bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occult nodal metastasis in patients with non‐small cell lung cancer at clinical stage IA by PET/CT
Authors: PARK Hye Kyeong , JEON Kyeongman , KOH Won‐Jung , SUH Gee Young , KIM Hojoong , KWON O Jung , CHUNG Man Pyo , LEE Kyung Soo , SHIM Young Mog , HAN Joungho , UM Sang‐Won 
Published: June 2010

ABSTRACTBackground and objective:  The introduction of 18F‐FDG PET/CT has enhanced the diagnostic accuracy of nodal staging for non‐small cell lung cancer (NSCLC). We analysed risk factors for occult nodal metastasis in patients with clinical stage IA NSCLC as determined by 18F‐FDG PET/CT.Methods:  Data for 147 patients diagnosed as clinical stage IA NSCLC by PET/CT from 2005 to 2007 were retrospectively reviewed. All study patients underwent 18F‐FDG PET/CT for lung cancer staging. They also underwent cervical mediastinoscopy or systematic lymph node dissection.Results:  Cervical mediastinoscopy was performed in 78 patients (53.1%), and N2 involvement was detected in 3.8% (3/78) of these patients. Thoracotomy with systematic lymph node dissection was done in 144 patients. Four patients (2.8%, 4/144) were diagnosed with N2 disease after systematic lymph node dissection. Total N2 involvement was 4.8% (7/147). As 9.5% (14/147) of study patients had N1 disease, 14.3% (21/147) of patients had occult nodal (N1 or N2) metastasis. In univariate analyses, larger tumour size and a higher primary tumour maximum standardized uptake value >7.3 (SUVmax) were associated with occult nodal metastasis. Multivariate analysis demonstrated that a primary tumour SUVmax >7.3 was an independent predictor of occult nodal metastasis (odds ratio: 7.574; P = 0.001).Conclusions:  Preoperative PET/CT scans contribute to reduce the frequency of occult nodal metastasis compared with those reported in the pre‐PET/CT era. The higher SUVmax in primary tumour was an independent predictor of occult nodal metastasis in patients with clinical stage IA NSCLC by PET/CT.
Five‐year outcome in COPD patients after their first episode of acute exacerbation treated with non‐invasive ventilation
Authors: CHUNG Li Ping , WINSHIP Peta , PHUNG Scott , LAKE Fiona , WATERER Grant 
Published: June 2010

ABSTRACTBackground and objective:  Little is known about long‐term survival of patients surviving the first episode of type II respiratory failure requiring non‐invasive ventilation (NIV). We aimed to determine the 1‐, 2‐ and 5‐year survival, cause of death and potential prognostic indicators in this patient cohort.Methods:  We retrospectively identified 100 sequential COPD patients (mean age 70, mean FEV1 37% predicted) treated with NIV for the first time. Mortality and data on hospital morbidity and potential prognostic factors were collected from patient records and a State Health Data Linkage Service.Results:  Survival at 1, 2 and 5 years was 72%, 52% and 26%, respectively. Respiratory failure secondary to COPD was the commonest cause of death (56.8%), followed by cardiovascular events (25.7%). Readmission rate at 1 year was 60% for those who survived 2 years or more and 52% for those deceased within 2 years. Recurrent respiratory failure requiring NIV was observed in 31% of the cohort. Only advance age (P = 0.04), BMI (P = 0.014) and prior domiciliary oxygen use (P = 0.03) correlated with death within 5 years. Severity of respiratory failure did not correlate with mortality.Conclusions:  The 2‐ and 5‐year mortality rates for patients with COPD surviving their first episode of respiratory failure requiring NIV are high. Physiological measures of the severity of respiratory failure at presentation do not predict subsequent survival and nor does the time interval between first and second admissions requiring NIV. Age, BMI and prior need for domiciliary oxygen are the main predictors of mortality at 5 years.
EXPERIENCES OF BILIARY INTERVENTIONS USING SHORT DOUBLE‐BALLOON ENTEROSCOPY IN PATIENTS WITH ROUX‐EN‐Y ANASTOMOSIS OR HEPATICOJEJUNOSTOMY
Authors: Tsujino Takeshi , Yamada Atsuo , Isayama Hiroyuki , Kogure Hirofumi , Sasahira Naoki , Hirano Kenji , Tada Minoru , Kawabe Takao , Omata Masao 
Published: June 2010

