bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right Ventricular Variants and Pulmonary Embolism—Association or Coincidence?
Authors: Ker James 
Published: December 2010

It has been stated that the interior of the right ventricle is as unique to each individual as one's fingerprint. This statement is backed by numerous publications which demonstrates considerable variation in the number, shape and configuration of papillary muscles inside the normal right ventricle. It has also been shown that these variants may be the cause of cardiac rhythm disorders. In this case report another potential complication of such right ventricular papillary muscle variants is proposed—these muscles may be the source of pulmonary emboli. The pathogenesis may be that of local stasis around these aberrant muscular structures and/or emboli may form inside the right ventricle as a result of cardiac rhythm disorders, induced by these muscles. It is proposed that in future the role of the right ventricle as the source of pulmonary emboli will become more apparent and an important part of the diagnostic work up in cases of idiopathic pulmonary embolism.
Subaortic (Type 6) Muscular Band—Innocent Bystander or Pathologic Structure?
Authors: Ker J 
Published: December 2010

Intraventricular tendons are structures that was identified more than a hundred years ago. It has been suggested that they represent intracavitary radiations of the bundle of His and that they may be an isolated finding or be associated with structural cardiac abnormalities. Loukas et al divided these structures into five categories and recently a sixth type have been added. Various physiological disturbances have been observed due to the sixth type of tendon, such as ST segment elevation and right bundle branch block. It has been noted that this peculiar structure appears too thick to be called a tendon, thus the term band. This retrospective analysis analyzed the incidence of the thick, subaortic (type 6) muscular band in a cardiovascular clinic.
Expression of Toll-Like Receptor 4, Tumor Necrosis Factor-Alpha, Matrix Metalloproteinase-9 and Effects of Benazepril in Patients with Acute Coronary Syndromes
Authors: Xie Ping , Cao Yun-Shan , Su Peng , Li Yu-Hong , Gao Zhi-Ling , Borst Mathias M. 
Published: December 2010

Objectives The study aims to explore the relationship between expressions of toll-like receptor 4 (TLR4) on peripheral blood monocytes, serum tumor necrosis factor-alpha (TNF-α) and matrix metalloproteinase-9 (MMP-9) in patients with acute coronary syndromes(ACS), and to investigate the possible mechanisms of Benazepril stabilizing atherosclerosis plaques. Methods 70 patients selected were randomly divided into Benazepril treatment group (35 patients) and regular treatment group (35 patients). Meanwhile, Stable angina pectoris (SAP) group of 32 patients and control group of 22 patients were also set up. With the help of flow-cytometry, expressions of TLR4 on peripheral blood monocytes of the four groups were analyzed and compared to show differences, correlations and changes of the above mentioned indicators. The concentration of TNF-α and MMP-9 in serum were measured by enzyme linked immunosorbent assay (ELISA). Results (1) Expressions of TLR4, levels of TNF-α and MMP-9 were increased and the rate was rising from the control group, to SAP group and then to ACS group. All these indicators in ACS group are significantly higher than those in other groups ( P < 0.05). (ACS versus SAP, control; all ( P < 0.05). (2) Multi-linear regression analysis indicates that there was a positive correlation between the expression level of TLR4 and serum levels of TNF-α and MMP-9 in patients with ACS ( P < 0.01). (3) There is no significant differences between the expression level of TLR4 and serum levels of TNF-α and MMP-9 in Benazepril treatment group and regular treatment group before treatment ( P > 0.05) while they all fell after treatment ( P < 0.05). In addition, all the indicators decreased more greatly than the regular treatment group. Conclusions TLR4 on peripheral blood monocytes and serum TNF-α and MMP-9 in patients with coronary arteriosclerosis disease may be effective markers of the vulnerable plaque. Benazepril can inhibit over-expression of TLR4 and reduce serum levels of TNF-α and MMP-9, thus stabilize the vulnerable plaques and improve the condition of the patients with ACS.
Post-Mortem Echocardiography as a Guide to Cardiac Autopsy—A Worthwhile Concept?
Authors: Ker J. , Du Toit-Prinsloo L. , Van Heerden WFP. , Saayman G 
Published: December 2010

