bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of metachronous second primary cancers in Osaka, Japan: Update of analyses using population‐based cancer registry data
Authors: Tabuchi Takahiro , Ito Yuri , Ioka Akiko , Miyashiro Isao , Tsukuma Hideaki 
Published: February 2012

Cancer survivors are at excess risk of developing second primary cancers, but the precise level of risk in Japanese patients is not known. To investigate the risk of survivors developing second primary cancers, we conducted a retrospective cohort study using data from the Osaka Cancer Registry. The study subjects comprised all reported patients aged 0–79 years who were first diagnosed with cancer between 1985 and 2004 in Osaka and who survived for at least 3 months, followed‐up through to December 2005. A metachronous second primary cancer was defined as any invasive second cancer that was diagnosed between 3 months and 10 years after the first cancer diagnosis. The main outcome measures were incidence rates per 100 000 person‐years, cumulative risk and standardized incidence ratios (SIR) of second primary cancer. Metachronous second primary cancers developed in 13 385 of 355 966 survivors (3.8%) after a median follow‐up of 2.5 years. Sex‐specific incidence rates of metachronous second primary cancer per 100 000 person‐years increased with age, and were higher among men than women (except for the 0–49 years age group), but these rates did not differ over the study period. The 10‐year cumulative risk was estimated as 13.0% for those who first developed cancer at 60–69 years of age (16.2% for men, 8.6% for women). The SIR among those with first cancer diagnosed at 0–39 and 40–49 years of age were 2.13 and 1.52, respectively, in both sexes, whereas the SIR among cancers of the mouth/pharynx, esophagus and larynx were much higher than one as for site relationships. We showed that cancer survivors in Osaka, Japan, were at higher risk of second primary cancers compared with the general population. Our findings indicate that second primary cancers should be considered as a commonly encountered major medical problem. Further investigations are required to advance our understanding to enable the development of effective measures against multiple primary cancers. (Cancer Sci 2012; 103: 1111–1120)
Final results of the phase II study of rabbit anti‐thymocyte globulin, ciclosporin, methylprednisone, and granulocyte colony‐stimulating factor in patients with aplastic anaemia and myelodysplastic syndrome
Authors: Kadia Tapan M. , Borthakur Gautam , Garcia‐Manero Guillermo , Faderl Stefan , Jabbour Elias , Estrov Zeev , York Sergerrne , Huang Xuelin , Pierce Sherry , Brandt Mark , Koller Charles , Kantarjian Hagop M. , Ravandi Farhad 
Published: February 2012

SummaryThis report describes the final results of a Phase II clinical trial investigating the efficacy of rabbit antithymocyte globulin (rATG), ciclosporin, steroids, and granulocyte colony‐stimulating factor (GCSF) in patients with untreated aplastic anaemia (AA), or low to intermediate‐risk and hypocellular myelodysplastic syndrome (MDS). We treated 24 patients each with AA and MDS with rATG (3·5 mg/kg/d × 5; reduced to 2·5 mg/kg/d × 5 in patients with MDS ≥55 years), ciclosporin (5 mg/kg orally daily × 6 months), steroids (1 mg/kg daily, tapered off over 1 month), and GCSF. The overall response rate in AA patients was 64% compared to 25% in MDS patients. The median time to response was 3 months in AA patients and 4 months in MDS patients. Pretreatment clinical characteristics, such as age, sex, blood counts, cellularity, cytogenetics, or HLA‐DR15 status, did not predict for response. Response to therapy, however, predicted for improved overall survival (OS), with a 3‐year OS of 89% vs. 43% in responders versus non‐responders, respectively (P < 0·001). Infusion reactions occurred in about half the patients and were manageable. Myelosuppression, elevation in liver enzymes, and infections were common. The early mortality in MDS patients was 13% vs. 0% in AA patients.
Management of autoimmune diseases after haematopoietic stem cell transplantation
Authors: Holbro Andreas , Abinun Mario , Daikeler Thomas 
Published: February 2012

