bluuebunny/crossref_metadata_2025_split huggingface dataset:
Withholding and withdrawing life-sustaining therapy in a Moroccan Emergency Department: An observational study
Authors: Damghi Nada , Belayachi Jihane , Aggoug Badria , Dendane Tarek , Abidi Khalid , Madani Naoufel , Zekraoui Aicha , Benchekroun Belabes Abdellatif , Zeggwagh Amine Ali , Abouqal Redouane 
Published: August 2011

Abstract

Background
Withdrawing and withholding life-support therapy (WH/WD) are undeniably integrated parts of medical activity. However, Emergency Department (ED) might not be the most appropriate place to give end-of life (EOL) care; the legal aspects and practices of the EOL care in emergency rooms are rarely mentioned in the medical literature and should be studied. The aims of this study were to assess frequency of situations where life-support therapies were withheld or withdrawn and modalities for implement of these decisions.

Method
A survey of patients who died in a Moroccan ED was performed. Confounding variables examined were: Age, gender, chronic underlying diseases, acute medical disorders, APACHE II score, Charlson Comorbidities Index, and Length of stay. If a decision of WH/WD was taken, additional data were collected: Type of decision; reasons supporting the decision, modalities of WH/WD, moment, time from ED admission to decision, and time from processing to withhold or withdrawal life-sustaining treatment to death. Individuals who initiated (single emergency physician, medical staff), and were involved in the decision (nursing staff, patients, and families), and documentation of the decision in the medical record.

Results
177 patients who died in ED between November 2009 and March 2010 were included. Withholding and withdrawing life-sustaining treatment was applied to 30.5% of all patients who died. Therapies were withheld in 24.2% and were withdrawn in 6.2%. The most reasons for making these decisions were; absence of improvement following a period of active treatment (61.1%), and expected irreversibility of acute disorder in the first 24 h (42.6%). The most common modalities withheld or withdrawn life-support therapy were mechanical ventilation (17%), vasopressor and inotrops infusion (15.8%). Factors associated with WH/WD decisions were older age (OR = 1.1; 95%IC = 1.01-1.07; P = 0.001), neurological acute medical disorders (OR = 4.1; 95%IC = 1.48-11.68; P = 0.007), malignancy (OR = 7.7; 95%IC = 1.38-8.54; P = 0.002) and cardiovascular (OR = 3.4;95%IC = 2.06-28.5;P = 0.008) chronic underlying diseases.

Conclusion
Life-sustaining treatment were frequently withheld or withdrawn from elderly patients with underlying chronic cardiovascular disease or metastatic cancer or patients with acute neurological medical disorders in a Moroccan ED. Religious beliefs and the lack of guidelines and official Moroccan laws could explain the ethical limitations of the decision-making process recorded in this study.
An evaluation of clinical treatment of convergence insufficiency for children with reading difficulties
Authors: Dusek Wolfgang A , Pierscionek Barbara K , McClelland Julie F 
Published: August 2011

Abstract

Background
The present study investigates two different treatment options for convergence insufficiency CI for a group of children with reading difficulties referred by educational institutes to a specialist eye clinic in Vienna.

Methods
One hundred and thirty four subjects (aged 7-14 years) with reading difficulties were referred from an educational institute in Vienna, Austria for visual assessment. Each child was given either 8Δ base-in reading spectacles (n = 51) or computerised home vision therapy (HTS) (n = 51). Thirty two participants refused all treatment offered (clinical control group). A full visual assessment including reading speed and accuracy were conducted pre- and post-treatment.

Results
Factorial analyses demonstrated statistically significant changes between results obtained for visits 1 and 2 for total reading time, reading error score, amplitude of accommodation and binocular accommodative facility (within subjects effects) (p < 0.05). Significant differences were also demonstrated between treatment groups for total reading time, reading error score and binocular accommodative facility (between subjects effects) (p < 0.05).

Conclusions
Reading difficulties with no apparent intellectual or psychological foundation may be due to a binocular vision anomaly such as convergence insufficiency. Both the HTS and prismatic correction are highly effective treatment options for convergence insufficiency. Prismatic correction can be considered an effective alternative to HTS.
Arthrofibrosis after TKA - Influence factors on the absolute flexion and gain in flexion after manipulation under anaesthesia
Authors: Ipach Ingmar , Mittag Falk , Lahrmann Julia , Kunze Beate , Kluba Torsten 
Published: August 2011

Abstract

Background
Stiffness with decreased range of motion (ROM) has been described as a frustrating complication after TKA. If all methods of physiotherapeutic treatment have been exhausted trying to develop ROM, manipulation under anaesthesia (MUA) can be discussed. The aim of the present study was to show the effect of MUA and to determine the influence of BMI, number of previous surgical procedures, pre-MUA ROM and timing of MUA for the results after MUA in regard to absolute flexion and gain in flexion.

