bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tongue cancer in young patients: case report of a 26-year-old patient
Authors: Credé Aleksandra , Locher Michael , Bredell Marius 
Published: May 2012

Abstract

Introduction
This article presents the case of a 26-year-old woman with tongue cancer. The median age at the diagnosis of the tongue’s cancer is 61 years. Only approximately 2% of patients are diagnosed before the age of 35.

Case presentation
Our patient survived acute myeloid leukemia (AML) before her second year. She had been having recurrent, poorly healing aphtae on the right side of the tongue for a period of months before the symptoms of the tongue cancer appeared. As a treatment a partial glossectomy was conducted on the right side and a neck dissection of levels I-III. Than a reconstruction of the tongue with a radialis free vascularised flap from left side was performed.

Discussion
It should be always looked for the causal factor in young patients with a neoplasm. There is strong evidence for second malignant neoplasms in survivors of childhood cancer.
DelPhi: a comprehensive suite for DelPhi software and associated resources
Authors: Li Lin , Li Chuan , Sarkar Subhra , Zhang Jie , Witham Shawn , Zhang Zhe , Wang Lin , Smith Nicholas , Petukh Marharyta , Alexov Emil 
Published: May 2012

Abstract

Background
Accurate modeling of electrostatic potential and corresponding energies becomes increasingly important for understanding properties of biological macromolecules and their complexes. However, this is not an easy task due to the irregular shape of biological entities and the presence of water and mobile ions.

Results
Here we report a comprehensive suite for the well-known Poisson-Boltzmann solver, DelPhi, enriched with additional features to facilitate DelPhi usage. The suite allows for easy download of both DelPhi executable files and source code along with a makefile for local installations. The users can obtain the DelPhi manual and parameter files required for the corresponding investigation. Non-experienced researchers can download examples containing all necessary data to carry out DelPhi runs on a set of selected examples illustrating various DelPhi features and demonstrating DelPhi’s accuracy against analytical solutions.

Conclusions
DelPhi suite offers not only the DelPhi executable and sources files, examples and parameter files, but also provides links to third party developed resources either utilizing DelPhi or providing plugins for DelPhi. In addition, the users and developers are offered a forum to share ideas, resolve issues, report bugs and seek help with respect to the DelPhi package. The resource is available free of charge for academic users from URL: http://compbio.clemson.edu/DelPhi.php
The simultaneous expression of both ephrin B3 receptor and E-cadherin in Barrett`s adenocarcinoma is associated with favorable clinical staging
Authors: Schauer Matthias C , Stoecklein Nikolas H , Theisen Joerg , Kröpil Feride , Baldus Stephan , Hoelscher Arnulf , Feith Markus , Bölke Edwin , Matuschek Christiane , Budach Wilfried , Knoefel Wolfram Trudo 
Published: May 2012

Abstract

Background
In intestinal epithelium, tyrosine kinase receptor Ephrin B3 (Eph B3) maintains the architecture of the crypt-villus axis by repulsive interaction with its ligand ephrin-B1. While loss of Eph B3 is linked to colorectal cancer initiation, overexpression of Eph B3 in cancer cell lines inhibits growth and induces functional changes with decreased mesenchymal and increased epithelial markers. In order to study this tumor suppressor activity of Eph B3 in esophageal adenocarcinoma we analyzed the simultaneous expression of Eph B3 and E-cadherin in both the healthy esophagus and in Barrett’s carcinoma.

Methods
Simultaneous expression of Eph B3 and E-cadherin was investigated in samples from 141 patients with Barrett’s carcinoma and from 20 healthy esophagi using immunhistology and quantitative PCR. Results from healthy squamous epithelium, Barrett’s metaplasia and staging-specific esophageal adenocarcinoma were correlated.

Results
A significantly reduced E-cadherin mRNA expression could be detected in adenocarcinoma compared to dysplasia. The immunhistological activity of E-cadherin and Eph B3 was reduced in adenocarcinoma compared to dysplasia or healthy esophageal mucosa. The intracellular E-cadherin distribution changed significantly from the cytoplasm to the membrane, when the Eph receptor was simultaneously expressed. Simultaneous expression of E-cadherin and Eph B3 showed a significant inverse correlation to tumor stage.