Background:  The efficacy of double‐balloon enteroscopy (DBE) for biliary interventions has been shown in patients with surgical anatomy. However, the use of available endoscopic retrograde cholangiography accessories during this procedure is limited because of the length of the conventional instrument (200 cm). The aim of this study was to evaluate the feasibility of short DBE for managing biliary disorders in patients with a Roux‐en‐Y gastrectomy or hepaticojejunostomy (HJ).Patients and Methods:  Using a short enteroscope (152 cm) and commercially available endoscopic retrograde cholangiography accessories, biliary interventions were performed in six patients with Roux‐en‐Y reconstruction or HJ anastomosis.Results:  A total of 12 biliary interventions were performed; balloon dilations of the HJ anastomosis or intrahepatic ducts (four patients), nasobiliary drainages (three patients), bile duct stone removal after endoscopic papillary large balloon dilation with or without small sphincterotomy (two patients), and a biliary stent placement (one patient). One patient showed retroperitoneal air following endoscopic papillary large balloon dilation, but recovered conservatively.Conclusions:  Biliary interventions via DBE using a short enteroscope are feasible in patients with surgical anatomy.
MANAGEMENT OF OBSCURE GASTROINTESTINAL BLEEDING BASED ON THE CLASSIFICATION OF CAPSULE ENDOSCOPIC BLEEDING FINDINGS
Authors: Maeda Mitsunori , Kanke Kazunari , Terano Akira , Hiraishi Hideyuki 
Published: June 2010

Background:  Double‐balloon endoscopy (DBE) and capsule endoscopy (CE) have been useful in managing obscure gastrointestinal bleeding (OGIB). However, DBE is invasive, complex and time‐consuming, therefore indications should probably be selective. The aim of this study was to evaluate the usefulness of the classification of the CE bleeding findings for determining the indications and timing of DBE in patients with OGIB.Methods:  From February 2003 to January 2009, 123 patients with OGIB who underwent CE were included in this study. These CE findings were classified based on the bleeding source. Type CE‐I, II, III, IV and 0 indicate active bleeding, previous bleeding, lesions without active bleeding, a lesion outside of the small bowel, and no findings, respectively. We compared diagnostic yield and outcome between the classification and the findings of DBE or enteroclysis.Results:  Comparisons of the positive findings rate with DBE or enteroclysis, the treatment rate and the rebleeding rate with the classification showed: CE‐Ia, 100% (6/6), 50% (3/6), 33.3% (2/6); Ib, 66.7% (4/6), 0% (0/6), 16.7% (1/6); IIa, 33.3% (1/3), 33.3% (1/3), 33.3% (1/3); IIb, 53.8% (7/13),15.4% (2/13), 30.8% (4/13); III, 100% (84/84), 9.5% (8/84), 8.3% (7/84); IV, 100% (2/2), 50% (1/2), 0% (0/2); and 0, 0% (0/9), 0% (0/9), 0% (0/9), respectively.Conclusions:  The proportion of patients requiring treatment, the positive findings rate with DBE or enteroclysis and the rebleeding rates tended to be higher in the higher ranked classification types (CE‐I > II > III > IV > 0). These findings suggest that the classification can provide useful information on determining the indications and timing of DBE.
Recent vegetation changes at the high‐latitude tree line ecotone are controlled by geomorphological disturbance, productivity and diversity
Authors: Virtanen Risto , Luoto Miska , Rämä Teppo , Mikkola Kari , Hjort Jan , Grytnes John‐Arvid , Birks H. John B. 
Published: June 2010

