bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost‐Effectiveness of Clinical Breast Assessment‐Based Screening in Rural Egypt
Authors: Denewer Adel , Hussein Osama , Farouk Omar , Elnahas Waleed , Khater Ashraf , El‐Saed Aiman 
Published: June 2010

AbstractIntroductionBreast cancer is the most common cancer in Egyptian women. However, the mean tumor size at diagnosis is 4.5 cm, and the median age is approximately 46 years. Both of these factors decrease the utility and cost‐effectiveness of a mammography‐based screening program typically designed for developed countries. We report the first clinical breast assessment‐based screening project in an entirely rural Egyptian community.MethodsTargeted population: Women aged 25–65 years in three municipal regions of Dakahlia province, Egypt. The estimated targeted population was 57,500 and participation was voluntary. First stage was performed at primary health care points. Surgeons performed systematic clinical breast examination. All data were collected at Mansoura University. Abnormal findings in the primary examination led to an invitation to the Oncology Center—Mansoura University—where the second stage of the study took place. It comprised repeat examination, ultrasonography, and/or mammography. Therapeutic interventions were performed at the governmentally funded Mansoura Oncology Center.ResultsVoluntary participation reached 10.2% of the target group and abnormal clinical examination represented 3.2% (191/5,900). The screen‐detected cancers were (18/5,900) of examined population, and thus the cancer detection rate of clinical breast assessment‐based screening was 30.5 per 100,000 of participating women during 2 years. The tumor size was 1.5 cm (median) and 1.3 cm (mean). The cost of screening per cancer case detected was approximately 415 US$, and the overall cost of treating a screen‐detected cancer was 1,015–1,215 US$.ConclusionsClinical breast assessment‐based screening with selective mammography is an effective modality, which improves the results of breast cancer management in Egypt.
Disappointing Long‐Term Outcomes After Stapled Transanal Rectal Resection for Obstructed Defecation
Authors: Madbouly Khaled M. , Abbas Khaled S. , Hussein Ahmed M. 
Published: June 2010

AbstractBackgroundThe aim of this study was to assess both short and long‐term functional outcomes and the quality of life of patients treated with stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS).MethodsForty‐six patients with ODS as a result of rectocele and/or rectal intussusceptions were treated with STARR. Data collected included demographics, OR time, pain score using a visual analog scale (VAS), and complications. The study included defecographic assessment and anal manometry [urge‐to‐defecate volume (UTDV) and maximum tolerable volume (MTV)], both done preoperatively and 1 year postoperatively. A modified obstructed‐defecation syndrome questionnaire (MODS), constipation quality of life (PAC‐QOL) score, and CCF continence score were all recorded preoperatively and every 6 months during follow‐up.ResultsMean age of the patients was 48.4 years. Forty‐five patients had mild postoperative pain (VAS = 1–2). Only one male patient had severe pain (VAS = 7). Three patients developed stenosis at the staple line 6 months after surgery and were dilated manually. Follow‐up ranged from 18 to 48 months and the median follow‐up was 42 months. The recurrence rate was 6.5% after 18 months, 10.8% after 36 months, and 13% after 42 months. Significant reduction in MTV and UTDV was recorded. MODS and PAC‐QOL showed significant improvement after 6 months; this improvement was maintained for 18 months and then there was a rapid decline until the end of the follow‐up period.ConclusionsSTARR is a safe surgical procedure that effectively restores the anatomy and function of the anorectum in patients with ODS. This correction improves functional and QOL scores; however, a high rate of symptomatic recurrence and QOL score decline are expected after 18 months.
Increasing Donor Body Weight to Prevent Small‐for‐Size Syndrome in Living Donor Liver Transplantation
Authors: Liu Chinsu , Lee Rheun‐Chuan , Loong Che‐Chuan , Hsia Cheng‐Yuan , Yeh Yi‐Chen , Chiou See‐Ying 
Published: June 2010

