bluuebunny/crossref_metadata_2025_split huggingface dataset:
Melanoma Recurrence after Negative Sentinel Lymph Node Biopsy
Authors: Davis‐Malesevich Melinda , Goepfert Ryan , Myers Jeffrey N. 
Published: September 2011

ObjectiveDelineate clinico‐pathologic factors associated with recurrence of cutaneous melanoma of the head and neck region and survival after negative sentinel lymph node biopsy (SLNB).MethodA retrospective review from January 2000 to June 2009 was conducted at a tertiary referral center. Characteristics and outcomes of 204 patients with head and neck melanoma who underwent negative SLNB were analyzed in a univariant and multivariant fashion. Main outcomes measured included: local, regional, distant recurrences, and survival.ResultsA total of 204 patients with cutaneous melanoma of the head and neck underwent successful SLNB, in which final pathology was negative for nodal metastasis. Fifty‐nine recurrences occurred in 42 patients: local/in‐transit 18, regional 17, and distant metastasis 24. Five recurrences occurred within the same nodal basin that harbored the negative SLN(s). Decreased survival was associated with Breslow thickness (P <. 05) and ulceration (P <. 006). Local recurrence was associated with Clark level, Breslow thickness, and perineural invasion (P <. 05). Regional recurrence was correlated with Breslow thickness (P <. 05). Distant metastasis was associated with Breslow thickness, ulceration, nodular histology, and negative SLN(s) located in level V (P <. 05).ConclusionRegional recurrence in a primary echelon nodal basin after negative SLNB is rare (2‐4%) and is associated with increased Breslow thickness (>2.0mm). Thus, sentinel node biopsy is highly effective in assessing the draining nodal basin for metasatic disease and for directing further treatment leading to regional disease control.
Microvascular Free Flaps and Intraoperative Vasopressors
Authors: Wilson Matt , Hunt Jason P. , Buchmann Luke 
Published: September 2011

ObjectiveIdentify if the use of an intraoperative vasopressor increases the risk of microvascular free flap failure or affects the rate of complications.MethodA retrospective chart review performed between November 2008 and November 2010 of patients undergoing head and neck microvascular reconstruction. Flap type, ASA classification, use of a vasopressor, and fluid status were documented and analyzed with respect to flap failure and complications. A Fisher exact test was used for statistical analysis.ResultsEighty‐six patients underwent microvascular reconstruction during the study period. No patients were excluded. Seventy‐six (88.4%) patients received at least 1 vasopressor intraoperatively. Ten (11.6%) did not have administration of vasopressors. Total flap failure occurred in 3 (3.5%) patients. All flap failures occurred in patients that received vasopressors (3.9%) (P =. 696). Flap complications (intraoperative clot requiring revision anastomosis, leech therapy, or flap failure) occurred in 11 (12.8%) patients, including 2 (20%) of the patients that did not receive a vasopressor and 9 (11.8%) of the patients that received a vasopressor (P =. 408).ConclusionThe use of vasopressors in head and neck microvascular reconstruction is very common. There is no evidence that vasopressors have an effect on microvascular free flap survival or complications.
Outcomes for Total Glossectomy vs Laryngoglossectomy
Authors: Sinclair Catherine Fiona , Desmond Renee , Rosenthal Eben L. , Carroll William R. 
Published: September 2011

ObjectiveCompare functional and survival outcomes for patients undergoing total glossectomy (TG) or total glossectomy plus laryngopharyngectomy (TGLP) for advanced squamous cell carcinoma (SCC) of the tongue.MethodA retrospective review was undertaken of all patients undergoing TG or TGLP at an academic tertiary referral center between 2002 and 2010. There were 30 included patients (20 TG, 10 TGLP). Outcomes included tumor recurrence, disease‐free survival and functional data (swallowing, gastrostomy tube dependence, speech, airway).ResultsMean patient age was 56 years with a male predominance (90%). Compared with TG, TGLP was more commonly performed for recurrent tumors (P =. 06). Perineural invasion and extracapsular extension occurred more commonly for TGLP patients (80% vs 50%, P =. 12). There was a trend toward increased tumor recurrence in the TG group (61% vs 40%, P =. 43). Twelve month disease free survival was 40% (TG) vs 50% (TGLP). Functionally, more TG patients were totally gastrostomy tube dependent (70% vs 30%, P =. 04), and 50% of TG patients were also tracheostomy dependent. Intelligible speech was achieved by 30% TG and 10% TGLP patients (P =. 68).ConclusionPatients undergoing TGLP had similar functional and survival outcomes to patients undergoing TG despite more locally advanced disease with greater adverse pathological features. Positive or close margins for TG occurred most commonly at the inferior resection margin which could explain why TGLP for advanced tongue SCC may improve local disease control.
pERK Expression in Skin Squamous and Basal Cell Carcinoma
Authors: Phillips Jeffrey , Sonavane Kunal , Moore‐Medlin Tara , Nathan Cherie‐Ann O. , Abreo Fleurette , Clark Cheryl 
Published: September 2011

