bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2‐weighted, dynamic contrast‐enhanced and diffusion‐weighted imaging
Authors: Delongchamps Nicolas Barry , Rouanne Mathieu , Flam Thierry , Beuvon Frédéric , Liberatore Mathieu , Zerbib Marc , Cornud François 
Published: November 2010

Study Type – Diagnostic (exploratory cohort)  Level of Evidence 2b What’s known on the subject? and What does the study add? Dynamic contrast enhanced (DCE) and diffusion weighted (DW) MRI have demonstrated their potential value in distinguishing malignant from benign prostate tissue, but none of them used alone is capable of optimally characterizing tumours in the prostate.The combination of DW, DCE and T2W imaging increased significantly MRI performance for cancer detection in the peripheral zone.OBJECTIVE• To evaluate the combination of multiple magnetic resonance imaging (MRI) techniques, including T2‐weighted imaging (T2W), dynamic contrast‐enhanced imaging (DCE) and diffusion‐weighted imaging (DWI), for the detection and localization of prostate cancer.PATIENTS AND METHODS• In all, 57 patients underwent endorectal MRI at 1.5 T before radical prostatectomy (RP) for localized prostate cancer.• On T2W images and histological whole‐mount analysis, the peripheral zone (PZ) and transition zone (TZ) were divided into upper and lower glands, as well as left and right halves, thus yielding four quadrants for each zone.• On histological analysis, the total number of tumour foci, their location and larger diameter were recorded. T2W alone, T2W + DWI, T2W + DCE and all three techniques combined were scored for the likelihood of tumour in each area and results were compared with whole‐mount analysis.• The area under the receiver operating characteristic curve (Az) was used to evaluate accuracy for tumour detection. The association between MR accuracy and Gleason score was statistically assessed.RESULTS• Of the 456 prostate octants analysed, 145 showed cancer on whole‐mount analysis, 120 (83%) of them with a diameter assumed to correspond to a volume >0.2 cm3. Gleason score was ≥7 in 68 (47%) tumours.• In the PZ, the Az value was significantly higher for T2W + DWI, T2W + DCE and all three techniques combined than for T2W alone (P < 0.05).• In the TZ, the Az value was higher for T2W + DWI than for T2W alone, but the difference was not significant.• The Az value for T2W + DWI was significantly higher than that for T2W + DCE or for the three sequences combined.• Gleason score was significantly associated with cancer detection in the PZ.CONCLUSIONS• Adding DWI and DCE to T2W imaging increased MRI performance in cancer detection in the PZ significantly.• However, this multiparametric model failed to improve performance in the TZ.• Gleason score significantly influenced cancer detection in the PZ but not in the TZ.
Periprostatic fat correlates with tumour aggressiveness in prostate cancer patients
Authors: van Roermund Joep G.H. , Hinnen Karel A. , Tolman Christine J. , Bol Gijsbert H. , Witjes J. Alfred , Bosch J.L.H. Ruud , Kiemeney Lambertus A. , van Vulpen Marco 
Published: November 2010

Study Type – Prognostic (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Nowadays more and more publications have been published about the topic prostate cancer aggressiveness and obesity with mixed results. However, most of the publications used the BMI as a marker for obesity, while the most metabolic active fat is the visceral fat. To learn more about these relations we measured and used the visceral fat in our paper.OBJECTIVE• To examine if the periprostatic fat measured on computed tomography (CT) correlates with advanced disease we examined patients who received radiotherapy for localized prostate cancer. Several USA reports found a positive association between obesity and prostate cancer aggressiveness. However, in recent European studies these conclusions were not confirmed. Studies concerning this issue have basically relied on body mass index (BMI), as a marker of general obesity. Visceral fat, however, is the most metabolically active and best measured on CT.PATIENTS AND METHODS• In 932 patients, who were treated with external radiotherapy (N= 311) or brachytherapy (N= 621) for their T1‐3N0M0 prostate cancer, different fat measurements (periprostatic fat, subcutaneous fat thickness) were performed on a CT.• Associations between the different fat measurements and risk of having high‐risk (according to Ash et al., PSA > 20 or Gleason score ≥8 or T3) disease was measured.RESULTS• The median age (IQR) was 67.0 years (62.0–71.0) and median BMI (IQR) was 25.8 (24.2–28.3). Logistic regression analyses, adjusted for age, revealed a significant association between periprostatic fat density (PFD) and risk of having a high risk disease. (Odds ratio [95% CI] 1.06 [1.04–1.08], P < 0.001)CONCLUSION• Patients with a higher PFD had more often aggressive prostate cancer.
Prostate‐specific antigen velocity based risk‐adapted discontinuation of prostate cancer screening in elderly men
Authors: Tang Ping , Sun Leon , Uhlman Matthew A. , Robertson Cary N. , Polascik Thomas J. , Moul Judd W. 
Published: November 2010