Conclusions
We present novel evidence of the tumor suppressor activity of Eph B3 in esophageal adenocarcinoma possibly due to the impact on redistribution of cellular E-cadherin to the membrane. Our results suggest that this effect might play a role in the dysplasia-adenocarcinoma sequence, the infiltrative growth pattern and the development of lymph node metastases.
Low-dose oral prednisone improves clinical and ultrasonographic remission rates in early rheumatoid arthritis: results of a 12-month open-label randomised study
Authors: Montecucco Carlomaurizio , Todoerti Monica , Sakellariou Garifallia , Scirè Carlo Alberto , Caporali Roberto 
Published: May 2012

Abstract

Introduction

In early rheumatoid arthritis (RA), low-dose oral prednisone (PDN) co-medication yields better clinical results than monotherapy with disease-modifying anti-rheumatic drugs (DMARDs). In addition, ultrasonography (US) evaluation reveals rapid and significant effects of glucocorticosteroids on subclinical synovitis. No data currently exist that examine the clinical and US results offered by glucocorticoid co-medication over DMARD monotherapy in early RA patients.

Methods

Two hundred and twenty patients with early RA (< 1 year from clinical onset) were treated according to a low disease activity (LDA) targeted step-up protocol including methotrexate (MTX) and, in the active treatment arm, low-dose (6.25 mg/day) oral PDN over 12 months. Clinical disease activity measures were collected at baseline, 2, 4, 6, 9 and 12 months, and US examination of hands was performed at baseline, 6 and 12 months. Grey-scale and power Doppler (PD) synovitis were scored (0 to 3) for each joint. At 12 months, clinical remission according to the disease activity score among 28 joints was defined as the clinical outcome, and a total joint PD score of 0 (PD negativity) as the imaging outcome.

Results

Each group included 110 patients with comparable demographic, clinical, laboratory and US characteristics. At 12 months, the LDA rate was similar in the two groups, whilst the clinical remission rate (risk ratio = 1.61 (95% confidence interval = 1.08, 2.04)) and PD negativity rate (risk ratio = 1.31 (95% confidence interval = 1.04, 1.64)) were significantly higher in the MTX+PDN group.

Conclusion

In early RA, despite a similar response rate in terms of LDA, low-dose oral PDN co-medication led to a higher proportion of clinical remission and PD negativity compared with MTX monotherapy, thus ensuring a better disease activity control.

Trial registration number

Current Controlled Trials ISRCTN2486111
Morbidity and cost burden of methicillin-resistant Staphylococcus aureus in early onset ventilator-associated pneumonia
Authors: Shorr Andrew F , Tabak Ying P , Gupta Vikas , Johannes RS , Liu Larry Z , Kollef Marin H 
Published: May 2012

Abstract
Introduction
To gain a better understanding of the clinical and economic outcomes associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in patients with early onset ventilator-associated pneumonia (VAP), we retrospectively analyzed a multihospital US database to identify patients with VAP over a 24 month period (2002–2003).

Method
Data recorded included physiologic, laboratory, culture, and other clinical variables from 59 institutions. VAP was defined as new positive respiratory culture after at least 24 hours of mechanical ventilation (MV) and the presence of primary or secondary ICD-9-CM diagnosis codes of pneumonia. Outcomes measures included in-hospital morbidity and mortality for the population overall and after onset of VAP (duration of MV, intensive care unit [ICU] stay, in-hospital stay, and case mix and severity-adjusted operating cost). The overall cost was calculated at the hospital level using the Center for Medicare and Medicaid Services Cost/Charge Index for each calendar year.

