bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastroduodeno-plasty performed by distal gastric transection.- A new technique for large duodenal defect closure
Authors: Büsing Martin , Shaheen Hassan , Riege Raute , Utech Markus 
Published: August 2012

Abstract

Introduction
Duodenal ulcer lesions can represent a surgical challenge, especially if the duodenal wall is chronically inflamed, the defect exceeds a diameter of 3 cm and the ulceration is located in the second part of the duodenum.

Patient and method
We present the case of a 70-year-old male, who suffered from a 3 x 4 cm duodenal defect caused by duodenal pressure necrosis due to a 12.5 x 5.5 x 5 cm gallstone. Additionally, this stone caused intestinal obstruction (Bouveret’s syndrome) and bleeding with signs of shock. Besides the gallstone extraction, the common bile duct was drained by a T-tube and the duodenal defect closure was performed by a gastroduodeno-plasty and Bilroth II gastroenterostomy. The postoperative phase was uneventful. The reconstructed duodenum was endoscopically accessible and showed no pathological findings on follow-up.

Conclusion
The reconstruction of a large defect (> 3 cm) of the second part of the duodenum is safely feasible by a gastroduodeno-plasty. The critical gastroduodenal anastomosis can be protected by duodenal decompression, achieved by placing a T-tube in the common bile duct.
Renal tumors and second primary pancreatic tumors: a relationship with clinical impact?
Authors: Müller Sascha A , Pahernik Sascha , Hinz Ulf , Martin David J , Wente Moritz N , Hackert Thilo , Leowardi Christine , Haferkamp Axel , Büchler Markus W , Schmied Bruno M 
Published: August 2012

Abstract

Background
The occurrence of synchronous or metachronous renal cell carcinoma and pancreatic tumors has been described only in a few cases in the scientific literature. The study of double primary cancers is important because it might provide understanding of a shared genetic basis of different solid tumors and to detect patients at risk for secondary malignancy.

Methods
In a combined analysis of patient registries from University Departments of Urology and Visceral Surgery, 1178 patients with pancreatic tumors and 518 patients with renal cell carcinoma treated between 2001 and 2008 were evaluated,

Results
Overall 16 patients with renal cancer and synchronous (n = 6) or metachronous (n = 10) primary pancreatic tumors were detected. The median survival of all patients was 12.6 months, for the patients with synchronous resections 25.7 months and for the patients with metachronous resections 12.2 months, respectively.

Conclusions
The association between these two etiologies of malignancy demands more detailed epidemiological and molecular investigation. Clinical outcomes would support a resection as a recommended clinically valid option.
Excess dietary cholesterol may have an adverse effect on growth performance of early post-larval Litopenaeus vannamei
Authors: Niu Jin , Chen Peng-Fei , Tian Li-Xia , Liu Yong-Jian , Lin Hei-Zhao , Yang Hui-Jun , Liang Gui-Ying 
Published: August 2012

Abstract
One experiment was conducted to determine the nutritive value of cholesterol for post-larval shrimp, Litopenaeus vannamei. Four isoenergetic and isonitrogenous diets supplemented with four levels of cholesterol (D1, D2, D3 and D4 with 0, 0.5%, 1% and 2% cholesterol, respectively) were fed to triplicate groups of L. vannamei shrimp (mean initial wet weight 0.8 mg) for 27 days. After the trial, shrimp fed the D1 diet had the best growth performance (final body weights: FBW; weight gain: WG; specific growth rate: SGR), while there was no significant difference between diet treatments with respect to survival. The whole body crude protein level in the shrimp decreased with the increase in dietary cholesterol levels, while the whole body crude lipid level in shrimps in the D4 diet treatment was significantly higher (P < 0.05) than in other diet treatments. Dietary analysis indicated that the D1 diet contained 0.92% cholesterol prior to supplementation, which may have satisfied the dietary cholesterol requirement of post-larval L. vannamei; excess dietary cholesterol may thus lead to adverse effects on the growth performance of post-larval shrimp.
Forelimb muscle activity during equine locomotion
Authors: Harrison Simon M. , Whitton R. Chris , King Melissa , Haussler Kevin K. , Kawcak Chris E. , Stover Susan M. , Pandy Marcus G. 
Published: August 2012