Study Type – Prognostic (cohort)  Level of Evidence 2b What’s known on the subject? and What does the study add? Currently, the U.S. Preventive Services Task Force (USPSTF) recommends against PSA screening for prostate cancer in men aged ≥75 years as it concluded that “the harm of screening for prostate cancer in men age ≥75 years may outweigh the potential benefits”. Our findings suggest that elderly men with a PSA velocity of ≥0.45 ng/ml/year have higher risk of death from prostate cancer. Continuing PSA testing may be beneficial for these men.OBJECTIVE• To evaluate weather prostate‐specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk.PATIENTS AND METHODS• The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa.• The rates of death from PCa after diagnosis in different PSA velocity groups were calculated. Kaplan‐Meier and log rank test were used to assess the significant difference in death from PCa after diagnosis, stratified by PSA velocity cutoff.RESULTS• On multivariate analysis, men with a PSA velocity of PSA velocity ≥0.45 ng/mL/year had a 4.8‐fold higher risk of death from PCa as compared to men with a PSA velocity of <0.45 ng/mL/year (p value = 0.013). After a median 6.5 (up to 16.9) years of follow‐up from diagnosis, 1.4% of the men with a PSA velocity <0.45 ng/mL/year had died of PCa as compared to 8.7% of those with a PSA velocity ≥0.45 ng/mL/year.• The cumulative rate of death from PCa after diagnosis, stratified by a PSA velocity of 0.45 ng/mL/year, was statistically different (log rank test, P < 0.001).CONCLUSION• Men age ≥ 75 years old with a PSA velocity of <0.45 ng/mL/year are unlikely to die of PCa. It may be safe to discontinue PSA screening in these men.
Defecation disturbances after cystectomy for urinary bladder cancer
Authors: Thulin Helena , Kreicbergs Ulrika , Onelöv Erik , Ahlstrand Christer , Carringer Malcolm , Holmäng Sten , Ljungberg Börje , Malmström Per‐Uno , Robinsson David , Wijkström Hans , Wiklund N. Peter , Steineck Gunnar , Henningsohn Lars 
Published: November 2010

Study Type – Preference (prospective cohort)Level of Evidence 4 What’s known on the subject? and What does the study add? Functional gastrointestinal symptoms and problems are common after radical cystectomy with urinary diversion. This study adds new important epidemiological data on this group of symptoms.OBJECTIVE

To describe and compare long‐term defecation disturbances in patients who had undergone a cystectomy due to urinary bladder cancer with non‐continent urostomies, continent reservoirs and orthotopic neobladder urinary diversions.

PATIENTS AND METHODS

During their follow‐up we attempted to contact all men and women aged 30–80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals.
During a qualitative phase we identified defecation disturbances as a distressful symptom and included this item in a study‐specific questionnaire together with free‐hand comments. The patients completed the questionnaire at home.
Outcome variables were dichotomized and the results are presented as relative risks with 95% confidence interval.

RESULTS

The questionnaire was returned from 452 (92%) of 491 identified patients. Up to 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability).
A sense of decreased straining capacity was reported by 20% of the men and women with non‐continent urostomy and 14% and 8% of those with continent reservoirs and orthotopic neobladders, respectively.

CONCLUSIONS

Of the cystectomized individuals 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability).
Those wanting to improve the situation for bladder cancer survivors may consider communicating before surgery the possibility of stool‐emptying problems, and asking about them after surgery.
Social inequality and health: the role of social capital
Authors: Dahl Espen , Malmberg‐Heimonen Ira 
Published: November 2010