SummaryAutologous and allogeneic haematopoietic stem cell transplantation (HSCT) is an option for the treatment of malignant and non‐malignant diseases, including the severe autoimmune diseases. Intriguingly, the ‘new’ autoimmunity developing after transplantation is a constantly recognized phenomenon, which has to be differentiated from original disease relapse, toxicity, infection and graft‐versus‐host disease. The reported autoimmune diseases occurring in this setting are mainly antibody‐associated and organ‐specific, with scarce evidence in support for specific treatment options. This review focuses on current concepts on the pathogenesis, the available data on incidence, risk factors, manifestations and treatment of post‐HSCT autoimmune diseases.
Effect of continuous education for evidence‐based medicine practice on knowledge, attitudes and skills of medical students
Authors: Liabsuetrakul Tippawan , Sirirak Thanitha , Boonyapipat Sathana , Pornsawat Panumad 
Published: February 2012

AbstractObjective  To assess the effect of the integration of evidence‐based medicine (EBM) in a medical curriculum using small‐group discussions with case scenario and problem‐based learning on the knowledge, attitudes and skills of medical students.Method  A quasi‐experimental study was conducted in a medical school in southern Thailand during 2008–2009. EBM practice was begun before the completion of the fourth year using case scenario and continued through the fifth year using learner‐centred, problem‐based self‐practice. Knowledge improvement was measured by summative assessment using pre‐ and post‐tests after small‐group discussions with a case scenario. Attitudes and skills were measured by self‐rating assessments: before initiation of the course (T0) and after the course at week 1, 5, 13, 25 and 37 (T1, T2, T3, T4 and T5), respectively. Data were analyzed using paired t‐test and linear mixed‐effects model fitted by maximum likelihood.Results  One hundred fourteen students took the course, with a mean age of 22.1 years. Before and after knowledge scores showed a significant improvement (4.93 versus 7.43). The proportion of students who achieved the highest knowledge scores was higher (4% at pre‐test versus 54% at post‐test). Both self‐rated attitudes and skills after EBM practice increased dramatically from the initiation of the course (T0; P < 0.001). Compared with T1, significantly lower scores of attitudes and skills were observed at T2 and T3, but both were higher at T4 assessment.Conclusions  Continuous EBM education through small‐group discussion and learner‐centred, problem‐based self‐practice can be a useful way to improve a medical student's knowledge, attitudes and skills.
Limitations of the model of porcine islet transplantation in diabetic nonhuman primates affecting long‐term survival and graft function
Authors: Graham Melanie , Schuurman Henk‐Jan 
Published: February 2012

The model of porcine islet cell transplant to the diabetic macaque is well accepted to study efficacy in and immunological interference. This life‐supporting model is therefore considered an integral component in translational research, i.e. in efficacy‐toxicity studies before the phase transition to clinical trials. Diabetes reversal and graft survival >180 days has been achieved in incidental cases, but not in a consistent way. Especially later after transplantation complications can become manifest that are intrinsic to the model:
There are metabolic incompatibilities in the insulin‐glucose homeostasis between species. Fasting glucose levels are lower in monkeys than in pigs or man, and on the other hand C‐peptide levels are higher. In most studies efficacy is associated with moderate hyperglycemia. Insulin secretory capacity in vitro and in vivo is much lower in pigs than in human or monkeys. Hence, the amount and quality of porcine islets needed in the pig‐to‐monkey transplant setting differ from those in the pig‐to‐human setting.
The efficacy‐toxicity window of immunosuppressive drugs is smaller in nonhuman primates than in humans, in particular for small molecular weight xenobiotics. Chronic immunosuppression can induce gastrointestinal toxicity and cachexia, as a result of the high exposure to poorly absorbable drugs necessary to achieve acceptable systemic trough levels can result ingastrointestinal toxicity, with lipid wasting, malabsorption, and inflammation. This affects the diabetes model, namely a reduced challenge of the insulin‐producing machinery thanks to protein and carbohydrate malabsorption, wasting and body weight loss.
Husbandry and management of nonhuman primates in chronic survival studies is complicated, in particular under conditions of metabolic perturbations and chronic immunosuppression. In our unit an animal refinement program has been implemented to achieve optimal well‐being. Under such conditions long‐term survival is facilitated, but also model limitations become more evident.
We conclude that there are intrinsic aspects in the pig‐to‐nonhuman primate model of life‐supporting islet transplantation that are not apparent in short‐term survival studies, but become manifest later after transplantation. If long‐term survival is achieved, it might not unequivocally reflect good graft function, but rather a condition of marginal graft challenge and insulin secreting activity. This phenomenon has consequences for the design and interpretation of pivotal preclinical studies in preparation for the phase transition to clinical trials.
Mechanical heart support at the Deutsches Herzzentrum Berlin: Recent developments (2011)
Authors: Hennig Ewald , Hetzer Roland 
Published: February 2012