Methods
858 patients underwent TKA at our institution between 2004 and 2009. 39 of these patients underwent MUA because of postoperative knee stiffness. The data were retrospective analysed for the influence of BMI, pre-MUA flexion (</≥ 70°), timing of MUA (>/≤ 30 days after TKA) and number of previous surgery on the results after MUA (absolute Flexion/gain in flexion).

Results
The prevalence for stiffness after TKA was 4.54%. There was a statistically significant improvement in flexion not only directly after MUA but also 6 weeks after MUA. Patients with two or more previous operations before TKA showed statistically significant worse results six weeks after MUA in absolute flexion and gain in flexion
(p = 0.039) than patients with one or two previous operations. No statistical significance in absolute flexion (p = 0.655) and gain in flexion (p = 0.328) after MUA between "early" and "late" was detected. The stiffer knees with a flexion below 70° showed significantly worse results (p = 0.044) in absolute flexion six weeks after MUA, but they also had statistical statistically better results with regard to gain in flexion (p ≤ 0.001).

Conclusion
MUA is a good instrument for improving ROM after TKA. The time between TKA and MUA seems less important, so different types of physiotherapeutic treatment could be tried before the procedure is started. MUA in patients with many previous operations and a flexion of less than 70° before MUA is not as effective as in other patients, but they also benefit from MUA.
The effects of laryngeal mask airway passage simulation training on the acquisition of undergraduate clinical skills: a randomised controlled trial
Authors: Laiou Elpiniki , Clutton-Brock Thomas H , Lilford Richard J , Taylor Celia A 
Published: August 2011

AbstractBackgroundEffective use of the laryngeal mask airway (LMA) requires learning proper insertion technique in normal patients undergoing routine surgical procedures. However, there is a move towards simulation training for learning practical clinical skills, such as LMA placement. The evidence linking different amounts of mannequin simulation training to the undergraduate clinical skill of LMA placement in real patients is limited. The purpose of this study was to compare the effectivenessin vivoof two LMA placement simulation courses of different durations.MethodsMedical students (n = 126) enrolled in a randomised controlled trial. Seventy-eight of these students completed the trial. The control group (n = 38) received brief mannequin training while the intervention group (n = 40) received additional more intensive mannequin training as part of which they repeated LMA insertion until they were proficient. The anaesthetists supervising LMA placements in real patients rated the participants' performance on assessment forms. Participants completed a self-assessment questionnaire.ResultsAdditional mannequin training was not associated with improved performance (37% of intervention participants received an overall placement rating of > 3/5 on their first patient compared to 48% of the control group, X2= 0.81, p = 0.37). The agreement between the participants and their instructors in terms of LMA placement success rates was poor to fair. Participants reported that mannequins were poor at mimicking reality.ConclusionsThe results suggest that the value of extended mannequin simulation training in the case of LMA placement is limited. Educators considering simulation for the training of practical skills should reflect on the extent to which thein vitrosimulation mimics the skill required and the degree of difficulty of the procedure.
Relationship between lipid profiles and plasma total homocysteine, cysteine and the risk of coronary artery disease in coronary angiographic subjects
Authors: Xiao Yunjun , Zhang Yuan , Lv Xiaofei , Su Dongfang , Li Dan , Xia Min , Qiu Jian , Ling Wenhua , Ma Jing 
Published: August 2011

Abstract

Background
Homocysteine and cysteine are considered as risk factors of cardiovascular disease. Homocysteine influences the liver expression of ApoA-I and decreases its blood level and HDL in genetic mice model. We aimed therefore to evaluate whether homocysteine and cysteine are associated with lipid parameters, and the joint effects of them on the risk of coronary artery disease (CAD). Plasma total homocysteine (tHcy), cysteine (tCys) and lipid markers were measured in 2058 consecutive coronary artery angiographic patients.