AbstractThe aim of the article is to examine whether and to what degree the unequal distribution of social capital in the population explains the relationship between socioeconomic position and health in Norway. Theoretical insight and empirical evidence seem to suggest that social capital mediates the effect of socioeconomic position on health outcomes. However, only a few studies have addressed this question and those that have done so have used few and simple indicators of social capital. This study is based on a nationwide cross‐sectional survey (N = 3190) commissioned by Statistics Norway. The survey was designed to cover a comprehensive set of variables measuring different aspects of the theoretical construct of social capital. Two health outcomes, self‐perceived health and longstanding illness, were analysed. The results showed that the mediating role of social capital between socioeconomic position and health was negligible for both health outcomes. After controlling for socio‐demographic variables and socioeconomic position, only neighbourhood satisfaction and generalised trust showed a significant association with self‐perceived health, whereas none of the social capital variables had any significant association with longstanding illness. Some theoretical and methodological implications of the results are discussed.
Exosomal‐like vesicles with immune‐modulatory features are present in human plasma and can induce CD4+ T‐cell apoptosis in vitro
Authors: Ren Yana , Yang Jie , Xie Rufeng , Gao Li , Yang Yiming , Fan Huahua , Qian Kaicheng 
Published: November 2010

BACKGROUND: Exosomes are small membrane vesicles that are secreted from many cell types into various body fluids. These vesicles are thought to play a role in cell–cell interactions.STUDY DESIGN AND METHODS: Vesicles were isolated from human plasma of healthy donors by differential ultracentrifugation and ultrafiltration. The vesicles were identified by transmission electron microscopy, and their biochemical characteristics were analyzed by Western blot and flow cytometry. The immune‐modulatory ability of exosomal‐like vesicles was examined by incubating them with CD4+ T cells for CD4+ T‐cell proliferation and apoptosis assays in vitro.RESULTS: Vesicles purified from human plasma displayed shapes and sizes similar to those of previously described exosomes and contained exosomes marker proteins CD63 and CD81. They also expressed molecules such as MHC Class II molecules, CD80, CD86, and the cell signal transduction molecules Wnt3a, Wnt5a, and FasL. Furthermore, functional analysis showed that allogeneic plasma exosomes restrained the survival of CD4+ T cells. Plasma exosomes can induce dose‐dependent suppression of proliferation of activated CD4+ T cells, with the strongest responses induced by 500 µg/mL exosomes in vitro. Antibodies against exosomes FasL can block the activity of exosomes on CD4+ T‐cell apoptosis. Moreover, three different concentrations of CD4+ T cells were inhibited by plasma exosomes and the suppressive function was not dependent on interleukin‐2.CONCLUSION: Exosomes present in human plasma contain immunity‐associated molecules and can induce CD4+ T‐cell apoptosis in vitro. Plasma exosomes have the capacity to influence immune responses.
Expansion of adipose tissue mesenchymal stromal progenitors in serum‐free medium supplemented with virally inactivated allogeneic human platelet lysate
Authors: Shih Daniel Tzu‐Bi , Chen Jung‐Cheu , Chen Wan‐Yu , Kuo Ya‐Po , Su Chen‐Yao , Burnouf Thierry 
Published: November 2010

BACKGROUND:Single‐donor or pooled platelet lysates (PL) can substitute for fetal bovine serum (FBS) for mesenchymal stromal cell (MSC) expansion. However, for clinical applications of MSCs, the use of virally inactivated PL would be desirable. Recently, we have developed a solvent/detergent (S/D)‐treated human PL preparation (S/D‐PL) rich in growth factors. The capacity to use this virally inactivated preparation for MSC expansion needs to be evaluated.STUDY DESIGN AND METHODS:Platelet concentrates were treated by S/D (1% tri‐n‐butyl phosphate and 1% Triton X‐45), extracted by oil, purified by C18 hydrophobic interaction chromatography, and sterile filtered. S/D‐PL was compared to FBS as a medium supplement (10% vol/vol) for isolating, maintaining, and expanding adipose tissue–derived MSCs (AT‐MSCs). Cell morphology; proliferation kinetics; immunophenotype; differentiation capacity toward the chondrogenic, osteogenic, and osteogenic lineages; and cytokine antibody array were assessed.RESULTS:AT‐MSCs had a typical spindle morphology and proliferated in S/D‐PL at least as well as in FBS. Immunophenotype at Passage 7 was characteristic of MSCs and similar for both culture conditions. Differentiation capacity into the three lineages was maintained and chondrogenesis was enhanced by S/D‐PL. In a 120 human cytokine antibody array analysis, 73 cytokines were detected in S/D‐PL, including 22 with a concentration higher than in FBS.CONCLUSION:S/D‐PL is an alternative to FBS for AT‐MSC maintenance and expansion, does not compromise the differentiation capacity nor the immunophenotype, and may accelerate chondrogenesis. S/D‐PL protocols for MSC clinical scale‐up may represent a major step toward challenging new use in stem cell therapies.
Triaging Herpes Zoster Ophthalmicus Patients in the Emergency Department: Do All Patients Require Referral?
Authors: Adam Robert S. , Vale Noah , Bona Mark D. , Hasanee Khalid , Farrokhyar Forough 
Published: November 2010