ObjectiveCurcumin, a naturally occurring bioactive food compound has been shown to inhibit progression of cutaneous SCCa, possibly via inhibition of the MEK/ERK signaling pathway. In our effort to selectively inhibit cutaneous SCCa, we hypothesize that the MEK/ERK pathway is over‐expressed in SCCa, suggesting a novel target for curcumin.MethodNormal human skin (N = 28), BCCa (N = 12), and SCCa (N = 11) were analyzed for pERK (Thr202/Tyr204) expression by IHC. Tumor sections were subjectively scored from 0 to 2+ (none, weak or focal, strong) based on the intensity of the stain, and compared by Chi Square analysis.ResultsAll SCCa (N = 11) and only 5/12 (54%) BCC stained positive for pERK. Tumors expressed more pERK than normal skin χ2 (2, N = 51) = 26.37, P <. 001, and differed by tumor type, χ2 (1, N = 23) = 6.77, P =. 009. Tumor type significantly predicted pERK staining, b =. 67, t(20) = 2.39, P =. 027, and explained a significant proportion of variance in pERK scores, R2 =. 33, F(3, 20) = 3.33, P =. 04, whereas age (P =. 59) and gender (P =. 17) did not explain the variance in pERK staining.ConclusionThe MEK/ERK pathway appears to be over‐expressed in SCCa compared with the more common BCCa. As curcumin has been shown to slow progression of cutaneous SCCa and inhibit pERK expression, the MEK/ERK pathway may prove a key biomarker in developing pharmaceutical agents that prevent SCCa tumor growth.
Prevention of type 2 diabetes by lifestyle intervention in primary health care setting in Poland: Diabetes in Europe Prevention using Lifestyle, physical Activity and Nutritional intervention (DE-PLAN) project
Authors: Gilis-Januszewska Aleksandra , Szybinski Zbigniew , Kissimova-Skarbek Katarzyna , Piwonska-Solska Beata , Pach Dorota , Topor-Madry Roman , Tuomilehto Jaakko , Lindström Jaana , Peltonen Markku , Schwarz Peter Eh , Hubalewska-Dydejczyk Alicja 
Published: September 2011

Aim To find out whether diabetes prevention via a lifestyle intervention programme is feasible in a primary healthcare setting in Poland. Methods The intervention (Diabetes in Europe: Prevention using Lifestyle, physical Activity and Nutritional intervention; DE-PLAN project) was completed by 175 middle-aged, slightly obese participants in nine primary healthcare centres in Krakow, Poland. The inclusion criterion was diabetes risk (Finnish Diabetes Risk score (FRS) >14). The nurse-delivered intervention consisted of 10 group sessions on lifestyle changes, six motivational telephone sessions, two motivational letters and the opportunity to participate in once or twice weekly physical activity sessions. Results At 12 months there were mean reductions in weight, 85.7 to 83.7 kg; body mass index, 31.8 to 31.1 kg/m2 (p<0.05); waist circumference, 98.8 to 95.5 cm (p<0.05); total cholesterol 5.6 to 5.3 mmol/L (p<0.05), systolic and diastolic blood pressure 133 to 130 and 83 to 81 mmHg respectively (p<0.05); FRS 18–16 (p<0.05) and 25% of participants lost ≥5% of initial body weight. No changes were observed in fasting or 2-h post-oral glucose tolerance test plasma glucose, triglycerides, or high-density lipoproteins. Significant improvements were found in lifestyle risk factors like diet and physical activity. Conclusions Prevention of type 2 diabetes through lifestyle intervention is feasible in primary healthcare settings in Poland.
Neomacrolides in the treatment of patients with severe asthma and/or bronchiectasis: a retrospective observational study
Authors: Coeman Mathieu , van Durme Yannick , Bauters Fre , Deschepper Ellen , Demedts Ingel , Smeets Peter , Joos Guy , Brusselle Guy 
Published: September 2011