SUMMARYFew quantitative data exist to describe the activity of the distal muscles of the equine forelimb during locomotion, and there is an incomplete understanding of the functional roles of the majority of the forelimb muscles. Based on morphology alone it would appear that the larger proximal muscles perform the majority of work in the forelimb, whereas the smaller distal muscles fulfil supplementary roles such as stabilizing the joints and positioning the limb for impact with the ground. We measured the timing and amplitude of the electromyographic activity of the intrinsic muscles of the forelimb in relation to the phase of gait (stance versus swing) and the torque demand placed on each joint during walking, trotting and cantering. We found that all forelimb muscles, except the extensor carpi radialis (ECR), were activated just prior to hoof-strike and deactivated during stance. Only the ECR was activated during swing. The amplitudes of muscle activation typically increased as gait speed increased. However, the amplitudes of muscle activation were not proportional to the net joint torques, indicating that passive structures may also contribute significantly to torque generation. Our results suggest that the smaller distal muscles help to stabilize the forelimb in early stance, in preparation for the passive structures (tendons and ligaments) to be stretched. The distal forelimb muscles remain active throughout stance only during canter, when the net torques acting about the distal forelimb joints are highest. The larger proximal muscles activate in a complex coordination to position and stabilize the shoulder and elbow joints during ground contact.
Leg adjustments during running across visible and camouflaged incidental changes in ground level
Authors: Müller Roy , Ernst Michael , Blickhan Reinhard 
Published: August 2012

SUMMARY
During running in a natural environment, humans must routinely negotiate varied and unpredictable changes in ground level. To prevent a fall, changes in ground level, especially those that are invisible, require a quick response of the movement system within a short time. For 11 subjects we investigated two consecutive contacts during running across visible (drop of 0, 5 and 10 cm) and camouflaged (drop of 0 and 10 cm) changes in ground level. For both situations, we found significant variances in their leg parameters and ground reaction forces (GRFs) during the perturbed second contact but also one step ahead, in the unperturbed first contact. At visible first contact, humans linearly adapt their GRF to lower and smooth their centre of mass. During the camouflaged situation, the GRF also decreased, but it seems that the runners anticipate a drop of approximately 5–10 cm. The GRF increased with drop height during the visible perturbed second contact. At the camouflaged second contact, GRFs differed noticeably from the observed reaction when crossing a similar visible drop, whereas the contact time decreased and the initial impact peak increased. This increased impact can be interpreted as a purely mechanical contribution to cope with the event. Furthermore, we observed an increased angle of attack and leg length with drop height for both situations. This is in accordance with results observed in birds running over a track with an unexpected drop, and suggests that adaptations in swing leg retraction form part of the strategy for running across uneven ground.
Successful treatment of Strongyloides stercoralis hyperinfection in a case of systemic lupus erythematosus – review of the literature regarding various treatment schedules
Authors: Mohanasundaram Kavitha , Rajasekaran Kamesharun , Selvaraj Jeyachandran , Balasubramanian Arumugam 
Published: August 2012

Summary Strongyloides stercoralis hyperinfection poses a great challenge to physicians in the tropics due to their non-specific symptoms and signs. Early identification and initiation of treatment improves mortality rates. Reports of Strongyloides infection in Hansens disease, systemic lupus erythematosus (SLE), organ transplant recipients and malnourished individuals have been reported in the published literature. The outcomes were variable, which may be attributed to a lack of treatment protocol. Treatment has been individualized and reports available are based on individual case reports and small case series. We report a successfully treated case of hyperinfection in SLE and discuss the various treatment options available.
The cause of endomyocardial fibrosis in Uganda
Authors: Connor Daniel Henry , Somers Krishna , Nelson Anne Marie , D'arbela Paul G , Lukande Robert 
Published: August 2012