ABSTRACTAim We test how productivity, disturbance rate, plant functional composition and species richness gradients control changes in the composition of high‐latitude vegetation during recent climatic warming.Location Northern Fennoscandia, Europe.Methods We resampled tree line ecotone vegetation sites sampled 26 years earlier. To quantify compositional changes, we used generalized linear models to test relationships between compositional changes and environmental gradients.Results Compositional changes in species abundances are positively related to the normalized difference vegetation index (NDVI)‐based estimate of productivity gradient and to geomorphological disturbance. Competitive species in fertile sites show the greatest changes in abundance, opposed to negligible changes in infertile sites. Change in species richness is negatively related to initial richness, whereas geomorphological disturbance has positive effects on change in richness. Few lowland species have moved towards higher elevations.Main conclusions The sensitivity of vegetation to climate change depends on a complex interplay between productivity, physical and biotic disturbances, plant functional composition and richness. Our results suggest that vegetation on productive sites, such as herb‐rich deciduous forests at low altitudes, is more sensitive to climate warming than alpine tundra vegetation where grazing may have strong buffering effects. Geomorphological disturbance promotes vegetation change under climatic warming, whereas high diversity has a stabilizing effect.
Mathematical Models for Coinfection by Two Sexually Transmitted Agents: The Human Immunodeficiency Virus and Herpes Simplex Virus Type 2 Case
Authors: Mahiane S. Guy , Nguéma Eugène-P. Ndong , Pretorius Carel , Auvert Bertran 
Published: June 2010

SummaryTo study the interactions between two sexually transmitted diseases without remission of the infections, we propose to use Markovian models. One model allows the estimation of the per-partnership female-to-male transmission probabilities for each infection, and the other the per-sex-act transmission probabilities. These models take into account the essential factors for the propagation of both infections, including the variability according to age of the rates of prevalence in the population of female partners for the male individuals constituting our sample. We estimate transmission probabilities and relative risks (for circumcision, usage of condoms and the effect of one infection on the infectivity of the other) by using the maximum likelihood method. Bootstrap procedures are used to provide confidence intervals for the parameters. We illustrate the new procedures with the study of the interactions between herpes simplex virus type 2 and human immunodeficiency virus by using data from the male circumcision trial that was conducted in Orange Farm (South Africa). The study shows that the probability that a susceptible male individual acquires one of the viruses is significantly higher when he is already infected with the other. Using the Akaike information criterion, we show that the per-partnership model fits the data better than the per-sex-act model.
Cream or foam in pedal skin care: towards the ideal vehicle for urea used against dry skin
Authors: Borelli C. , Bielfeldt S. , Borelli S. , Schaller M. , Korting H. C. 
Published: June 2010

SynopsisThe aim of this study was to evaluate different urea‐containing cosmetic preparations designed for foot care regarding skin occlusion. The primary aim was therefore to screen the short‐term transepidermal water loss (TEWL) as a parameter for skin barrier function and skin occlusion and to characterize the relative role of the vehicle, i.e. cream or foam in the context of cosmetics containing urea in the 2–10% range addressing the cosmetic products urea 2% cream (GEHWOL FUSSKRAFT blau), petrolatum containing cream (GEHWOL med Schrundensalbe), urea 10% cream (GEHWOL med Lipidro‐Crème), urea 10% foam (Allpresan Fuss Schaum) and vaseline (positive control) compared with an untreated area on the volar forearms of volunteers. Moreover, the short time (24 h) kinetics regarding the moisturizing effect of cream and foam formulations in diabetic patients were compared. The efficacy of a cream on reduction of skin thickness of hyperkeratotic skin in the heel region before and after a period of product application was also evaluated. In some of the trials, healthy individuals and in others, diabetic patients (type I and II) were enrolled. TEWL was determined before product application, as well as at given points of time thereafter. In this study, no excessive occlusion effects comparable with a blockage of the skin’s natural water evaporation could be observed for any of the test products. To the extent to be expected, this was found neither for the cream products nor for the foam product. Slightly lowered TEWL values after application of the 10% urea cream can be interpreted as a beneficial effect in terms of an improved barrier function. Regarding skin moisture, the urea‐containing cream formulation appeared equal or slightly superior to the foam formulation. The thickness of the horny layer was found reduced after application of 10 % urea‐containing cream. At present it looks as if cream vehicles would still be vehicles of choice in general, when it comes to the formulation of skin care preparations for not only dry skin but also in the context of pedal skin care.
Assessment of the variation of skin barrier function with anatomic site, age, gender and ethnicity
Authors: Machado M. , Hadgraft J. , Lane M. E. 
Published: June 2010