AbstractObjectives:  The objective was to assess the predictive value of clinical signs and symptoms of herpes zoster ophthalmicus (HZO) for development of moderate to severe eye disease.Methods:  This was a prospective cohort multicenter study of 54 patients referred to the ophthalmology service after presenting to the emergency department (ED) or primary care clinic with a zosteriform rash of less than 10 days’ duration. Upon referral to ophthalmology, easily assessable clinical signs and symptoms were documented. A complete ocular exam was then performed. Patients were followed for 2 months.Results:  Twenty‐three patients (43%) developed moderate to severe disease as defined by corneal or intraocular involvement. Eye redness and rash in the supratrochlear nerve distribution had a statistically significant association with clinically relevant eye disease. All 23 patients who developed moderate to severe eye disease presented with a red eye. Hutchinson’s sign (nasociliary nerve involvement) was not predictive of clinically relevant eye disease.Conclusions:  Eye redness was 100% sensitive for predicting moderate to severe eye disease in this sample of patients and should necessitate immediate referral for ophthalmologic assessment. Patients lacking eye redness, even with a positive Hutchinson’s sign, may not require immediate specialist consultation. All patients not being referred require careful instructions to seek further care should they develop any concerning eye symptoms such as redness, pain, photophobia, or visual disturbance.ACADEMIC EMERGENCY MEDICINE 2010; 17:1183–1188 © 2010 by the Society for Academic Emergency Medicine
Use of Intranasal Fentanyl for the Relief of Pediatric Orthopedic Trauma Pain
Authors: Saunders Mary , Adelgais Kathleen , Nelson Douglas 
Published: November 2010

AbstractObjectives:  The objective was to evaluate the use of a single 2 μg/kg dose of intranasal fentanyl as analgesia for painful orthopedic injuries in children presenting to a pediatric emergency department (ED).Methods:  This was a prospective, nonblinded interventional trial, in a convenience sample of patients 3 to 18 years of age seen in a tertiary care pediatric ED. All had clinically suspected fractures and were treated between July and November 2006. Eligible patients had moderate to severe pain based on initial pain scores using the Wong Baker Faces Scale (WBS) for patients aged 3–8 years or the Visual Analog Scale (VAS) for patients aged 9–18 years. All enrolled patients received fentanyl via intranasal atomization. Pain scores were obtained at baseline and at 10, 20, and 30 minutes after intranasal fentanyl administration. Satisfaction scores were obtained using a 100‐mm VAS. Vital signs and adverse events were recorded.Results:  Eighty‐one patients were enrolled, 28 in the VAS group and 53 in the WBS group. The mean patient age was 8 years. Fracture locations included forearm, 38 (47%); supracondylar, 16 (20%); clavicle, 7 (9%); tibia/fibula, 5 (6%); and other, 15 (18%). In the WBS group, the median pain scores decreased from five faces (interquartile range [IQR] = 4–6) at baseline to three faces (IQR = 2–5) at 10 minutes, two faces (IQR = 1–4) at 20 minutes, and two faces (IQR = 1–3) at 30 minutes. The mean pain score in the VAS group at baseline was 70 mm (95% confidence interval [CI] = 63 to 77 mm). In this group, the pain scores decreased by a mean of 21 mm (95% CI = 14 to 28 mm) at 10 minutes, 25 mm (95% CI = 15 to 34 mm) at 20 minutes, and 27 mm (95% CI = 16 to 37 mm) at 30 minutes. Mean satisfaction scores were 79 mm for providers, 74 mm for parents, and 62 mm for patients. No adverse events were recorded.Conclusions:  Intranasal fentanyl at a dose of 2 μg/kg provides effective analgesia for pediatric ED patients with painful orthopedic trauma within 10 minutes of administration.ACADEMIC EMERGENCY MEDICINE 2010; 17:1155–1161 © 2010 by the Society for Academic Emergency Medicine
Tissue Doppler of Early Mitral Filling Correlates With Simulated Volume Loss in Healthy Subjects
Authors: Moore Christopher L. , Tham Edward T. , Samuels Kathleen J. , McNamara Robert L. , Galante Nicholas J. , Stachenfeld Nina , Shelley Kirk , Dziura James , Silverman David G. 
Published: November 2010