Summary The cause of endomyocardial fibrosis in Uganda remains unknown in spite of studies dating back to 1948. Herbal decoctions have been used by traditional healers for countless generations to treat many complaints, especially fever. We present evidence – ethnic, geographical, tribal, pathological and distribution by age – that the toxic herbal decoctions taken as medicines in Uganda can cause endomyocardial fibrosis.
Poor Absorption of High-Dose Posaconazole in Pediatric Bone Marrow Transplant Patients
Authors: Matthias Kathryn R , Nix David E , Peloquin Charles A , Graham Michael L 
Published: August 2012

OBJECTIVE: To describe the use of high-dose posaconazole in 2 pediatric patients who received bone marrow transplant (BMT) and highlight concerns regarding posaconazole absorption. CASE SUMMARY: We present 2 pediatric BMT patients in whom prescribed high doses of posaconazole (120-300 mg/kg/day for >3 months) provided serum concentrations less than 1 μg/mL. Both patients received posaconazole with other antifungal therapy and surgical debridement for Rhizopus spp. infections after allogeneic BMTs. Various alternative dosing strategies to potentially enhance posaconazole absorption to increase serum concentrations were attempted, including higher daily doses, frequent or continuous oral administration via feeding tube, use of enteral nutrition, and limiting use of acid-blocking agents. During high-dose therapy, frequent posaconazole serum concentration measurement and other monitoring techniques, such as continuous telemetry, were used. While the fungal infections resolved in both patients and no serious adverse effects could be attributed to high-dose posaconazole administration, posaconazole therapy may have contributed to nausea and vomiting in 1 of the patients. DISCUSSION: These 2 cases describe complex circumstances, with several reasons that may have affected the patients' posaconazole serum concentrations. Both patients received significantly higher doses than those recommended in the posaconazole prescribing information, but potentially serious adverse events were not observed since serum concentration measurements were rarely more than 0.5 μg/mL. CONCLUSIONS: The safety of high-dose posaconazole therapy was not determined in these 2 patients. However, given that limited alternative therapy options are available for severely ill patients with suspected posaconazole malabsorption, research regarding dosing strategies should be considered.
Pharmacists' Recommendations to Improve Care Transitions
Authors: Haynes Katherine Taylor , Oberne Alison , Cawthon Courtney , Kripalani Sunil 
Published: August 2012

BACKGROUND: Increasingly, hospitals are implementing multifaceted programs to improve medication reconciliation and transitions of care, often involving pharmacists. OBJECTIVE: To assess pharmacists' views on their roles in hospital-based medication reconciliation and discharge counseling and provide their recommendations for improving care transitions. METHODS: Eleven study pharmacists at 2 hospitals participated in the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study and completed semistructured one-on-one interviews, which were coded systematically in NVivo. Pharmacists provided their perspectives on admission and discharge medication reconciliation, in-hospital patient counseling, provision of simple medication adherence aids (eg, pill box, illustrated daily medication schedule), and telephone follow-up. RESULTS: Pharmacists indicated that they considered medication reconciliation, although time consuming, to be their most important role in improving care transitions, particularly through detection of errors that required correction in the admission medication history. They also identified patients who required additional counseling because of poor understanding of their medications. Providing adherence aids was felt to be highly valuable for patients with low health literacy, although less useful for patients with adequate health literacy. Pharmacists noted that having trained administrative staff conduct initial postdischarge follow-up calls to screen for issues and triage which patients needed pharmacist follow-up was helpful and an efficient use of resources. Pharmacists' recommendations for improving care transitions included clear communication among team members, protected time for discharge counseling, patient and family engagement in discharge counseling, and provision of patient education materials. CONCLUSIONS: Pharmacists are well positioned to participate in hospital-based medication reconciliation, identify patients with poor medication understanding or adherence, and provide tailored patient counseling to improve transitions of care. Additional studies are needed to confirm these findings in other settings and to determine the efficacy and cost-effectiveness of different models of pharmacist involvement.
Safe Use of Hemodialysis for Dabigatran Removal before Cardiac Surgery
Authors: Wanek Matthew R , Horn Edward T , Elapavaluru Subbarao , Baroody Samuel C , Sokos George 
Published: August 2012