Sudden and unexpected death in the young is a common and worldwide problem. Sudden, unexpected death in infancy (SUDI), clinically unexpected death in an infant between one week and one year of age, affects around 1 in 1000 infants. Autopsy will reveal a specific cause of death in only one third of cases. This has led to various ancillary examinations in an effort to increase the diagnostic yield of the autopsy. In this case report it is suggested that another diagnostic modality, that of the post-mortem echocardiogram might be a worthwhile concept to explore.
The Double U Wave—Should the Electrocardiogram be Interpreted Echocardiographically?
Authors: Ker James 
Published: December 2010

The U wave is still an electrocardiographic deflection of enigmatic origin. Numerous hypotheses on its origin have been formulated, but to date none has been conclusively proven. Recently, a report described the first case of bifid (or notched) U waves. Until then this phenomenon has only been described in the T wave. This is the first report of double U waves—two separate deflections, ascribed to an accessory papillary muscle. Hypothesis The presence of a double U wave will be associated with an accessory papillary muscle (s). Materials and Methods This is a retrospective analysis of 4729 patient files of patients who were evaluated at a cardiology practice. The 12-lead surface electrocardiogram was evaluated for the possible presence of a double U wave. In cases where a double U wave was found, the transthoracic echocardiogram was then scrutinized for the presence of an accessory papillary muscle. Results A total of 3 cases of a double U wave were found. In every case an accessory papillary muscle was clearly seen on the transthoracic echocardiogram. Conclusion A double U wave is a new variant of an old electrocardiographic deflection of enigmatic origin. This variant may be associated with an accessory papillary muscle.
Characteristics and Prognostic Importance of Myocardial Fibrosis in Patients with Dilated Cardiomyopathy Assessed by Contrast-Enhanced Cardiac Magnetic Resonance Imaging
Authors: Looi Jen-Li , Edwards Colin , Armstrong Guy P. , Scott Anthony , Patel Hitesh , Hart Hamish , Christiansen Jonathan P. 
Published: December 2010

Introduction Dilated cardiomyopathy (DCM) is associated with significant morbidity and mortality. Contrast-enhanced cardiac MRI (CE-CMR) can detect potentially prognostic myocardial fibrosis in DCM. We investigated the role of CE-CMR in New Zealand patients with DCM, both Maori and non-Maori, including the characteristics and prognostic importance of fibrosis. Methods One hundred and three patients (mean age 58 ± 13, 78 male) referred for CMR assessment of DCM were followed for 660 ± 346 days. Major adverse cardiac events (MACE) were defined as death, infarction, ventricular arrhythmias or rehospitalisation. CE-CMR used cines for functional analysis, and delayed enhancement to assess fibrosis. Results Myocardial fibrosis was present in 30% of patients, the majority of which was mid-myocardial (63%). Volumetric parameters were similar in patients with or without fibrosis. At 2 years patients with fibrosis had an increased rate of MACE (HR = 0.77, 95% CI 0.3-2.0). Patients with full thickness or subendocardial fibrosis had the highest MACE, even in the absence of CAD). More Maori had fibrosis on CE-CMR (40% vs. 28% for non-Maori), and the majority (75%) was mid-myocardial. Maori and non-Maori had similar outcomes (25% vs. 24% with events during follow-up). Conclusions DCM patients frequently have myocardial fibrosis detected on CE-CMR, the majority of which is mid-myocardial. Fibrosis is associated with worse outcome in the medium term. The information obtained using CE-CMR in DCM may be of incremental clinical benefit.
Sudden Infant Death Syndrome and Left Ventricular Hypertrabeculation-Hidden Arrhythmogenic Entity?
Authors: Ker J. , Du Toit-Prinsloo L. , Van Heerden W.F.P. , Saayman G. 
Published: December 2010

Left ventricular noncompaction/hypertrabeculation is a condition which is characterized by a highly trabeculated, “spongy” myocardium. It can present at any age with heart failure, arrhythmia and/or thromboembolic events. A wide variety of mutations have been found to be a cause of hypertrabeculation and it is possible that there is a continuum of hypertrophic cardiomyopathy, dilated cardiomyopathy and hypertrabeculation/noncompaction. We present a case of left ventricular hypertrabeculation which presented as sudden infant death syndrome and we propose that this entity may be a hidden cause of arrhythmic death in some infants presenting as sudden infant death syndrome.
A Pain-free Lancet with a Small Needle for Glucose Measurement
Authors: Kim Stanley 
Published: December 2010

