bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of extended transurethral resection of bladder tumour (TURBT) in the treatment of bladder cancer
Authors: Richterstetter Mario , Wullich Bernd , Amann Kerstin , Haeberle Lothar , Engehausen Dirk Gerhard , Goebell Peter Juergen , Krause Frens Steffen 
Published: February 2012

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Transurethral resection of bladder tumour (TURBT) is the ‘gold standard’ in the diagnosis and therapy of non‐muscle‐invasive bladder cancer. To improve the quality of this technique an additional TUR (after 4–6 weeks) or a simultaneous photodynamic diagnosis is often offered.The present study shows different variables that influence, to a greater or lesser extent, the accuracy of the TUR diagnosis and the success of the operation. This is very important for the further management of bladder cancer, be it in tumour follow‐up or in preparation for more invasive therapies.OBJECTIVE
To analyse the impact of a standardised extended transurethral resection of bladder tumour (TURBT) protocol on the determination of the residual tumour status at initial TURBT session and recurrence rate in the primary resection area. Despite, the fact that there is a clear consensus on the aims of TURBT, there is little agreement on how to perform TURBT to achieve that goal.
PATIENTS AND METHODS
We retrospectively evaluated 221 consecutive patients, who underwent 305 TURBT sessions for bladder cancer, including patients with recurrent tumours.
All the TURBTs were extended by taking additional deep and marginal specimens, according to a standardised protocol.
Clinical and histopathological data were retrieved from the patients' records.
RESULTS
Across all tumour stages, residual tumour (pR1) was found in 38% of the additionally taken specimens.
There was a significant association of pR1 status with tumour stage, grade, and size.
Also in the group of non‐muscle‐invading tumours, the rate of R1 resection was rather high at 22%.
There was no association with focality and the training status of the surgeon.
At follow‐up, of all the patients with a unifocal primary tumour there was recurrence in the same area as the primary in 5.1%.
CONCLUSIONS
Extended TURBT provides detailed information about the horizontal and vertical extent of the bladder tumour.
The implementation of standardised TURBT procedures, such as our protocol of an extended TURBT, is greatly needed to improve local tumour control.
Whether a diagnostic re‐TUR may be restricted to those cases with positive margins or ground specimens remains to be studied.
Complications following prostate needle biopsy requiring hospital admission or emergency department visits – experience from 1000 consecutive cases
Authors: Pinkhasov G. Igor , Lin Yu‐Kuan , Palmerola Ricardo , Smith Paul , Mahon Frank , Kaag Matthew G. , Dagen J. Edward , Harpster Lewis E. , Reese Carl T. , Raman Jay D. 
Published: February 2012

Study Type – Harms (cohort series)Level of Evidence 2bWhat's known on the subject? and What does the study add?Population‐based studies implicate an increased incidence of complications after prostate needle biopsy. Such information is essential for adequate patient counselling before the procedure.A limitation of population‐based studies is the absence of individual patient data to better characterize the nature of post‐biopsy complications. This study of 1000 consecutive patients treated at a single centre highlights hospital admissions as well as Emergency Department visits for patients after prostate needle biopsy. Importantly, it allows for characterization of specific complications, aetiologies, management and outcomes for affected patients.OBJECTIVE
To review a contemporary cohort of patients undergoing a transrectal ultrasound‐guided prostate needle biopsy (TRUS PNBx) at a single centre to determine the incidence of major complications necessitating hospital admission or emergency department (ED) visits.
PATIENTS AND METHODS
The charts of 1000 consecutive patients undergoing TRUS PNBx were reviewed.
All patients received peri‐procedural antibiotic prophylaxis with either ciprofloxacin or co‐trimoxazole.
Hospital admission and ED visits within 30 days of the procedure were identified for indication, management and outcome.
Patient comorbidities and biopsy characteristics were reviewed for association with complications.
RESULTS
Of the 1000 patients, 25 (2.5%) had post‐biopsy complications requiring hospital admission or an ED visit.
Indications included twelve patients (1.2%) with urosepsis, eight (0.8%) with acute urinary retention requiring urethral catheterization, four (0.4%) with gross haematuria requiring bladder irrigation for <24 h, and one (0.1%) with a transient ischaemia attack 1 day after biopsy.
Patients with urosepsis had an average hospitalization of 5 days, and 75% carried quinolone‐resistant Escherichia coli organisms.
All patients with urinary retention had catheters removed within 10 days. No patients with haematuria required a blood transfusion.
No demographic or biopsy variables were particularly associated with development of a post‐procedure complication.
CONCLUSIONS
In this large contemporary series of TRUS PNBx, we observed a 2.5% rate of major complications requiring hospital admission or an ED visit.
No clinical or biopsy variables were directly associated with development of complications.
These data may be valuable when counselling patients before biopsy.
Prospective assessment of histological serial sectioning of pelvic lymph nodes in prostate cancer: a cost‐benefit analysis
Authors: Schilling David , Hennenlotter Jörg , Gakis Georgios , Schwentner Christian , Kuehs Ursula , Stenzl Arnulf , Sotlar Karl 
Published: February 2012