AbstractBackgroundThis study was designed to evaluate the possibility of avoiding small‐for‐size syndrome (SFSS) in living donor liver transplantation (LDLT) by increasing the donor’s body weight (BW) before liver donation.MethodsNineteen participants, including 15 volunteers and 4 liver donors, were enrolled in this study to increase their BW by 1.5–5 kg within 3 months by eating a high‐protein and high‐carbohydrate diet according to a flexible formula to increase calorie intake.ResultsFifteen participants, including 12 volunteers and 3 live liver donors, successfully increased their BW by 1.5–5 kg within 3 months (failure rate, 21%). The actual liver weight (LW) gain was more than the expected LW gain using the formula for calculating standard liver volume (2.77‐ to 8.94‐fold; median, 4.49‐fold; mean, 4.45‐fold, P < 0.005) and using the ratio of liver weight to body weight (1.36‐ to 4.49‐fold; median, 2.01‐fold; mean, 2.06‐fold, P < 0.005). The enlargement of the livers was symmetrical without significant fatty change. The graft‐versus‐recipient weight ratio increased 0.17%, 0.07%, and 0.08%, respectively, for the three live liver donors and successful LDLTs were performed.ConclusionsBy having liver donors eat a high‐protein, high‐carbohydrate diet to increase their BW in a short period of time, the actual LW may increase more than the expected LW gain without fatty change. This method of increasing LW may be used in selected cases of LDLT to avoid SFSS.
The Role Of Alcohol Use Disorder And Alcohol Consumption In Suicide Attempts-A Secondary Analysis Of 1921 Suicide Attempts
Authors: Boenisch S. , Bramesfeld A. , Mergl R. , Havers I. , Althaus D. , Lehfeld H. , Niklewski G. , Hegerl U. 
Published: June 2010

AbstractBackgroundIt is not known how characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts.MethodsData on 1921 suicide attempts was gathered in a major German city over a 5-year period. Suicide attempts were categorised according to a diagnosis of alcohol use disorder and acute alcohol consumption at the time of the attempt. Group comparisons and multinomial logistic regression were used for statistical analysis.ResultsIn 331 suicide attempts (17%) an alcohol use disorder was diagnosed. Six hundred and twenty-two suicide attempts (32%) were committed with acute alcohol consumption. Suicide attempts by individuals with alcohol use disorder were more often committed by men, older individuals and as a recurrent attempt, independently of alcohol consumption at the time of the attempt. When alcohol was consumed in suicide attempts by individuals with alcohol use disorder, low-risk methods were used most often.ConclusionsIndividuals with a diagnosis of alcohol use disorder are a high-risk group for multiple suicide attempts and should be a target group for suicide prevention. Screening for suicidality should be a regular part of the clinical assessment in individuals with alcohol use disorder.
Premorbid sleep, appetite, energy, and cognitive circadian profile in patients with depressive disorders
Authors: Bersani G. , Liberati D. , Rasa A. , Polli E. , Ciuffa M. , Limpido L. , Russo D. , Marconi D. , Pacitti F. 
Published: June 2010

AbstractAimAlterations of biological rhythms are well recognized to play a crucial role in the origin and maintenance of depression, but little is known about the profile of circadian rhythms at a premorbid age in adult depressed patients. The present study was aimed at investigating the association, if any, of depressive disorders with biological and behavioural rhythm modifications both at the time of observation and at an earlier age than the clinical onset of depression. The hypothesis was that such modifications could be an early biological index of vulnerability to the illness.Subjects and methodsOne hundred and seventy-eight patients affected by DSM-IV Major Depressive Disorder were examined/observed, compared to a group of 178 matched healthy subjects. All the included subjects were asked to fill in a retrospective questionnaire reporting time of awakening and falling asleep and time of subjective peaks of appetite, energy and cognitive function during “Adolescence” (12–15 years), “Youth” (16–20 years) and “Present condition” periods.ResultsAn advance of awakening time by about 20 minutes during “Adolescence” was reported in the depressed subjects as compared to the controls. Awakening is also reported as significantly (P < 0.001) advanced by about 36 minutes during “Youth” in depressed patients, while time of falling asleep at the same age in the patients group shows 19 minutes delay. Regarding “Present condition” an advance of awakening time (33 minutes) in depressed patients was reported, in association with a delay of the subjective peak of cognitive functioning (62 minutes).DiscussionDepressed patients show clear-cut differences in sleep pattern as compared to controls, consisting in a constant and significant advance of awakening time, while the time of sleep onset never reaches any statistical difference between the groups throughout ages.ConclusionsThe results are consistent with the hypothesis that early alterations of the general circadian profile can contribute to the onset of adult life Major Depressive Disorders.
Sleep apnea in patients with oral cavity and oropharyngeal cancer after surgery and chemoradiation therapy
Authors: Qian Wei , Haight James , Poon Ian , Enepekides Dan , Higgins Kevin M. 
Published: June 2010