AbstractObjectives:  The accurate noninvasive assessment of preload in emergency department (ED) patients remains elusive. Point‐of‐care ultrasound (US) imaging, particularly evaluation of the inferior vena cava (IVC), has been shown to be qualitatively helpful. Doppler and tissue Doppler are now routinely available on ED US equipment, but few studies have looked at the correlation of dynamic changes in these parameters in a controlled model of hypovolemia. Our objective was to examine the correlation of Doppler parameters to simulated volume loss in healthy subjects using a lower‐body negative pressure (LBNP) model and to compare these measurements to commonly used IVC measurements of preload.Methods:  Twelve paid volunteers with no known cardiovascular disease between the ages of 23 and 31 years old (mean ± SD = 25.5 ± 2.5 years old) were recruited. Hypovolemia was simulated using graduated LBNP levels with measurements taken at 0, −30, and −60 mm Hg and lower pressures as tolerated. Vital signs were monitored in all patients. US measurements recorded at each negative pressure level included IVC maximum (IVCmax) and minimum (IVCmin) dimensions; early (E) and late (A) transmitral filling velocities using pulsed‐wave spectral Doppler; and early (E′) and late (A′) tissue Doppler velocities at the septal (sep) and lateral (lat) mitral annulus, using pulsed‐wave tissue Doppler.Results:  Lower‐body negative pressure correlated significantly and positively within subjects for all US parameters except for the A filling wave. E′lat and E′sep showed the strongest correlation with R2 values of 0.749 (95% confidence interval [CI] = 0.577 to 0.854) and 0.738 (95% CI = 0.579 to 0.875) respectively, followed by A′sep 0.674 (95% CI = 0.416 to 0.845), IVCmax 0.638 (95% CI = 0.425 to 0.806), A′lat 0.547 (95% CI = 0.280 to 0.802), IVCmin 0.512 (95% CI = 0.192 to 0.777), and E 0.478 (95% CI = 0.187 to 0.762). Ratios correlated only moderately with LBNP level, including E/ E′latR2 of 0.430 (95% CI = 0.131 to 0.706), E/ E′sep 0.416 (95% CI = 0.183 to 0.686), and IVC collapsibility index (IVCCI) 0.201 (95% CI = 0.003 to 0.681). Vital signs, including heart rate and blood pressure, did not vary significantly with LBNP levels.Conclusions:  In this pilot study of healthy subjects, tissue Doppler assessment of early diastolic filling correlated most strongly with simulated hypovolemia.ACADEMIC EMERGENCY MEDICINE 2010; 17:1162–1168 © 2010 by the Society for Academic Emergency Medicine
The Learning Curve of Resident Physicians Using Emergency Ultrasonography for Cholelithiasis and Cholecystitis
Authors: Jang Timothy B. , Ruggeri Wendy , Dyne Pamela , Kaji Amy H. 
Published: November 2010

AbstractBackground:  Emergency department bedside ultrasonography (EUS) can expedite treatment for patients. However, it is unknown how much experience is required for competency in the sonographic diagnosis of cholelithiasis and cholecystitis.Objectives:  The objective was to assess the learning curve of physicians training in right upper quadrant (RUQ) EUS.Methods:  This was a prospective study at an urban, academic emergency department from August 1999 to July 2006. Patients with suspected biliary tract disease underwent RUQ EUS followed by abdominal ultra sonography (AUS) by the Department of Radiology. Results of EUS were compared to AUS using a predesigned, standardized data sheet.Results:  A total of 1,837 patients underwent EUS by 127 physicians. The overall sensitivity and specificity of EUS for cholelithiasis were 84% (95% confidence interval [CI] = 81% to 86%) and 86% (95% CI = 83% to 88%), respectively. The overall sensitivity of EUS for ductal dilation, gallbladder wall thickening, pericholecystic fluid, and sludge were each < 60%. When analyzing the EUS test characteristics, for every increase in 10 examinations up to 50 examinations, there was no significant improvement in the sensitivity or specificity for any of these sonographic findings. Moreover, on probit regression analysis, accounting for clustering or correlation among the examinations performed by each of the operators, there was no improvement for detecting any of the sonographic findings except for pericholecystic fluid for every 10 additional examinations performed.Conclusions:  When adjusting for operator dependence, performing up to 50 EUS examinations appears to have little effect on the accuracy of RUQ EUS. Rather than simply requiring an arbitrary number of examinations, another method of competency assessment may be necessary.ACADEMIC EMERGENCY MEDICINE 2010; 17: 1247–1252 © 2010 by the Society for Academic Emergency Medicine