Since the inception of the mechanical circulatory support (MCS) program at the Deutsches Herzzentrum Berlin (DHZB) in 1987, more than 1600 patients have received support with 18 different designs of technical blood pump systems, in accordance with the respective state of the art. At the beginning, pulsatile pneumatic extracorporeal ventricular assist devices (VAD) and implantable pneumatic total artificial hearts (TAH) were available, followed by pulsatile electromechanical implantable devices. At this time the assist program was based on three objectives: bridging to recovery, bridging to heart transplantation (HTx) and for permanent support. Very soon (in 1995) patients of advanced age – over 65 years – were included in the program.In 1998 rotary blood pumps with continuous flow entered the program, from 2006 edging out step by step the pulsatile systems. Today the implantable pulsatile systems have disappeared from the DHZB program, with the exception of the extracorporeal uni‐ or biventricular pneumatic EXCOR systems (Berlin Heart GmbH), which are the only systems available for newborns and children. The only approved total artificial heart is the CardioWest device, implanted in rare cases after explantation of the natural heart.Miniaturized rotary blood pumps, axial flow turbines or centrifugal radial flow pumps are leading today's market. The size and configuration of one of these pumps, the hydrodynamically and magnetically levitated HeartWare HVAD, allowed its application as a biventricular implantable assist device. The worldwide first clinical implantation of this system was performed at the DHZB in 2009.With the increasing number of patients needing immediate circulatory support and the stagnating or even decreasing number of donor hearts available for HTx, the extreme discrepancy means that other therapies are gaining increasing importance. The objectives of the MCS program therefore had to focus on permanent VADs, thus creating a growing population of long‐term outpatients with implanted systems, living with their families a near‐normal life.Within a quarter century VAD implantation has grown from an experimental procedure into an established and generally accepted therapy. Facing the rapidly increasing population of patients with end‐stage heart failure and the stagnating number of heart transplants, the use of VAD technology may represent the most advanced progress in cardiac care in the coming years. Further minaturization of the devices will allow the treatment of patients with a wide age spectrum, from newborn children to the elderly, even with biventricular support.The ultimate goal will be the development of a durable total artificial heart, based on the rotary blood pump technology, with transcutaneous energy transfer through the intact skin, guaranteeing the patients optimal quality of life for many years of support.
Quality of life in patients operated on for digestive neoplasia: a prospective study
Authors: Caro A. , Olona C. , Jiménez A. , Olona M. , Vicente V. 
Published: February 2012

AbstractAim  The aim of this study was to evaluate the quality of life in patients having surgery for a digestive neoplasm and to monitor how the patient’s perception evolves during the first 6 months after surgery.Method  A prospective study was carried out on the pre and postoperative quality of life of patients undergoing surgery for a digestive system neoplasm between May 2009 and December 2010. Patients were asked to complete the Short Form (36) Health Survey questionnaire (SF‐36; spanish version 1.4).Results  The study included 80 patients. At 1 month after surgery there was a statistically significant improvement in some domains of the SF‐36. At 6 months, a statistically significant improvement was seen in physical functioning, social functioning, mental health and in the two physical and mental domains. We also found statistically significant differences, with women having a worse quality of life.Conclusion  Comparison of quality of life before and 6 months after surgical intervention showed improvement in both the psychological and the physical elements. This can be attributed to the fact that the patients have had time to recover from the surgery.
Glucose‐lowering treatment and clinical results in 163 121 patients with type 2 diabetes: an observational study from the Swedish national diabetes register
Authors: Ekström N. , Miftaraj M. , Svensson A. ‐M. , Andersson Sundell K. , Cederholm J. , Zethelius B. , Gudbjörnsdottir S. , Eliasson B. 
Published: February 2012

