IC 
Published: February 2012

Please cite this paper as: Maaløe N, Sorensen B, Onesmo R, Secher N, Bygbjerg I. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion‐based audit at two Tanzanian rural hospitals. BJOG 2012;119:605–613.Objective  To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour.Design  A quality assurance analysis of a retrospective criterion‐based audit supplemented by in‐depth interviews with hospital staff.Setting  Two Tanzanian rural mission hospitals.Population  Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed.Methods  Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings.Main outcome measures  Prevalence of suboptimal management and themes emerging from an analysis of the transcripts.Results  Suboptimal management was identified in most cases. Non‐invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence‐based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions.Conclusion  The lack of use and awareness of evidence‐based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections.
Is cellular senescence an example of antagonistic pleiotropy?
Authors: Giaimo Stefano , d’Adda di Fagagna Fabrizio 
Published: February 2012

SummaryIt is generally accepted that the permanent arrest of cell division known as cellular senescence contributes to aging by an antagonistic pleiotropy mechanism: cellular senescence would act beneficially early in life by suppressing cancer, but detrimentally later on by causing frailty and, paradoxically, cancer. In this review, we show that there is room to rethink this common view. We propose a critical appraisal of the arguments commonly brought in support of it, and we qualitatively analyse published results that are of relevance to understand whether or not cellular senescence‐associated genes really act in an antagonistic‐pleiotropic manner in humans.