Rationale: Previous studies have demonstrated that long-term low-dose macrolides are efficacious in cystic fibrosis (CF) and diffuse panbronchiolitis, two chronic neutrophilic airway diseases. Aims: The aims of this study were to evaluate the efficacy and safety of low-dose neomacrolides as add-on therapy in patients with severe asthma and/or bronchiectasis and to identify predictors for therapeutic response. Methods: In a retrospective observational cohort study, we examined 131 adult, non-CF patients with severe asthma and/or bronchiectasis, receiving low-dose neomacrolides as add-on treatment. Pulmonary function tests and symptom scores were assessed at baseline and after 3 to 8 weeks of therapy. Results: After 3–8 weeks of treatment with low-dose neomacrolides, 108 patients were available for evaluation. In asthma patients ( n = 47), pulmonary function tests and symptom scores improved significantly. Responders (≥7% forced expiratory volume in one second predicted [FEV1%] improvement) were older (55 vs. 47 years; p = 0.042) and had a longer duration of asthma (29 vs. 9 years; p = 0.052). In patients with bronchiectasis only ( n = 61), symptom scores improved significantly. Responders (≥60% symptom score improvement) were older (61 vs. 53 years; p = 0.004), more frequently male (53% vs. 27%; p = 0.043), and there was a nonsignificant trend towards higher high-resolution CT (HRCT) score for bronchiectasis in responders (6.4 vs. 4.6; p = 0.053). In multivariate logistic regression analysis, age and male gender were independent predictors for improvement in this group. Conclusion: The results of this retrospective study suggest that neomacrolides may be useful as an add-on therapy in patients with severe asthma and/or bronchiectasis. Older age may predict good response in patients with severe asthma, whereas older age, male gender and a higher HRCT score for bronchiectasis may predict therapeutic response in patients with bronchiectasis only. Prospective controlled trials of neomacrolides in patients with severe asthma are needed to confirm these observations.
Nasal continuous positive airway pressure: influence on digital volume pulse in obstructive sleep apnoea patients
Authors: Scholze Alexandra , Lamwers Stephanie , Tepel Martin , Sanner Bernd M. 
Published: September 2011

Obstructive sleep apnoea (OSA) is linked to increased cardiovascular risk. This risk can be reduced by nasal continuous positive airway pressure (nCPAP) treatment. As OSA is associated with an increase of several vasoconstrictive factors, we investigated whether nCPAP influences the digital volume pulse wave.We performed digital photoplethysmography during sleep at night in 94 consecutive patients who underwent polysomnography and 29 patients treated with nCPAP. Digital volume pulse waves were obtained independently of an investigator and were quantified using an algorithm for continuous automated analysis.In patients with OSA and an apnoea/hypopnoea index (AHI) of >10 events·h−1, a significant vasoconstriction was observed during the night (p<0.0001 by Friedman’s test). A significant positive correlation existed between vasoconstriction and AHI (Spearman correlation, r=0.27; p<0.01; n=94) and the arousal index (Spearman correlation, r=0.21; p<0.05; n=94). After 6 months of nCPAP treatment, the AHI was significantly reduced from 27±3 events·h−1to 4±2 events·h−1(each n=29; p<0.001) and vasoconstriction during the night was significantly reduced from 10±3% to 3±1% (p<0.01).We show changes in the reflective index during the night consistent with vasoconstriction in patients with OSA, which are significantly reduced after 6 months of nCPAP treatment.
Assessing the Liverpool Respiratory Symptom Questionnaire in children with cystic fibrosis
Authors: Trinick R. , Southern K.W. , McNamara P.S. 
Published: September 2011