OBJECTIVETo determine the point prevalence of sleep apnea in patients following oral and oropharyngeal cancer treatment at a major tertiary care referral center.STUDY DESIGNA retrospective cross‐sectional survey.SUBJECTS AND METHODSTwenty‐four patients with established oral or oropharyngeal cancer were submitted to overnight polysomnography. The surgical group consisted of 15 patients (11 male, 4 female; average age 64.2 yrs) having undergone primary surgery with radial forearm free flap reconstruction. The remaining patients (5 male, 4 female; average age 54.8 yrs) were treated nonsurgically with chemoradiation therapy. The fatigue‐related daytime sleepiness was measured with the Epworth sleepiness scale (ESS).RESULTSEleven patients in the surgical group and three in the nonsurgical group had a respiratory disturbance index (RDI) greater than 15 (odds ratio = 5.5, P = 0.092). Twelve patients in the surgical group and five in the nonsurgical group had significant oxygen desaturation during sleep hours (odds ratio = 3.3, P = 0.356). There was no observed significant correlation between RDI and oxygen desaturation (r2 = 0.28), nor was there any observed association between the RDI and ESS score (r2 = 0.18).CONCLUSIONThis preliminary study has suggested that surgical patients in our cohort have a higher prevalence of moderate to severe obstructive sleep apnea in the postoperative period, when tested, compared with a nonsurgical group. A small sample size and incomplete matching on important cofactors of interest, such as primary site location, body mass index, and thyroid function, limit this study. A pretreatment and post‐treatment analysis is obviously required to demonstrate any significant level of association between treatment type and sleep apnea status.© 2010 American Academy of Otolaryngology‐Head and Neck Surgery Foundation. All rights reserved.
S14-03 - Dysfunctional Reward Processing in Alcohol Addiction
Authors: Beck A. , Schlagenhauf F. , Deserno L. , Friedel E. , Wrase J. , Heinz A. 
Published: June 2010

Alcohol dependence is one of the most fatal mental diseases amongst men in western industrialized nations and is the major risk factor for the development of more than 60 chronic illnesses. With no further intervention, relapse rates in detoxified alcoholics are high and usually exceed 85% of all detoxified patients. It has been suggested that stress and exposure to priming doses of alcohol and to alcohol-associated stimuli (cues) contribute to the relapse risk after detoxification.In the last decades there has been substantial progress in scientific research of the neurobiological principles of alcohol-related disorders. Recent studies using multi modal imaging techniques like functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) observed dysfunctions of the mesolimbic dopaminergic brain reward system (ventral striatum including the nucleus accumbens): Functional brain activation is increased during the processing of alcohol-associated cues and decreased during the confrontation with other non-alcoholic reward-indicating stimuli. This alcohol-associated “hijacking” of the reward system is associated with craving and the prospective relapse risk.Moreover, the reward-associated learning seems to be disturbed in alcohol-dependent patients, so that addicted persons have problems to integrate informations about positive and negative consequences of their actions and to adapt their behavior accordingly. Personality traits like impulsiveness seem to be relevant in this context as well.These findings about the different neurobiological mechanisms of addiction and relapse raise hope for new psychotherapeutic and pharmacological treatment approaches of alcohol dependence that is adapted to individual relapse mechanisms and needs.
S26-01 - Antidepressant Treatment: Polypharmacy Versus Monotherapy
Authors: Kasper S. , Konstantinidis A. 
Published: June 2010