A new lancet with an extremely small needle (0.15 mm diameter and 0.75 mm length) mounted on a small pedestal was tested in diabetic patients for blood glucose measurement in a randomized clinical study. A total of 37 diabetic patients were enrolled for the study. A pain scale categorized from 0 to 3 was created to measure the intensity of puncture pain which was explained to patients before testing. The patients' fingers were punctured with their own old style lancets at least 1 hour before the punctures by the new lancets, and puncture pains recorded according to the pain scale. All patients tested with the new lancet reported no pain and recorded the puncture pain as scale 0. Among the total 37 patients tested with their old style lancets, 2 patients (5.40%) reported no pain and recorded the pain as scale 0, thirteen patients (35.14%) recorded as scale 1, 16 patients (43.24%) as scale 2, and 6 patients (16.22%) as scale 3. The average pain scale of the patients who used old style lancets was 1.702 with the standard error 0.133. The chi-square goodness-of-fit test shows that the proportion of the pain scales comes from the claimed distribution with unequal frequencies, and chi-square tests for independence indicate that neither sex nor age of the sample patients is related to the pain scales. The paired t-test to test the existence of any difference in pain levels between the new lancet and the old style lancet showed; t = 1.702/0.133 = 12.796 with p-value ≤ 0.005 (df = 36). The average pain level from the old style lancet is significantly higher than from the new lancets. Pain-free needle puncture was achieved by limiting the puncture depth to less than 0.75 mm with a thin needle with a 0.15 mm diameter. By allowing patients to see the new lancets before testing, psychological pain anticipation was minimized as the very thin and short needle is visually less intimidating. With a pain free puncture, better compliance and improved subsequent glucose levels may be achieved.
Higher Dietary Protein Intake is Associated with Lower Body Fat in the Newfoundland Population
Authors: Green Kristian K. , Shea Jennifer L. , Vasdev Sudesh , Randell Edward , Gulliver Wayne , Sun Guang 
Published: December 2010

Background Increased protein proportions in the diet combined with energy restriction has been shown to enhance weight loss during dietary intervention. It is not known if the beneficial effect of dietary protein exists in the general population under normal living conditions without a negative energy balance. Methods A total of 1834 participants (n = 443 men, n = 1391 women) were recruited from the CODING study. Participants' dietary macronutrient compositions were determined through a Willett FFQ. Body composition variables including percent body fat (%BF), percent trunk fat (%TF), percent total lean mass (%LM), and percent trunk lean mass (%TLM) were determined using DXA. Major confounding factors including age, physical activity levels, total caloric intake, carbohydrate intake, menopausal status, smoking status and medication use were controlled for in all analyses. Results Significant inverse relationships were observed between dietary protein intake (g/kg body weight/day) and weight, waist circumference, waist-to-hip ratio, BMI, %BF, and %TF ( P ≤ 0.001). Significant positive relationships were observed with %LM and %TLM ( P ≤ 0.001). Additionally, significant differences in weight (12.7 kg in men, 11.4 kg in women), BMI (4.1 BMI units in men, 4.2 units in women), and %BF (7.6% in men, 6.0% in women) were observed between low and high dietary protein consuming groups ( P ≤ 0.001). Dietary protein explained 11% of the total variation in %BF in the NL population. Conclusion This study provides strong evidence that higher protein intake, even in the absence of energy restriction, is associated with a more favorable body composition in the general population.
Use of the Nd-YAG Laser for Inferior Turbinectomy: A comparative study
Authors: Abdullah Nazik E. , Al-Muslet Nafie A. 
Published: December 2010