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Metastatic spread to the regional lymph nodes (LNs) is the single worst predictor of survival in prostate cancer. Knowledge of the LN status is crucial, as the treatment strategy is substantially altered in non‐organ‐confined disease. Current routine pathological protocols for evaluation of LN resection specimens do not demand a minimum of cross‐sections per LN to be examined. Depending on the LN size, usually one to two sections are examined. This might lead to underestimation of the true metastatic burden.The present study shows that additional examination of cross‐sections in pelvic LNs and applying prostate cancer‐specific cytokeratine immunostaining does not lead to significantly increased detection of prostate cancer metastases. However, the work‐load and the expenses were significantly higher compared with routine evaluation.OBJECTIVE
To evaluate the diagnostic gain in the detection of lymph node (LN) metastases of prostate cancer and the additional expenses of histological step‐section analysis, including immunohistochemistry compared with routine histopathological evaluation.
PATIENTS AND METHODS
In a prospective study, 19 patients with prostate cancer at high risk of LN metastases (>cT2c and/or PSA level of >20 ng/mL and/or Gleason score >8) underwent sentinel‐guided LN resection.
All palpable LNs were submitted to step‐section analysis in 200‐µm sections and concomitant immunohistochemical staining for cytokeratine (AE1/AE3), in addition to routine histopathology of one or two haematoxylin and eosin‐stained sections per LN.
The number of positive LNs and LN‐positive patients for each method was compared; additional expenses in labour time and material for the extended evaluation were estimated.
RESULTS
In all, 413 LNs were resected; 220 LNs were palpable and were included in the study.
In seven of the 19 patients routine histopathological evaluation revealed LN metastases in 24 of 220 LNs (10.9%).
Extended LN evaluation with step sectioning and cytokeratin immunohistochemistry did not reveal any additional patients with LN metastases.
In one patient already diagnosed with LN metastases on routine histology, four additional LN metastases were detected upon extended LN evaluation. Three LNs of two patients, one of them pN0, contained disseminated tumour cells.
Compared with conventional histological evaluation, serial‐section analysis and immunohistochemistry increased expenses in materials and labour time 18.7‐fold.
CONCLUSIONS
Serial‐section analysis seems to have only a minimal diagnostic gain; however, valid conclusions cannot be drawn, as not all LNs were submitted to extended evaluation.
Considering the additional expenses, extensive LN evaluation in prostate cancer cannot generally be recommended.
A case–control study of chronic prostatitis/chronic pelvic pain syndrome and colorectal cancer
Authors: Chung Shiu‐Dong , Keller Joseph J. , Lin Herng‐Ching 
Published: February 2012