Aims: To analyse clinical characteristics and treatment results in unselected type 2 diabetes mellitus (T2DM) patients, with non‐pharmacological treatment as well as the most commonly used pharmacological glucose‐lowering treatment regimens, in everyday clinical practice.Methods: In this population‐based cross‐sectional study, information was linked from the Swedish National Diabetes Register, Prescribed Drug Register and Patient Register. T2DM patients with non‐pharmacological treatment and T2DM patients continuously using the 12 most common pharmacological treatment regimens were included in the study (n = 163121).Results: There were statistically significant differences in clinical characteristics between the groups. Patients with insulin‐based treatment regimens had the longest duration of diabetes and more cardiovascular risk factors than the T2DM‐population in general. The proportion of patients reaching HbA1c ≤7% varied between 70.1% (metformin) and 25.0% [premixed insulin (PMI) + SU) in patients with pharmacological treatment. 84.8% of the patients with non‐pharmacological treatment reached target. Compared to patients on metformin, patients on other pharmacological treatments had a lower likelihood, with hazard ratios ranging from 0.58; 95% confidence interval (CI), 0.54–0.63 to 0.97;0.94–0.99, of having HbA1c ≤7% (adjusted for covariates). Patients on insulin‐based treatments had the lowest likelihood, while non‐pharmacological treatment was associated with an increased likelihood of having HbA1c ≤7%.Conclusion: This nation‐wide study shows insufficiently reached treatment goals for haemoglobin A1c (HbA1c) in all treatment groups. Patients on insulin‐based treatment regimens had the longest duration of diabetes, more cardiovascular risk factors and the highest proportions of patients not reaching HbA1c target.
Clinicopathological study of invasive extramammary Paget’s disease: subgroup comparison according to invasion depth
Authors: Shiomi T. , Noguchi T. , Nakayama H. , Yoshida Y. , Yamamoto O. , Hayashi N. , Ohara K. 
Published: February 2012

AbstractBackground  Extramammary Paget’s disease (EMPD) is a distinct form of malignant skin neoplasm. Invasive EMPD is relatively rare and its detailed histopathological features have not been investigated to date.Methods  Surgical specimens were obtained from 51 patients with primary invasive EMPD. Clinical data including lymph node status were retrieved from the patients’ medical records. Cases were divided into subgroups according to invasion depth: dermal invasion ≤1 mm (minimal invasion) and dermal invasion >1 mm in depth. Histological patterns (nodular/glandular pattern or micronodular pattern), lymphatic/venous invasion, mitosis and lymph node status were compared between the two groups.Results  The invasive EMPDs included 26 cases (51.0%) with dermal invasion ≤1 mm (minimal invasion) and 25 cases (49.0%) with dermal invasion >1 mm in depth. Lymph node metastasis was detected in 2/26 (7.7%) patients with minimally invasive EMPD. Nodular/glandular pattern (72.0%), lymphatic/venous invasion (52.0%), mitosis (88.0%) and nodal metastasis (88.0%) were all significantly more frequent in cases with dermal invasion >1 mm, compared to EMPDs with dermal invasion ≤1 mm (minimal invasion) (P < 0.001).Conclusion  These results suggest that invasive EMPD can be divided according to invasion depth, with a cut‐off depth of 1 mm. This might represent the basis for a useful, EMPD‐specific staging system.
Clinical and instrumental assessment of the effects of a new product based on hydroxypropyl chitosan and potassium azeloyl diglycinate in the management of rosacea
Authors: Berardesca Enzo , Iorizzo Matilde , Abril Elva , Guglielmini Giancarlo , Caserini Maurizio , Palmieri Renata , Piérard Gérald E 
Published: February 2012

SummaryBackground  Rosacea is a chronic inflammatory skin disease affecting mostly facial skin. Its origin is multifactorial. Important steps in its treatment are avoidance of any triggering factor and control of skin inflammation.Aim  To assess the benefit of topical applications of a new product (P‐3075).Patients/Methods  A randomized, multicenter, double‐blind, placebo‐controlled, parallel‐group, pilot study was carried out to evaluate the efficacy and tolerability of a cream (P‐3075) based on 5% potassium azeloyl diglycinate (PAD, Azeloglicina®) and 1% hydroxypropyl chitosan (HPCH). Forty‐two patients (rosacea stages I and II) were enrolled and randomized, 28 in the P‐3075 group and 14 in the placebo group. They were asked to apply the cream twice daily for 4 weeks. The main assessments were the objective quantification of erythema and skin hydration using the Mexameter® and Corneometer® devices, respectively. Clinical signs and symptoms were evaluated on a four‐point scale.Results  The P‐3075 cream applied for 28 days was effective in skin protection by reducing erythema, evaluated both instrumentally and clinically. In addition, the clinical assessments of other symptoms such as flushing, stinging, and burning supported the beneficial effect of the P‐3075 cream.Conclusions  The anti‐inflammatory and moisturizing effects of potassium azeloyl diglycinate combined with the protective properties of HPCH allow the new product to be a good candidate for controlling signs and symptoms of rosacea.
Can strict volume control be the key for treatment and prevention of posterior reversible encephalopathy syndrome in hemodialysis patients?
Authors: Gungor Ozkan , Kircelli Fatih , Kitis Omer , Asci Gulay , Toz Huseyin , Ok Ercan 
Published: February 2012