OBJECTIVE: To describe a case in which hemodialysis was performed before cardiac transplantation in an attempt to reverse the effects of dabigatran and reduce the risk of bleeding associated with surgery. CASE SUMMARY: A 59-year-old female with heart failure and atrial fibrillation was admitted for orthotropic heart transplant. She had been stable at home with continuous milrinone therapy 0.25 μg/kg/min, amiodarone 200 mg twice daily, and dabigatran 150 mg twice daily for stroke prevention secondary to atrial fibrillation. Upon notification of organ availability, the patient was admitted to the hospital for transplant surgery, with her last dose of dabigatran taken approximately 36 hours before admission. Coagulation studies indicated normal activated partial thromboplastin time, slightly elevated international normalized ratio of 1.2, and elevated thrombin time (TT) of 90.6 seconds (upper limit of normal 19.9 seconds). A hemodialysis catheter was emergently placed and dialysis was initiated. One hour after initiation, TT decreased to 65.5 seconds. After 2.5 hours of dialysis, TT further decreased to 60.2 seconds; at that time, the patient underwent transplantation with no abnormal bleeding during or following surgery. DISCUSSION: Minimal data exist on techniques to reverse the effects of dabigatran in cases of bleeding or emergent surgery. This case examines the efficacy of hemodialysis to decrease dabigatran's effect on clotting assays prior to surgery to reduce the risk of bleeding. In this case, a TT of 60.2 seconds with recent dabigatran administration did not result in abnormal bleeding associated with cardiac surgery. CONCLUSIONS: To our knowledge, this case report represents the first published data on the effects of hemodialysis on dabigatran removal and reversal of anticoagulation associated with dabigatran before surgery. The routine use of preoperative hemodialysis in patients on dabigatran is not recommended; however, the potential efficacy in such circumstances is supported by the successful results in this case.
Impact of Enteral Methadone on the Ability to Wean off Continuously Infused Opioids in Critically Ill, Mechanically Ventilated Adults: A Case-Control Study
Authors: Al-Qadheeb Nada S , Roberts Russel J , Griffin Ryan , Garpestad Erik , Ruthazer Robin , Devlin John W 
Published: August 2012

BACKGROUND: Continuously infused opioids are frequently used to optimize patient comfort in the intensive care unit (ICU). However, concerns about rebound pain and opioid withdrawal may delay efforts to discontinue this therapy. OBJECTIVE: To measure the association between use of scheduled enteral methadone according to a protocol in mechanically ventilated, medical critically ill adults receiving prolonged continuously infused fentanyl and the time to discontinue continuously infused fentanyl therapy. METHODS: This case-control study included 20 consecutive mechanically ventilated adults in a medical ICU, without a history of chronic opioid use, who received 72 or more hours of continuously infused fentanyl and were prescribed scheduled enteral methadone as part of a protocol medical ICU strategy to wean off continuously infused fentanyl. Patients were matched in a 1:2 fashion, by duration of mechanical ventilation, to 40 consecutive preprotocol medical ICU patients meeting the same criteria but who were never given methadone. Duration of continuously infused fentanyl was compared between the 2 groups by constructing Kaplan-Meier plots and estimating the likelihood that methadone use was associated with a decrease in continuously infused fentanyl requirements over time, using a Cox proportional hazards model. RESULTS: The groups were well matched except the methadone patients were older (p = 0.04). Time (median [interquartile range]) to continuously infused fentanyl discontinuation was shorter in the methadone group (4.5 [3.9-5.8] vs 7.0 [4.9-11.5] days; p = 0.002). Continuously infused fentanyl was more likely to be discontinued 2 days after methadone was first initiated (hazard ratio 9.1; p = 0.0004). The proportion of patients who experienced 1 or more episodes of either QTc interval prolongation (p = 0.79) or unarousability (p = 0.47) was similar between the groups. CONCLUSIONS: Enterally administered methadone is associated with earlier cessation of continuously infused fentanyl in mechanically ventilated adults without a history of opioid dependence admitted to a medical ICU. Prospective, controlled studies are needed to further evaluate the safety and efficacy of methadone as a strategy to wean off continuously infused fentanyl in different ICU populations.
Metaphernproduktion für Begreifbare Benutzerschnittstellen
Authors: Groh Rainer , Gründer Thomas , Keck Mandy 
Published: August 2012