Although a good selection of antidepressants is available nowadays, the pharmacotherapy of depression still represents a challenge for psychiatrists worldwide. International guidelines and textbooks advise monotherapy with a selective serotonin reuptake inhibitor as treatment of first choice in depression. However, still one third of the depressive patients do not respond to the first antidepressant treatment implicated. Furthermore, approximately 20%-30% of them prove to be treatment resistant for two different antidepressants with different mechanisms of action. For these treatment resistant patients (TRD) augmentation and combination strategies are advised.According to AMSP surveillance data (European international pharmacovigilance program, named AMSP: Arzneimittelsicherheit für Psychiatrie) from 2007 (obtained in 54 psychiatric institutions), 1829 depressive inpatients were recorded on the two reference days. 1674 inpatients received an antidepressant medication and among them 875 were concomitantly treated with an antipsychotic medication. Although the majority of inpatients were treated with one antidepressant (72%); 28% received two or more antidepressants. The most common combination of antidepressants was Venlafaxine with Mirtazapine (5,6%) being followed from Citalopram with Mirtazapine (2,7%). Interestingly similar findings have been recently reported from an US database.Polypharmacy, although needed in treatment resistant cases, has a greater risk for adverse drug reactions and most augmentation strategies have not been tested regarding their long term safety. A combination of antidepressants seems only to be useful if they engage different mechanisms of action. Further clinical studies addressing combination strategies are needed in order to evaluate their benefit against monotherapy.
S32-02 - Pathological Stress and the Vulnerability to Addiction
Authors: van de Wetering B.J.M. , Franzek E.J. 
Published: June 2010

Stress can be defined as the subject's response - both emotionally and physically - to stimuli (stressors) from the environment. Stressors are not necessarily negative. They are, when they exceed the subject's ability to cope with them in a physiological way. This level of stress is indicated as pathological stress.Addiction and pathological stress are strongly interrelated on several levels. Animal studies have shown that the pathological stress during the development may be the most important factor that brings the vulnerability for addiction to expression. Stress during pregnancy may have a decisive influence on brain development and the subject's ability to cope with stress during later life. Patients with post traumatic stress disorder have an increase risk for the development of substance use disorders.The brain reward system is a major target for the central and peripheral stress system. The catecholamines that mediate the stress response play an important role in the development of addiction. Addictive drugs such as stimulantia act as stressors by activating stress hormons. The process of craving is strongly associated with activated stress systems. Therefore, the adequate treatment of substance use disorders requires interventions that reduce pathological stress for the patient, either by diminishing environmental stress or by increasing the ability to cope with stress.
S32-03 - Changing Paradigms in the Treatment of Addiction - the Orpheus Project
Authors: Musalek M. 
Published: June 2010

Major problems in treating patients suffering from addictions derive from the fact that the diagnostic category dependence syndrome covers a highly inhomogeneous patient group. Therefore uniform therapeutic approaches inflexibly following treatment guidelines have not fulfilled prognostic expectations. This was the starting point for developing a new modular resource-oriented treatment program in the Anton Proksch Institute Vienna.Changing paradigms in the treatment of addiction, the Orpheus Programme offers a host of different modules designed to help patients to discover their own aims, objectives, values, and resources. The main task of the Orpheus modules is an increasing autonomous and joyful life. Abstinence represents no longer the only final goal of therapy, but is an important step to offer space and possibilities for the patients’ new life. When life becomes once again beautiful and filled with joy and meaning, addictive substances lose their seductive power: The more beautiful and attractive the patient's life, the less the drugs attractiveness. As illustrated by Orpheus, who defeated the sirens (as a symbol for addictive agents) by making the better, louder, and more attractive music, it becomes the patients’ main task to make a better “music of life”; the Orpheus modules are not training programs telling the patients how the better life looks like (as in former moral therapy); they intend to provide places, spaces and atmospheres encouraging and promoting the patients to make possible the possible.
S29-04 - Cognitive-Psychoeducative Group Therapy for Patients with Bipolar Disorder
Authors: Bernhard B. 
Published: June 2010