SynopsisThe skin is the largest organ of the human body and its functions include protection, thermoregulation sensation and secretion. Significant advances in our understanding of how the morphology and physiology of the skin contribute to the skin’s barrier role have been achieved in recent years. The aim of this review is to summarize the principal approaches which have been used to assess variation in skin barrier function with anatomic site, age, gender, and ethnicity. The methods discussed include trans‐epidermal water loss (TEWL) measurement, assessment of corneocyte size, response to vasoactive compounds and attenuated total reflectance Fourier transform infrared (ATR‐FTIR) interrogation of skin. The utility of the various methods is considered and the most important findings in the literature to date are highlighted.
Airway response to emotion‐ and disease‐specific films in asthma, blood phobia, and health
Authors: Ritz Thomas , Wilhelm Frank H. , Meuret Alicia E. , Gerlach Alexander L. , Roth Walton t. 
Published: June 2010

AbstractEarlier research found autonomic and airway reactivity in asthma patients when they were exposed to blood‐injection‐injury (BII) stimuli. We studied oscillatory resistance (Ros) in asthma and BII phobia during emotional and disease‐relevant films and examined whether muscle tension counteracts emotion‐induced airway constriction. Fifteen asthma patients, 12 BII phobia patients, and 14 healthy controls viewed one set of negative, positive, neutral, BII‐related, and asthma‐related films with leg muscle tension and a second set without. Ros, ventilation, cardiovascular activity, and skin conductance were measured continuously. Roswas higher during emotional compared to neutral films, particularly during BII material, and responses increased from healthy over asthmatic to BII phobia participants. Leg muscle tension did not abolish Rosincreases. Thus, the airways are particularly responsive to BII‐relevant stimuli, which could become risk factors for asthma patients.
Material Flow Indicators in the Czech Republic in Light of the Accession to the European Union
Authors: Kovanda Jan , Weinzettel Jan , Hák Tomáš 
Published: June 2010

SummaryThis article deals with the economy‐wide material flows in the Czech Republic in 1990–2006. It presents in brief the overall trends of the material flow indicators in 1990–2002. The major part of the article is focused on the years 2002–2006, which immediately preceded and followed the accession of the Czech Republic to the European Union in 2004. It is shown that this accession had quite a significant impact on the volume and character of the material flows of the Czech Republic. The accession was beneficial from an economic point of view, as it allowed for an increased supply of materials needed for economic growth. Furthermore, it was accompanied by an improvement in the efficiency of material transformation into economic output. From an environmental and broader sustainability point of view, however, this accession brought about some controversial outcomes. There was a significant increase in the net export of environmental pressure, on one hand, and an increase in net additions to the physical stock of the economy, on the other. Although the former is controversial from the viewpoint of equity in sharing area and resources, the latter places an additional burden on future generations because all physical stocks will turn into waste and emissions at some point, when their life span expires.
Arterial ReOcclusion and Persistent Distal Occlusion after Thrombus Aspiration
Authors: Zhao Limin , Rubiera Marta , Harrigan Mark R. , Alexandrov Andrei V. 
Published: June 2010