Zusammenfassung
In der Mensch-Computer-Interaktion werden konkrete Bilder oder Gestaltstrukturen ausgewählt, um sie als Metaphern auf abstrakte Funktionen und Operationen eines technischen Systems zu übertragen. In diesem Aufsatz wird eine Methode vorgestellt, mit welcher die Metapher im Sinne der Gestaltung von Begreifbaren Benutzerschnittstellen produziert wird. Durch die Interaktion mit alltäglichen Stoffen und Strukturen werden neue Metaphern gefunden und erforscht. Die vorgestellte Methode wird mit Beispielen der studentischen Feldforschung illustriert.
Prognostic Significance of TOP2A Gene Dosage in HER-2-Negative Breast Cancer
Authors: Żaczek Anna J. , Markiewicz Aleksandra , Seroczyńska Barbara , Skokowski Jarosław , Jaśkiewicz Janusz , Pieńkowski Tadeusz , Olszewski Wojciech P. , Szade Jolanta , Rhone Piotr , Wełnicka-Jaśkiewicz Marzena , Jassem Jacek 
Published: August 2012

Abstract

Learning Objectives
After completing this course, the reader will be able to: Describe the prognostic role of TOP2A gene dosage determined by quantitative PCR in HER-2-negative breast cancer.Describe the relationship between HER-2 status and TOP2A status in breast cancer tumors.Gain greater understanding of methods used for TOP2A status determination, including the advantages of quantitative PCR.
CME This article is available for continuing medical education credit at CME.TheOncologist.com

Background.
Previous studies showed the prognostic and predictive impact of human epidermal growth factor receptor 2 (HER-2) gene alterations analyzed separately and jointly with topoisomerase II α (TOP2A) gene alterations; however, the role of TOP2A gene abnormalities alone has not been thoroughly investigated. Additionally, TOP2A aberrations were typically studied in HER-2-positive (HER-2+) tumors because these genes are frequently coamplified. Therefore, the knowledge concerning the impact of TOP2A abnormalities in HER-2-negative (HER-2−) patients is scarce. This study aimed to investigate the clinical significance of TOP2A anomalies in breast cancer patients with HER-2− and HER-2+ tumors.

Materials and Methods.
Snap-frozen tumor samples from 322 consecutive stage I–III breast cancer patients were analyzed for TOP2A gene dosage using quantitative real-time PCR (qPCR).

Results.
A high TOP2A gene dosage was found in 94 tumors (29%)—32% and 27% of HER-2+ and HER-2− tumors, respectively. The mean TOP2A gene dosages in the HER-2+ and HER-2− groups were 1.49 ± 1.03 and 1.09 ± 0.35, respectively. High TOP2A gene dosage had an inverse prognostic impact in terms of shorter disease-free survival (DFS) and overall survival (OS) times in the entire group and in both the HER-2− and HER-2+ subgroups. The unfavorable prognostic impact of TOP2A gene dosage was maintained in the multivariate Cox regression analysis in the entire group and in HER-2− patients.

Conclusions.
A high gene dosage of TOP2A determined using qPCR occurs frequently both in HER-2+ and HER-2− tumors and has a strong adverse prognostic impact.
Change of Periodontal Disease Status During and After Pregnancy
Authors: Xie Yiqiong , Xiong Xu , Elkind‐Hirsch Karen E. , Pridjian Gabriella , Maney Pooja , Delarosa Robert L. , Buekens Pierre 
Published: August 2012

Background: This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy.Methods: A follow‐up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty‐nine females who were previously enrolled in a case‐control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status.Results: Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy.Conclusions: Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.