AbstractPosterior reversible encephalopathy syndrome (PRES) is a rare but if diagnosed late an irreversible disease. The majority of the patients present with severe hypertension, and effective blood pressure control is the mainstay of therapy. In this case report, we present three cases with PRES, treated successfully with strict volume control policy and propose that strict volume control policy may be a key element for the treatment of PRES.
Phosphate removal model: An observational study of low‐flux dialyzers in conventional hemodialysis therapy
Authors: Wang Mengjing , Li Haiming , Liao Huimin , Yu Yongfu , You Li , Zhu Jianguo , Huang Bihong , Yuan Li , Hao Chuanming , Chen Jing 
Published: February 2012

AbstractPrecise assessing phosphate removal by hemodialysis (HD) is important to improve phosphate control in patients on maintenance HD. We reported a simple noninvasive model to estimate phosphate removal within a 4‐hour HD. One hundred sixty‐five patients who underwent HD 4 hours per session using low‐flux dialyzers made of polysulfone (1.2 m2) or triacetate (1.3 m2) were enrolled. Blood flows varied from 180 to 300 mL/min. Effluent dialysate samples were collected during the 4‐hour HD treatment to measure the total phosphate removal. Predialysis levels of serum phosphate, potassium, hematocrit, intact parathyroid hormone, total carbon dioxide (TCO2), alkaline phosphatase, clinical and dialysis characteristics were obtained. One hundred thirty‐five observations were randomly selected for model building and the remaining 30 for model validation. Total amount of phosphate removal within the 4‐hour HD was mostly 15–30 mmol. A primary model (model 1) predicting total phosphate removal was Tpo4 = 79.6 × C45 (mmol/L) − 0.023 × age (years) + 0.065 × weight (kg) − 0.12 × TCO2 (mmol/L) + 0.05 × clearance (mL/min) − 3.44, where C45 was phosphate concentration in spent dialysate measured at the 45 minute of HD and clearance was phosphate clearance of dialyzer in vitro conditions offered by manufacturer's data sheet. Since the parameter TCO2 needed serum sample for measurement, we further derived a noninvasive model (model 2):Tpo4 = 80.3 × C45 − 0.024 × age + 0.07 × weight + 0.06 × clearance − 8.14. Coefficient of determination, root mean square error, and residual plots showed the appropriateness of two models. Model validation further suggested good and similar predictive ability of them. This study derived a noninvasive model to predict phosphate removal. It applies to patients treated by 4‐hour HD under similar conditions.
Large Strain Response in the Ternary Bi0.5Na0.5TiO3–BaTiO3–SrTiO3 Solid Solutions
Authors: Wang Feifei , Xu Min , Tang Yanxue , Wang Tao , Shi Wangzhou , Leung Chung Ming 
Published: February 2012

A ternary solid solution (0.935‐x)Bi0.5Na0.5TiO3–0.065BaTiO3–xSrTiO3 was designed and fabricated using a conventional fabrication process. Temperature and composition dependence of the ferroelectric, dielectric, and piezoelectric properties were systematically investigated and a schematic phase diagram was established. The SrTiO3 substitution was found to induce a transition from ferroelectric to relaxor pseudocubic phases. Around a critical composition x of 0.22, large strain response of ~0.2% (under a moderate field of 4 kV/mm) with normalized strain of 490 pm/V was obtained. The large unipolar strain response would be of great interest for environmental‐friendly “on‐off” actuators.
What makes child workers go to school? A case study from West Bengal
Authors: Pal Manoranjan , Pal Jadab K. , Tiwari Hare Ram , Bharati Premananda 
Published: February 2012

Abstract.Based on data from 327 households comprising at least one child labourer in 2008, this paper investigates the effects of different socio‐economic and demographic variables on the relationship between child labour and schooling. The results show that the socio‐demographic variables, capturing the “enlightenment” of the parents (e.g. education) do not have much influence on children's school attendance, whereas the economic variables, capturing the standard of living of the households, have a strong influence on whether the children go to school.