ABSTRACTBACKGROUND AND PURPOSEEarly reocclusion of intracranial arteries can lead to poor clinical outcome. We report reocclusion detection after endovascular clot aspiration, followed by administration of GPIIb‐IIIa antagonist under continuous ultrasound monitoring.CASE DESCRIPTIONA 73‐year‐old man developed the right middle cerebral artery (MCA) occlusion with NIHSS 17 points, 6 days after aortic valve replacement. Recanalization was achieved with Penumbra™ system and reocclusion was detected with transcranial Doppler (TCD) 30 minutes postcompletion of intra‐arterial procedure. Proximal recanalization was achieved with the second thrombus aspiration while M2 MCA occlusion persisted beyond the reach of the device. Intravenous abciximab was administered under continuous TCD monitoring. Recanalization with Thrombolysis in Brain Ischemia (TIBI) flow grade 4 was observed at 60 minutes postintervention accompanied with clinical recovery to NIHSS 3 points. Abciximab was given for 12 hours with no hemorrhagic transformation on repeat CT scan. Patient was discharged home with mild left pronator drift and facial droop, and his modified ranking score was 1 at 6‐week follow‐up visit.CONCLUSIONSEarly arterial reocclusion can occur after successful thrombus aspiration while GPIIb‐IIIa antagonist administration may lead to subsequent recanalization of persisting distal occlusions not amenable to mechanical removal.
Stem Cell Research as Innovation: Expanding the Ethical and Policy Conversation
Authors: Dresser Rebecca 
Published: June 2010

In 1998, researchers established the first human embryonic stem cell line. Their scientific triumph triggered an ethics and policy argument that persists today. Bioethicists, religious leaders, government officials, patient advocates, and scientists continue to debate whether this research poses a promise, a threat, or a mixed ethical picture for society.Scientists are understandably excited about the knowledge that could come from studying human embryonic stem cells. Most of them believe these cells offer a precious opportunity to learn more about why diseases develop and how they might be prevented or attacked. In their quest to gain support for stem cell research, scientists and others have claimed that the research could generate cures and treatment for everything from heart disease to cancer.
The Metamorphosis of Managed Care: Implications for Health Reform Internationally
Authors: Rodwin Marc A. 
Published: June 2010

Many writers suggest that managed care had a brief life and that we are now in a post-managed care era. Yet managed care has had a long history and continues to thrive. Writers also often assume that managed care is a fixed entity, or focus on its tools, rather than the context in which it operates and the functions it performs. They overlook that managed care has evolved and neglect to examine the role that it plays in the health system.This article argues that private actors and the state have used managed care tools to promote diverse goals. These include the following: increasing access to medical care; restricting physician entrepreneurialism; challenging professional control over the medical economy; curbing medical spending; managing medical practice and markets; furthering the growth of medical markets and private insurance; promoting for-profit medical facilities and insurers; earning bounties for reducing medical expenditures; and reducing governmental responsibility for, and oversight of, medical care. Struggles over these competing goals spurred the metamorphosis of managed care internationally.
Interpretation of the Subjects' Condition Requirement: A Legal Perspective
Authors: Shah Seema , Wendler David 
Published: June 2010

Clinical research with children generates special ethical concern, raising the need for additional protections beyond those for research with competent adults. Most guidelines permit research with children when it offers a prospect of direct benefit, or poses minimal risk. Unlike many other guidelines, the U.S. federal regulations also allow institutional review boards (IRBs) to approve pediatric research that does not offer a prospect of direct benefit when the risks are no greater than a minor increase over minimal risk. To approve research in this category, IRBs must find that two additional conditions obtain:1). The intervention or procedure presents experiences to subjects that are reasonably commensurate with those inherent in their actual or expected medical, dental, psychological, social, or educational situations; and 2). The intervention or procedure is likely to yield generalizable knowledge about the subjects disorder or condition which is of vital importance for the understanding or amelioration of the subjects disorder or condition.
Reviews in Medical Ethics
Authors: Pope Thaddeus Mason , Gagne Joshua J. , Kesselheim Aaron S. 
Published: June 2010

Through the Louisiana Purchase in 1803, the United States expanded its size by over 800,000 square miles. But neither President Thomas Jefferson nor Congress knew exactly what they had bought until 1806, when Meriwether Lewis and William Clark returned from their famous expedition. One of the most significant contributions of the Expedition was a better perception of the geography of the Northwest. Lewis and Clark prepared approximately 140 maps and filled in the main outlines of the previously blank map of the northwestern United States. Robert I. Field has done much the same for the vast territory of U.S. health care regulation.On the front cover of Fields new book, Health Care Regulation in America: Complexity, Confrontation, and Compromise, is a picture of a giant three-dimensional labyrinth. Rarely is cover art so perfectly appropriate.