Results
A total of 499 patients were identified as having VAP. S. aureus was the leading organism (31% of isolates). Patients with MRSA were significantly older than patients with methicillin-sensitive Staphylococcus aureus (MSSA; median age 74 versus 67 years, P < 0.05) and more likely to be medical patients. Compared with MSSA patients, MRSA patients on average consumed excess resources of 4.4 (95% confidence interval 0.6–8.2) overall MV days, 3.8 (-0.5 to +8.0) days of inpatient length of stay (LOS), 5.3 (1.0–9.7) ICU days, and US$7731 (-US$8393 to +US$23,856) total cost after controlling for case mix and other factors. Furthermore, MRSA patients needed excess resources after the onset of VAP (4.5 [95% confidence interval 1.0–8.1] MV days, 3.7 [-0.5 to +8.0] inpatient days, and 4.4 [0.4–8.4] ICU days) after controlling for the same case mix and admission severity covariates.

Conclusion
S. aureus remains a common cause of VAP. VAP due to MRSA was associated with increased overall LOS, ICU LOS, and attributable ICU LOS compared with MSSA-related VAP. Although not statistically significant because of small sample size and large variation, the attributable excess costs of MRSA amounted to approximately US$8000 per case after controlling for case mix and severity.
A multivariate Bayesian model for assessing morbidity after coronary artery surgery
Authors: Biagioli Bonizella , Scolletta Sabino , Cevenini Gabriele , Barbini Emanuela , Giomarelli Pierpaolo , Barbini Paolo 
Published: May 2012

Abstract
Introduction
Although most risk-stratification scores are derived from preoperative patient variables, there are several intraoperative and postoperative variables that can influence prognosis. Higgins and colleagues previously evaluated the contribution of preoperative, intraoperative and postoperative predictors to the outcome. We developed a Bayes linear model to discriminate morbidity risk after coronary artery bypass grafting and compared it with three different score models: the Higgins' original scoring system, derived from the patient's status on admission to the intensive care unit (ICU), and two models designed and customized to our patient population.

Methods
We analyzed 88 operative risk factors; 1,090 consecutive adult patients who underwent coronary artery bypass grafting were studied. Training and testing data sets of 740 patients and 350 patients, respectively, were used. A stepwise approach enabled selection of an optimal subset of predictor variables. Model discrimination was assessed by receiver operating characteristic (ROC) curves, whereas calibration was measured using the Hosmer-Lemeshow goodness-of-fit test.

Results
A set of 12 preoperative, intraoperative and postoperative predictor variables was identified for the Bayes linear model. Bayes and locally customized score models fitted according to the Hosmer-Lemeshow test. However, the comparison between the areas under the ROC curve proved that the Bayes linear classifier had a significantly higher discrimination capacity than the score models. Calibration and discrimination were both much worse with Higgins' original scoring system.

Conclusion
Most prediction rules use sequential numerical risk scoring to quantify prognosis and are an advanced form of audit. Score models are very attractive tools because their application in routine clinical practice is simple. If locally customized, they also predict patient morbidity in an acceptable manner. The Bayesian model seems to be a feasible alternative. It has better discrimination and can be tailored more easily to individual institutions.
An observational study into the management of arteriomegaly: a call for a revised classification system
Authors: Barandiaran JV , Hall TC , Glaves I , El-Barghouti N , Perry EP 
Published: May 2012