Study Type – Symptom prevalence (case control)Level of Evidence 2bWhat's known on the subject? and What does the study add?Associations are well established between intestinal infection/inflammation or inflammatory bowel diseases and colorectal cancer (CRC).Our study found an association between CRC and previously diagnosed chronic prostatitis/chronic pelvic pain syndrome. Patients with CRC had a 1.45‐fold higher risk of having a previous diagnosis of chronic prostatitis/chronic pelvic pain syndrome than controls. This phenomenon was found to be more prominent in subjects younger than 60 years.OBJECTIVE
To estimate the association between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and colorectal cancer (CRC) using a nationwide population‐based data set.
PATIENTS AND METHODS
This case–control study used data sourced from the Taiwan Longitudinal Health Insurance Database.
The cases comprised 2899 patients with CRC and 14 995 randomly selected subjects as controls.
We used conditional logistic regression to examine the association between CRC and previous diagnosis of CP/CPPS.
RESULTS
Of the sampled patients, 531(3.05%) had been diagnosed with CP/CPPS before the index date, with 123 (4.24% of the patients with CRC) coming from the cases and 408 individuals (2.81% of patients without CRC) coming from the controls.
Conditional logistic regression analysis revealed that cases were more likely to have CP/CPPS than controls (odds ratio 1.45, 95% CI 1.17–1.79, P < 0.001) after adjusting for the monthly income, geographic location, urbanization level, hypertension, diabetes, renal disease, obesity and cystic kidney disease.
In subgroup analysis, we found the magnitude of the association to be higher in subjects younger than 60 years (age 40–49, odds ratio 2.01; 95% CI 2.04–3.58 and aged 50–59, 2.40, 95% CI 1.48–3.87, both P < 0.001) than among other age groups.
CONCLUSION
We conclude that CP/CPPS patients are at higher risk for CRC, especially in males under 60 years of age.
Type 2 diabetes mellitus in a patient with malignant insulinoma manifesting following surgery
Authors: Ademoğlu E. , Ünlütürk U. , Ağbaht K. , Karabork A. , Çorapçıoğlu D. 
Published: February 2012

Diabet. Med. 29, e133–e137 (2012)AbstractBackground  Insulinomas, although they are rare, are the most common of pancreatic islet cell tumours. The incidence is estimated at only four per million person‐years and only 5–12% of reported cases are malignant. Distinction between malignant and benign tumours can only be made by the presence of metastasis, as there are no specific morphologic, biochemical or genetic features distinguishing them. Most patients with malignant insulinoma have lymph node or liver metastases and, rarely, bone involvement. The coincidence of insulinoma and diabetes mellitus is an extremely rare condition and reported only in a few cases.Case report  We report a 45‐year‐old woman who was diagnosed with insulinoma on the basis of clinical and laboratory findings and endoscopic examination. Histopathological diagnosis revealed well‐differentiated endocrine carcinoma of the pancreas with lymph node metastase. The case was accepted as malignant insulinoma and the patient underwent surgery. Interestingly, hyperglycaemia occurred after the removal of the insulinoma, with the requirement for insulin in the post‐operative 3 weeks, which was changed to oral anti‐diabetic agents as a permanent treatment. The patient is still being treated with oral anti‐diabetic agents. We think that the patient might have had diabetes mellitus, because of insulin resistance that developed with a high‐caloric intake stimulated by hypoglycaemia, and which had been masked for many years, but manifested overtly after removal of the tumour.Conclusions  Although this is a rare condition, clinicians should bear in mind that insulinomas may exist together with diabetes mellitus, and it is important to have this suspicion when considering the perioperative approach and for the prevention of morbidities.
The cost of diagnosing Type 2 diabetes mellitus by clinical opportunistic screening in general practice
Authors: Pereira Gray D. J. , Evans P. H. , Wright C. , Langley P. 
Published: February 2012