Nasal obstruction resulting from inferior turbinate hypertrophy was treated by Nd-YAG laser inferior turbinectomy (laser IT). The effectiveness of the procedure was assessed and compared with both functional endoscopic turbinoplasty (turbinoplasty) and conventional partial turbinectomy (conventional IT). Materials and methods A retrospective analytic study was carried out for 53 patients suffering from inferior turbinate hypertrophy. Twenty patients underwent Nd-YAG Laser IT (Group 1), 24 patients underwent turbinoplasy (Group 2) and 9 patients underwent conventional IT (Group 3). Improvement in nasal symptoms were assessed. Intra-operative bleeding, duration of hospital stay, and post-operative medications and instrumentation were compared between the three groups. Results The symptoms of sneezing, hyposmia and rhinorhoea were significantly reduced post-operatively among patients in the three groups and there were no differences statistically between them. The Nd-YAG laser turbinectomy group showed marked reduction in blood loss (average = 12 ml per patient) compared to the turbinoplasy group (average = 181 ml per patient) and conventional IT group (average 201 ml per patient). Hospital stay was much shorter in the laser IT group (average = 0.05 days) compared to Group 2 (1.2 days) and Group 3 (1.3 days). Only one patient in the laser IT group required nasal packing, whereas all patients in the other two groups required nasal packing routinely. Conclusions Nd-YAG laser IT was effective in reducing the symptoms of nasal obstruction, as well as other nasal symptoms without significant complications. The Nd-YAG laser is recommended as an alternative method, when applicable, in treating patients with nasal obstruction resulting from inferior turbinate hypertrophy.
A Phase II Study of S-1 Monotherapy as a First-line Combination Therapy of S-1 plus Cisplatin as a Second-line Therapy, and Weekly Paclitaxel Monotherapy as a Third-line Therapy in Patients with Advanced Gastric Carcinoma: A Second Report
Authors: Rino Yasushi , Yukawa Norio , Murakami Hitoshi , Wada Nobuyuki , Yamada Roppei , Hayashi Tsutomu , Sato Tsutomu , Ohshima Takashi , Masuda Munetaka , Imada Toshio 
Published: December 2010

Background We have previousy reported on a Phase II study of S-1 monotherapy as a first line, combination therapy of S-1 plus cisplatin as a second line, and weekly paclitaxel monotherapy as a third line therapy in patients with advanced gastric carcinomas. The median survival time (MST) of patients over the whole course of treatment was not previously calculated because 12 out of 19 patients had not yet succumbed. Since then, we have calculated the MST for this study and herein report our findings. Patients and Methods Between 2002 and 2005, 19 patients were enrolled in this study. Chemotherapy consisted of either 60 mg/m2 of S-1 for 4 weeks at 6-week intervals, a combination of 60 mg/m2 S-1 for 3 weeks and 60 mg/m2 cisplatin on day 8 at 5-week intervals, or 60 mg/m2 paclitaxel at days 1, 8, and 15, at 4-week intervals. The regimens were repeated until the occurrence of unacceptable toxicities, disease progression, or patient noncompliance. The primary end point was the overall survival. Results The median survival time was 774 days. The response rates were 33.3% (3/9), 12.5% (1/8), and 0% (0/4) after the first, second, and third line chemotherapies, respectively. The major adverse hematological toxicity was leukopenia, which reached grades 3–4 in all lines of chemotherapy investigated. In addition, the major adverse non-hematological toxicity was anorexia, which reached grade 3–4 in second line chemotherapy, and no deaths were attributable to the adverse effects of the drugs. Conclusion This sequential therapy was an effective treatment for advanced gastric cancer with acceptable toxic side-effects. We considered this therapy to be effective because of the smooth transition to the next regimen.
Pilot Study of a Clinical Pathway Implementation in Rectal Cancer
Authors: Uña Esther , López-Lara Francisco 
Published: December 2010