INTRODUCTION Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of these patients in our institution. METHODS Radiologists and surgeons prospectively reviewed aortofemoral angiography. Patients with arteriomegaly were identified. Data relating to demographics, mode of presentation, risk factors, type of arteriomegaly, management and progression of disease were analysed. RESULTS Arteriomegaly was identified in 1.3% of patients (n=69) undergoing lower limb angiography in the study period. Of these, the majority (n=67) were men. The mean age was 74 years (range: 60–89 years) and 76% were smokers. Co-morbidities included coronary artery disease (55%), diabetes mellitus (20%), hypertension (45%) and cerebrovascular events (6%). Fortynine patients presented with critical limb ischaemia and eighteen patients were seen electively in the outpatients department with symptoms of intermittent claudication. Data were incomplete for two male patients and were therefore not included. At presentation, 22 patients were classified as Hoi lier type I, 5 were type II and 9 were type III. Thirty-one patients had arteriomegalic vessels but no aneurysmal disease. After a median follow-up duration of 76 months (range: 6–146 months), 34 patients progressed to type I, 2 to type II and 18 to type III. Thirteen remained without aneurysmal disease. Twenty-nine patients required angioplasty and twenty-eight required bypass surgery during this time. In total, 102 procedures were required for complicated disease. The limb salvage rate was 92%. Although 8 patients in our series died, the remaining 59 are under regular follow up. CONCLUSIONS This study illustrates the progressive nature of arteriomegaly. Results of the management of these patients in our institution are similar to those in the literature. We suggest an additional fourth category to Hollier’s classification that describes arteriomegalic disease without aneurysmal degeneration as this, too, deserves special management. Regular follow-up visits and early intervention for patients with arteriomegaly is advocated to reduce the high incidence of morbidity.
Caliper measurement to improve clinical assessment of palpable neck lumps
Authors: Wasson J , Amonoo-Kuofi K , Scrivens J , Pfleiderer A 
Published: May 2012

INTRODUCTION One-stop neck lump clinics with ultrasonography and cytopathology support are an expensive and finite resource. Consequently, many neck lump patients are assessed in general ear, nose and throat or head and neck clinics. Optimal clinical assessment of neck lump size is important to guide investigation, monitor change and provisionally stage nodal disease. The aims of this study were to investigate whether caliper measurement is more accurate than clinical palpation in assessing neck lump size and whether caliper measurement of neck lump size correlates closely with accurate ultrasonography measurement. METHODS A prospective study was carried out involving 50 patients with clinically palpable neck lumps presenting to the one-stop neck lump clinic. Long and short axis neck lump dimensions were estimated first by clinical palpation and second by caliper measurement. Estimations were compared with accurate ultrasonography measurement. RESULTS The mean combined long and short axis measurement deviation from accurate ultrasonography measurement was smaller for caliper measurement (7.80mm) than for clinical palpation (12.38mm) (p<0.01). There was no significant difference observed between combined axis ultrasonography and combined axis caliper measurement of neck lumps (p=0.462). CONCLUSIONS Caliper measurement is more accurate than clinical palpation in estimating the size of clinically palpable neck lumps. The use of calipers to measure the skin surface dimensions of palpable neck lumps is statistically comparable to accurate ultrasonography measurement.
The STAR score: a method for auditing clinical records
Authors: Tuffaha H , Amer T , Jayia P , Bicknell C , Rajaretnam N , Ziprin P 
Published: May 2012

INTRODUCTION Adequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes. METHODS An initial ‘path finding’ study was performed to evaluate the quality of note keeping using the CRABEL scoring tool. The findings prompted the development of the Surgical Tool for Auditing Records (STAR) as an alternative. STAR was validated using inter-rater reliability analysis. An audit cycle of surgical notes using STAR was performed. The results were analysed and a structured form for the completion of surgical notes was introduced to see if the quality improved in the next audit cycle using STAR. An education exercise was conducted and all participants said the exercise would change their practice, with 25% implementing major changes. RESULTS Statistical analysis of STAR showed that it is reliable (Cronbach’s a = 0.959). On completing the audit cycle, there was an overall increase in the STAR score from 83.344% to 97.675% (p<0.001) with significant improvements in the documentation of the initial clerking from 59.0% to 96.5% (p<0.001) and subsequent entries from 78.4% to 96.1% (p<0.001). CONCLUSIONS The authors believe in the value of STAR as an effective, reliable and reproducible tool. Coupled with the application of structured forms to note keeping, it can significantly improve the quality of surgical documentation and can be implemented universally.
Changing incidence and management of penetrating neck injuries in the South East London trauma centre
Authors: Harris R , Olding C , Lacey C , Bentley R , Schulte KM , Lewis D , Kandasamy N , Oakley R 
Published: May 2012