Diabet. Med. 29, 863–868 (2012)AbstractAims  Type 2 diabetes is associated with serious complications and shortens life. Its prevalence is increasing rapidly worldwide and no cure is available. One logical response is to diagnose the condition as early as possible. Clinical opportunistic screening is one mechanism for making the diagnosis before symptoms are reported. This paper reports the cost of using this technique in UK general practice.Methods  In one UK general practice, the electronic medical records were searched to determine the number of blood glucose and oral glucose tolerance tests undertaken for non‐pregnant adults without known diabetes over three consecutive years. The laboratory, staff and administrative costs associated with these screening tests were calculated. The records of all patients newly diagnosed with Type 2 diabetes during the same period were reviewed to identify diagnoses made by clinical opportunistic screening. Total costs were divided by the number of diagnoses to determine a cost per diagnosis detected by opportunistic screening.Results  During the study period, 5720 screening tests were conducted for 2763 patients. Over the 3 years, 86 patients were diagnosed with Type 2 diabetes, 54 (63%) via screening (yield 2.0%; number needed to screen 51.2). The screening costs totalled £20 372. The average cost per new screen‐detected diagnosis was £377.Conclusions  Almost two‐thirds of new cases of Type 2 diabetes can be detected before symptoms are reported, at reasonable cost by opportunistic screening in general practice, without the use of extra resources. As an affordable alternative to population screening, clinical opportunistic screening merits further consideration.
New Policy Spaces: The Impact of Devolution on Third Sector Policy in the UK
Authors: Alcock Pete 
Published: February 2012

AbstractThe development of third sector policy in the UK since 1997 has seen changes which have been of significance both for analysts and practitioners. This period has seen government engagement with and support for the sector extend far beyond the levels found throughout much of the last century. This has led to a growth in the size and scale of the sector and a closer involvement of sector representatives in political debate and policy planning. These changes have taken place at the same time as third sector policy has been devolved to the new administrations in Scotland, Wales and Northern Ireland. This article explores the impact of devolution on these policy developments and assesses the extent to which political devolution has led to policy divergence across the four countries in the UK. The conclusion is reached that policy devolution has created important new space for policy development for the third sector across the UK, but that the direction of travel in all four regimes has remained remarkably similar.
Is the association between social capital and health robust across Nordic regions? Evidence from a cross‐sectional study of older adults
Authors: Nyqvist Fredrica , Nygård Mikael 
Published: February 2012

Nyqvist F, Nygård M. Is the association between social capital and health robust across Nordic regions? Evidence from a cross‐sectional study of older adultsThe study examined the association between structural and cognitive social capital and self‐rated health among 65‐ and 75‐year‐olds in Västerbotten in Sweden and Österbotten and Pohjanmaa in Finland. Data were retrieved from a cross‐sectional postal questionnaire survey conducted in 2005 and was answered by 3,370 persons, yielding a total response rate of 69 per cent. The association between self‐rated health and interpersonal trust and membership in organisations was tested by logistic regression analysis. The results showed that older adults in Västerbotten in Sweden experienced better self‐rated health than in Finland. Furthermore, interpersonal trust and active membership in organisations were associated with self‐rated health among 65‐ and 75‐year olds even after having controlled for the influence of region. We therefore conclude that the association between social capital and self‐rated health tends to be robust across contextually similar regions, but that further analyses are warranted in order to clarify the nature of this relationship.Key Practitioner Message: •Health status can be indirectly strengthened through investments in social capital, such as group participation and active networks; •When working with older adults, more focus needs to be put on how to develop trustful relationships; •The Nordic welfare state, with its universal and subsidised social and health care services, has an indirect and positive effect on health among older adults.
Managing the first period at home with a newborn: a grounded theory study of mothers’ experiences
Authors: Hjälmhult Esther , Lomborg Kirsten 
Published: February 2012