Monitoring respiratory status in cystic fibrosis (CF) is challenging, particularly in young children. We aimed to test whether the Liverpool Respiratory Symptom Questionnaire (LRSQ) could distinguish well, pre-school and older children with and without CF, whether it could distinguish well and unwell children with CF and, finally, whether LRSQ scores in older children with CF correlated with established measures of disease severity.20 stable pre-school children with CF had significantly higher total LRSQ scores than 51 pre-school controls, and higher scores in two out of eight domains. Similarly, 21 stable 6- to 12-yr-old children with CF had higher total scores than 97 6- to 12-yr-old controls, and higher scores in seven out of eight domains.In older children with CF, LRSQ scores correlated negatively with Shwachman score and forced expiratory volume in 1 s (r= -0.58, p<0.001, n=31; and r= -0.46, p<0.010, n=34, respectively). Within the CF group, patients who culturedPseudomonas aeruginosa, who used more “back-up” antibiotics or whose school attendance was lower also had higher LRSQ scores.The LRSQ differentiates well children from those with CF in both pre-school and the 6- to 12-yr-old age group, even at a point of stability. It also differentiates stable from unwell children with CF, and scores correlate with other measures of respiratory disease, highlighting its potential as a clinical monitoring tool in paediatric CF.
Chronic infection and inflammation affect exercise capacity in cystic fibrosis
Authors: van de Weert-van Leeuwen P.B. , Slieker M.G. , Hulzebos H.J. , Kruitwagen C.L.J.J. , van der Ent C.K. , Arets H.G.M. 
Published: September 2011

Pulmonary function and nutritional status are important determinants of exercise capacity in patients with cystic fibrosis (CF). Studies investigating the effects of determinants, such as genotype or infection and inflammation, are scarce and have never been analysed in a multivariate longitudinal model.A prospective longitudinal cohort study was performed to evaluate whether genotype, chronic inflammation and infection were associated with changes in exercise capacity. Furthermore, we investigated whether exercise capacity can predict clinical outcome.504 exercise tests of 149 adolescents with CF were evaluated. Maximal oxygen uptake corrected for body mass % predicted declined 20% during adolescence, and was associated with immunoglobulin (Ig)G levels and chronicPseudomonas aeruginosainfection. A lower exercise capacity was associated with a higher mortality, steeper decline in pulmonary function and greater increase in IgG levels.Since a decline in exercise capacity during adolescence was negatively associated with IgG levels and chronicP. aeruginosainfection, these data emphasise the importance of prevention and treatment of chronic inflammation and infections in patients with CF. Furthermore, a lower exercise capacity was associated with a higher mortality rate, steeper decline in pulmonary function and higher increase in IgG levels with increasing age in adolescents with CF. This stresses the value of regular exercise testing for assessing prognosis in adolescents with CF.
Expression of muscarinic receptors by human macrophages
Authors: Koarai A. , Traves S.L. , Fenwick P.S. , Brown S.M. , Chana K.K. , Russell R.E.K. , Nicholson A.G. , Barnes P.J. , Donnelly L.E. 
Published: September 2011

Macrophages increase in number and are highly activated in chronic obstructive pulmonary disease (COPD). Muscarinic receptor antagonists inhibit acetylcholine-stimulated release of neutrophilic chemoattractants, suggesting that acetylcholine may regulate macrophage responses. Therefore, expression and function of components of the non-neuronal cholinergic system in monocyte-macrophage cells was investigated.RNA was isolated from monocytes, monocyte-derived macrophages (MDMs), lung and alveolar macrophages from nonsmokers, smokers and COPD patients, and expression of the high-affinity choline transporter, choline acetyltransferase, vesicular acetylcholine transporter and muscarinic receptors (M1–M5) ascertained using real-time PCR. M2and M3receptor expression was confirmed using immunocytochemistry. Release of interleukin (IL)-8, IL-6 and leukotriene (LT)B4were measured by ELISA or EIA.All monocyte-macrophage cells expressed mRNA for components of the non-neuronal cholinergic system. Lung macrophages expressed significantly more M1mRNA compared with monocytes, and both lung macrophages and alveolar macrophages expressed the highest levels of M3mRNA. Expression of M2and M3protein was confirmed in MDMs and lung macrophages. Carbachol stimulated release of LTB4from lung macrophages (buffer 222.3±75.1versuscarbachol 1,118±622.4 pg·mL−1; n=15, p<0.05) but not IL-6 or IL-8. LTB4release was attenuated by the M3antagonist, 1,1-dimethyl-4-diphenylacetoxypiperidinium iodide (4-DAMP; half maximal effective concentration 5.2±2.2 nM; n=9).Stimulation of macrophage M3receptors promotes release of LTB4, suggesting that anti-muscarinic agents may be anti-inflammatory.
Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome
Authors: Mentzelopoulos S.D. , Malachias S. , Zintzaras E. , Kokkoris S. , Zakynthinos E. , Makris D. , Magira E. , Markaki V. , Roussos C. , Zakynthinos S.G. 
Published: September 2011