INTRODUCTION A total of 17 cases of penetrating neck injury were managed by the otolaryngology team at King’s College Hospital over a 3-year period in the 1980s. In April 2010 King’s College Hospital became the major trauma centre for South East London. This prospective cohort study compares the incidence, changing demographic features and treatment outcomes of penetrating neck trauma in South East London over the previous 23 years. METHODS Data were collected over a 12-month period (April 2010 to March 2011) and a selective management protocol was introduced to standardise initial investigations and further treatment. RESULTS The past 23 years have seen a 550% increase in the incidence of penetrating neck injuries in South East London, with a marked increase in gun crime. Only 38% of cases underwent negative neck exploration in 2011 compared with 65% in 1987. Selective conservative management based on the absence of haemodynamic instability or radiological findings reduces length of hospital stay, lightens surgical workload and cuts costs without affecting morbidity or mortality. CONCLUSIONS The increased incidence of penetrating neck injury is a reflection of more interpersonal violence rather than a consequence of the larger South East London trauma centre catchment area. Tackling this problem requires focus on wider issues of community prevention. Sharing of data between the four London trauma centres and the police is needed to help prevent interpersonal violence and develop a universal treatment algorithm for other institutions to follow.
Effectiveness of a gentamicin impregnated collagen sponge on reducing sternal wound infections following cardiac surgery: a meta-analysis of randomised controlled trials
Authors: Creanor S , Barton A , Marchbank A 
Published: May 2012

INTRODUCTION Gentamicin impregnated collagen sponges are licensed for use after cardiac surgery in over 50 countries but their effectiveness at preventing sternal wound infections (SWIs) remains uncertain. The aim of this meta-analysis was to assess the current evidence for effectiveness of such sponges at preventing SWIs in patients after cardiac surgery. METHODS A systematic search of the literature was undertaken and meta-analyses were performed on the results of the identified, eligible studies. Using random effects models, odds ratios (OR) and corresponding 95% confidence intervals (Cl) were calculated for all SWIs and deep SWIs for: a) all participants, and b) participants deemed as high risk. RESULTS Three unique randomised controlled trials (published between 2005 and 2010) involving 3,994 participants met the inclusion criteria. There was insufficient evidence of a significant difference between intervention and control groups for all SWIs (all participants: OR: 0.66, 95% Cl: 0.39–1.14; high risk participants: OR: 0.60, 95% Cl: 0.24–1.52). There was insufficient evidence of a significant benefit of the sponge in deep SWIs across all participants (OR: 0.72, 95% Cl: 0.47–1.10) but some evidence of benefit in terms of reducing the incidence of deep SWIs in high risk participants (OR: 0.62, 95% Cl: 0.39–0.98). CONCLUSIONS There is insufficient evidence of the effectiveness (or otherwise) of gentamicin impregnated sponges in preventing SWIs following cardiac surgery. However, some evidence does exist that such sponges can reduce the incidence of deep infections in high risk patients.
Subacute reaction to endoscopic mucosal resection mimicking perforation
Authors: Williamson JML , Dunkley P , Hewin D 
Published: May 2012

A 25-year-old woman underwent routine day-case endoscopic mucosal resection (EMR) of two ascending colonic polyps. Six hours later she re-presented with severe abdominal pain. On examination she was tachycardic with tenderness and peritonism in the right lower quadrant. Urgent abdominal computed tomography (CT) did not reveal any signs of free intra-abdominal gas or fluid but did detect transmural thickening and oedema in the ascending colon and caecum. As there was no radiological evidence of perforation, the patient was managed conservatively and made a full recovery. The exact aetiology of this patient’s symptoms is not known. She may have developed post-polypectomy electrocoagulation (a transmural diathermy injury), localised ischaemia of the colonic wall (secondary to the adrenaline used during EMR) or an allergic reaction to the dye used during EMR. As EMR is an increasingly used treatment modality in the management of colonic polyps, clinicians should have an awareness of the complications of treatment. We would advocate a low threshold for prompt CT investigation in any patient presenting with abdominal pain after EMR to detect any evidence of free intraperitoneal air. Patients without signs of perforation may be managed conservatively, as in this case.