Aim:  The article aims to present a theoretical account of mothers’ first period at home with their newborn in Norway.Background:  Mothers’ well‐being affects their babies and is therefore an important priority for public health. Early discharge after childbirth is common in many countries. In Norway, this has been practised for 5–10 years but without any distinct agreement between maternity hospitals and the community health services and without documented follow‐up care. Knowledge is lacking in how mothers deal with the first period at home with the baby.Method:  Seven focus group discussions were conducted with 26 mothers who had babies 1.5–3 months old. The grounded theory method was used to gather and analyse data.Results:  The mothers were strongly concerned about preserving their control and integrity in the new situation. This main concern was resolved by the strategy of prioritizing newborn care. The strategy encompassed a process of developing competence as a mother, changing focus in relationships, stretching to the critical level and seeking recognition. These parallel processes were inter‐related, sometimes mutually supportive and sometimes conflicting. When conflicts occurred, prioritizing newborn care guided mothers in finding solutions. Breaches of the implied conditions in health care tended to increase mothers’ level of strain and uncertainty and to influence their efficacy in breastfeeding the baby.Conclusion:  Being a mother to a newborn is a dynamic and extensive process. Succeeding in breastfeeding seems especially sensitive and essential in motherhood. The idea that giving birth is a simple and normal situation may obscure the importance of seamless health care and the need for professional support and information.
Clinical strategies for the alleviation of contractures from a predictive mathematical model of dermal repair
Authors: Murphy Kelly E. , McCue Scott W. , McElwain D.L. Sean 
Published: February 2012

AbstractHypertrophic scars arise when there is an overproduction of collagen during wound healing. These are often associated with poor regulation of the rate of programmed cell death (apoptosis) of the cells synthesizing the collagen or by an exuberant inflammatory response that prolongs collagen production and increases wound contraction. Severe contractures that occur, e.g., after a deep burn, can cause loss of function especially if the wound is over a joint such as the elbow or knee. Recently, we have developed a morphoelastic mathematical model for dermal repair that incorporates the chemical, cellular, and mechanical aspects of dermal wound healing. Using this model, we examine pathological scarring in dermal repair by first assuming a smaller than usual apoptotic rate for myofibroblasts, and then considering a prolonged inflammatory response, in an attempt to determine a possible optimal intervention strategy to promote normal repair, or terminate the fibrotic scarring response. Our model predicts that in both cases it is best to apply the intervention strategy early in the wound healing response. Further, the earlier an intervention is made, the less aggressive the intervention required. Finally, if intervention is conducted at a late time during healing, a significant intervention is required; however, there is a threshold concentration of the drug or therapy applied, above which minimal further improvement to wound repair is obtained.
Possible Association Between OPRM1 Genetic Variance at the 118 Locus and Alcohol Dependence in a Large Treatment Sample: Relationship to Alcohol Dependence Symptoms
Authors: Koller Gabriele , Zill Peter , Rujescu Dan , Ridinger Monika , Pogarell Oliver , Fehr Christoph , Wodarz Norbert , Bondy Brigitta , Soyka Michael , Preuss Ulrich W. 
Published: February 2012

BackgroundSeveral lines of evidence from previous research indicate that opioid receptors play an important role in ethanol reinforcement and alcohol dependence (AD) risk. Conflicting results were reported on the role of the mu‐opioid receptor (OPRM1) polymorphism A118G (Asn40Asp, rs1799971) in the development of alcoholism.MethodsWe investigated a total number of 1,845 alcohol‐dependent subjects recruited from inpatient facilities in Germany and 1,863 controls for the mu‐opioid receptor (OPRM1) polymorphism using chi‐square statistics.ResultsAn association between the OPRM variant and AD was detected (p = 0.022), in recessive (AA vs. GA/GG) and co‐dominant (AA vs. GA) models of inheritance. An association between the OPRM variant and the DSM‐IV criterion “efforts to cut down or could not” (p = 0.047) was found, but this did not remain significant after the correction for multiple testing.ConclusionsThe results indicate that this functional OPRM variant is associated with risk of AD and these findings apply to more severe AD, although the association is only nominally significant.