In acute respiratory distress syndrome (ARDS), recruitment sessions of high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) with short-lasting recruitment manoeuvres (RMs) may improve oxygenation and enable reduction of subsequent conventional mechanical ventilation (CMV) pressures. We determined the effect of adding HFO-TGI sessions to lung-protective CMV on early/severe ARDS outcome.We conducted a prospective clinical trial, subdivided into a first single-centre period and a second two-centre period. We enrolled 125 (first period, n=54) patients with arterial oxygen tension (Pa,O2)/inspiratory oxygen fraction (FI,O2) of <150 mmHg for >12 consecutive hours at an end-expiratory pressure of ≥8 cmH2O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n=61) or CMV group (receiving lung-protective CMV and RMs; n=64). The primary outcome was survival to hospital discharge.Pre-enrolment ventilation duration was variable. During days 1–10 post-randomisation,Pa,O2/FI,O2, oxygenation index, plateau pressure and respiratory compliance were improved in the HFO-TGI groupversusthe CMV group (p<0.001 for group×time). Within days 1–60, the HFO-TGI group had more ventilator-free daysversusthe CMV group (median (interquartile range) 31.0 (0.0–42.0)versus0.0 (0.0–23.0) days; p<0.001), and more days without respiratory, circulatory, renal, coagulation and liver failure (p≤0.003). Survival to hospital discharge was higher in the HFO-TGI groupversusthe CMV group (38 (62.3%) out of 61versus23 (35.9%) out of 64 subjects; p=0.004).Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.
Respiratory health and endotoxin: associations and modification byCD14/-260 genotype
Authors: Bakolis I. , Doekes G. , Heinrich J. , Zock J.P. , Heederik D. , Kogevinas M. , Guerra S. , Norbäck D. , Ramasamy A. , Nevalainen A. , Svanes C. , Chen C.M. , Verlato G. , Olivieri M. , Castro-Giner F. , Jarvis D. 
Published: September 2011

Exposure to endotoxin has been associated with increased respiratory symptoms and decrements in lung function in occupational settings but little is known about the health effects of domestic exposure in adults. Here, we describe the association of respiratory disease, immunoglobulin (Ig)E sensitisation, bronchial reactivity and lung function with mattress endotoxin levels in adults, and determine whether these associations are modified by polymorphisms inCD14.Endotoxin levels in mattress dust from a population-based sample of 972 adults were measured. Associations were examined using generalised linear mixed models, adjusting for individual and household confounders. Effect modification of these associations byCD14/-260 (rs2569190) was assessed.Mattress endotoxin levels varied from 0.1 to 402.6 EU·mg−1. Although there was no overall association of lung function with endotoxin exposure, there was evidence that the association of forced expiratory volume in 1 s and forced vital capacity with endotoxin was modified byCD14/-260 genotype (p-value for interaction 0.005 and 0.013, respectively). There was no evidence that symptoms, IgE sensitisation or bronchial reactivity were associated with mattress endotoxin levels.In this large epidemiological study of adults, there was no evidence that mattress endotoxin level was associated with respiratory symptoms or IgE sensitisation but the association of lung function with endotoxin levels may be modified byCD14genotype.
Pulmonary infections in HIV-infected patients: an update in the 21st century
Authors: Benito N. , Moreno A. , Miro J.M. , Torres A. 
Published: September 2011

From the first descriptions of HIV/AIDS, the lung has been the site most frequently affected by the disease. Most patients develop a pulmonary complication during the history of HIV infection, mainly of infectious aetiology.Important changes in the epidemiology of HIV-related pulmonary infections have occurred. Overall, prescription ofPneumocystis jiroveciiprophylaxis and the introduction of highly active antiretroviral therapy (HAART) are the main causes.Currently, the most frequent diagnosis in developed countries is bacterial pneumonia, especially pneumococcal pneumonia, the second most frequent cause isPneumocystispneumonia and the third is tuberculosis. However, in Africa, tuberculosis could be the most common pulmonary complication of HIV.Pulmonary infections remain one of the most important causes of morbidity and mortality in these patients, and the first cause of hospital admission in the HAART era. Achieving an aetiological diagnosis of pulmonary infection in these patients is important due to its prognostic consequences.