IntroductionCognitive-psychoeducative group therapy is an intervention developed in Munich to treat patients with bipolar disorder after an acute episode. First results of a prospective evaluation showed that the patients gained more knowledge after the intervention and relatives, who attended a separated group program showed less expressed emotion and burden in respect of the illness.ObjectivesWe investigated the outcome of this intervention.AimsIn a randomized controlled trial with 68 patients we analysed the days of illness, the amount of symptoms, quality of life and the knowledge about bipolar disorder.MethodsPatients of the experimental group received a 12 week group intervention, patients of the waiting list control group received the same intervention after 6 months. Every 3 months the patients were rated for days of illness, symptoms, quality of life, knowledge and compliance.ResultsThe results of 52 patients showed a significant reduction of depressive symptoms as well as an improvement of global functioning. We also showed a significant improvement of knowledge about bipolar disorder and satisfaction about the treatment. Detailed analysis showed that patients with less than 10 years of illness showed even more reduction of depressive symptoms as well as an improvement of psychological well being. Patients with more than one year of psychotherapy experience showed a reduction of manic symptoms.ConclusionsThe intervention is an important addition to pharmacological treatment, but further improvements of treatments for bipolar disorder are necessary.
S15-04 - Do Symptoms of Emotional Dysregulation Respond to Pharmacological Treatment of Adult ADHD?
Authors: Rösler M. , Retz W. 
Published: June 2010

The core psychopathology of ADHD comprises attentional deficits, hyperactivity and impulsivity. At least in subpopulations the majority of individuals suffering from ADHD present with emotional symptoms additonally. There is an ongoing and controversial debatte whether emotional symptoms belong to the disorder as further intrinsic ADHD psychopathology or may have their origin in comorbid affective disorders. There is growing evidence that emotional symptoms of ADHD as measured by the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) respond to treatment with Methylphenidate (MPH), while the classical symptoms of depression or anxiety disorder show no significant improvement.We report on a 24-week, placebo controlled treatment study with MPH-extended release in 359 adults with ADHD. Emotional symptoms were assessed with the WRAADDS. Symptoms of depression and anxiety were endorsed by use of the Symptom Checklist-90-Revised (SCL-90-R).As compared with placebo we found a significant treatment response in favour of MPH-ER regarding emotional symptoms like affective lability, emotional overreactivity and temper control. The psychopathology of depression and anxiety did not display a significant treatment response.
S24-03 - Glycogen Synthase kinase-3ß and Associated Proteins in the Phosphoinositide 3- kinase/akt Signaling Axis: Role in Major Depression
Authors: Karege F. , Perroud N. , La Harpe R. , Burkhardt S. , Ballmann E. , Malafosse A. 
Published: June 2010

ObjectivesMajor depression disorder (MDD) is still a major public health problem and the understading of its neurobiology is still poor. We are interested in the impairment of the neuroplasticity, as hypothesis. Evidence suggest that Akt/GSK3ß axis plays a role mediating hormones actions in neuronal survival. The objective of our study was to assess, in MDD, the regulation of protein and lipid kinases involved in the signaling pathway: PI3K-Akt/PKB-GSK3α/ß-ß-catenin and a phosphatase, PTEN.MethodsDrug-free postmortem brain cortices (VPFC) from antemortem diagnosed depressed subjects, and in few cases, neuroblastoma cells, were used. Applying the methods of western blot, enzymatic activity, we measured the activities, the levels of several proteins and their expression: Akt1 ; GSK3ß ; pGSK3ß ; PI3K ; PTEN ; ß-catenin. Statistical significance was set at p< 0.05.ResultsWith respect to control subjects, the main changes observed in MDD can be summarized as follow : The PI3K enzymatic activity was decreased without changes in protein levels. The GSK3ß activity was increased, but the total activity (α+ß isoforms) was not changed, nor were the total GSKαβ protein levels. The Akt1 activity was decreased, The PTEN protein levels were decreased. The ß catenin levels and the tGSK3ß-to-pGSK3 ratio were altered.ConclusionsThe data show a major depression-associated blunting of the PI3K-Akt-GSK3 signaling pathway. The study of protein and lipid kinases and phosphatases is particularly relevant because of crucial roles played by these proteins in neuron survival, proliferation and apoptosis. It adds further support to the neuroplastic hypothesis of affective disorder.