Background Rectal cancer is a highly prevalent disease which needs a multidisciplinary approach to be treated. The absence of specific protocols implies a significant and unjustifiable variability among the different professionals involved in this disease. The purpose is to develop a clinical pathway based on the analysis process and aims to reduce this variability and to reduce unnecessary costs. Methods We created a multidisciplinary team with contributors from every clinical area involved in the diagnosis and treatment in this disease. We held periodic meetings to agree on a protocol based on the best available clinical practice guidelines. Once we had agreed on the protocol, we implemented its use as a standard in our institution. Every patient older than 18 years who was diagnosed with rectal cancer was considered a candidate to be treated via the pathway. Results We evaluated 48 patients during the course of this study. Every parameter measured was improved after the implementation of the pathway, except the proportion of patients with 12 nodes or more analysed. The perception that our patients had about this project was very good. Conclusions Clinical pathways are needed to improve the quality of health care. This kind of project helps reduce hospital costs and optimizes the use of limited resources. On the other hand, unexplained variability is also reduced, with consequent benefits for the patients.
CD4 Count and anti Retroviral Therapy for HIV Positive Patients with Cancer in Nigeria -A Pilot Study
Authors: Ntekim Atara I. , Folasire Ayo M. 
Published: December 2010

Background Highly Active Anti Retroviral Treatment (HAART) improves the outcome of HIV positive patients treated for cancer. In our center HAART is only commenced in HIV positive patients with malignancy if the CD4 T lymphocyte count is less than 200 cells/ul. Presently, the outcome of treatment in these patients is poor. Objective To evaluate the influence of CD4 T- cell count and HAART on treatment outcome of HIV positive patients with cancer managed at the oncology service of The University College Hospital, Ibadan- South West Nigeria. Patients and Methods Twenty two adult HIV positive patients with malignancies who presented for treatment at our hospital from 2007 to 2009 were closely monitored by the investigators. Relevant clinical data collected included age, sex, HIV status, type of malignancy, CD4 counts, history of ART, ECOG performance status, prescribed oncology treatment with regularity of treatment and to follow up conditions. Results Twenty two patients aged between 26 and 67 years were evaluated. The performance status of all patients was at least ECOG 2. Three ART naive patients with initial CD4 counts 450 cells/ul and above were able to complete oncology treatment without HAART with good malignant disease control. Five other patients on HAART before the diagnosis of malignancy with CD4 counts 350 cells/ul and above were also able to complete their treatments on schedule with good outcome. Eight HAART naive patients with initial CD4 counts less than 370 cells/ul had inconsistent treatments with poor outcome. Conclusion Based on these observations, we propose that HAART should be commenced on all HIV positive patients diagnosed with malignancy with an initial CD4 count less than 450 cells/ul in our environment. Further studies in low resource settings with appropriate sample sizes are however needed to validate these findings.
Early Diagnosis of Invasive Aspergillosis in Neutropenic Patients. Comparison between Serum Galactomannan and Polymerase chain Reaction
Authors: Da Silva Rodrigo Lopes , Ribeiro Patrícia , Abreu Natacha , Ferreira Teresa , Fernandes Teresa , Monteiro Alexandra , Costa Fátima , Caldas Joana , Silva Madalena , Carande Luísa , Ferreira Gilda , Conduto António , Cruz Ernesto , Sousa Maria Henrique , Rodrigues António Silva , Costa Isabel , Veiga Joana , De Sousa Aida Botelho 
Published: December 2010

Background Invasive aspergillosis (IA) is a major cause of morbidity and mortality in profoundly neutropenic patients, so early diagnosis is mandatory. Aim Consecutive patients with hematological malignancies undergoing intensive chemotherapy were screened for IA with two different methods which were compared. Methods From October 2000 to August 2003 we tested 1311 serum samples from 172 consecutive patients with a polymerase chain reaction assay and between April 2005 and April 2008 we tested 806 serum samples from 169 consecutive patients with a Galactomannan (GM) test. Bronchoalveolar (BAL) samples were obtained whenever the patient's condition allowed and tested with either method. Results: The serum PCR assay had a sensitivity of 75.0% and a specificity of 91.9% and the serum GM assay had a sensitivity of 87.5% and a specificity of 93.1%, ( P > 0.05). The presence of two or more consecutive positive serum samples was predictive of IA for both assays. BAL GM/PCR was positive in some patients without serum positivity and in patients with 2 or more positive serum GM/PCR. Conclusions: No significant differences between the 2 serum tests were found. The GM assay has the advantage of being standardized among several laboratories and is incorporated in the criteria established by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), however is much more expensive. BAL GM and PCR sampling aids in IA diagnosis but needs further validation studies to differentiate between colonization and true infection in cases where serum GM or PCR are negative.