Results
Plasma tHcy but not tCys correlated negatively with ApoA-I (r = -0.153, P < 0.001) and with HDL cholesterol (r = -0.148, P < 0.001), and correlated positively with the risk of CAD (OR: 1.61; 95% confidence interval; 1.26 to 2.05). Combination of high tHcy and high tCys levels was associated with decreased ApoA-I and HDL cholesterol levels, and with increased risk of CAD (OR: 1.696, 95% CI (1.301-2.211)). Furthermore, low HDL cholesterol combined with low tHcy or high tHcy all had increased risk for CAD (OR: 1.254, 95% CI (1.114-1.565); OR: 1.332, 95% CI (1.093-1.624); respectively) whereas high HDL cholesterol counteracted the harmful effect of high tHcy on the risk of CAD. However, only the combination of high tHcy and high ApoA-I had an increased risk for CAD (OR: 1.438, 95% CI (1.170-1.768)).

Conclusions
The association of homocysteine and cysteine, ApoA-I or HDL cholesterol and their joint effects provide new insights on its role on CAD.
Decreased levels of genuine large free hCG alpha in men presenting with abnormal semen analysis
Authors: Zenzmaier Christoph , Gerth Regine , Gruschwitz Matthias , Lindner Herbert , Plas Eugen , Berger Peter 
Published: August 2011

Abstract

Background
The pregnancy hormone human chorionic gonadotropin (hCG) and its free subunits (hCG alpha, hCG beta) are produced in the male reproductive tract and found in high concentrations in seminal fluid, in particular hCG alpha. This study aimed to elucidate changes in peptide hormone profiles in patients showing abnormal semen analyses and to determine the genuineness of the highly abundant hCG alpha.

Methods
Seminal plasma was obtained from 45 male patients undergoing semen analysis during infertility workups. Comprehensive peptide hormone profiles were established by a panel of immunofluorometric assays for hCG, hCG alpha, hCG beta and its metabolite hCG beta core fragment, placental lactogen, growth hormone and prolactin in seminal plasma of patients with abnormal semen analysis results (n = 29) versus normozoospermic men (n = 16). The molecular identity of large hyperglycosylated hCG alpha was analyzed by mass-spectrometry and selective deglycosylation.

Results
hCG alpha levels were found to be significantly lower in men with impaired semen quality (1346 +/- 191 vs. 2753 +/- 533 ng/ml, P = 0.022). Moreover, patients with reduced sperm count had reduced intact hCG levels compared with normozoospermic men (0.097 +/- 0.022 vs. 0.203 +/- 0.040 ng/ml, P = 0.028). Using mass-spectrometry, the biochemical identity of hCG alpha purified from seminal plasma was verified. Under non-reducing conditions in SDS-PAGE, hCG alpha isolated from seminal plasma migrated in a manner comparable with large free hCG alpha with an apparent molecular mass (Mr, app) of 24 kDa, while hCG alpha dissociated from pregnancy-derived holo-hCG migrated at approximately 22 kDa. After deglycosylation with PNGase F under denaturing conditions, all hCG alpha variants showed an Mr, app of 15 kDa, indicating identical amino acid backbones.

Conclusions
The findings indicate a pathophysiological relevance of hCG, particularly its free alpha subunit, in spermatogenesis. The alternative glycosylation pattern on the free large hCG alpha in seminal plasma might reflect a modified function of this subunit in the male reproductive tract.
SERCA2a gene transfer improves electrocardiographic performance in aged mdx mice
Authors: Shin Jin-Hong , Bostick Brian , Yue Yongping , Hajjar Roger , Duan Dongsheng 
Published: August 2011

Abstract

Background
Cardiomyocyte calcium overloading has been implicated in the pathogenesis of Duchenne muscular dystrophy (DMD) heart disease. The cardiac isoform of sarcoplasmic reticulum calcium ATPase (SERCA2a) plays a major role in removing cytosolic calcium during heart muscle relaxation. Here, we tested the hypothesis that SERCA2a over-expression may mitigate electrocardiography (ECG) abnormalities in old female mdx mice, a murine model of DMD cardiomyopathy.

Methods
1 × 1012 viral genome particles/mouse of adeno-associated virus serotype-9 (AAV-9) SERCA2a vector was delivered to 12-m-old female mdx mice (N = 5) via a single bolus tail vein injection. AAV transduction and the ECG profile were examined eight months later.

Results
The vector genome was detected in the hearts of all AAV-injected mdx mice. Immunofluorescence staining and western blot confirmed SERCA2a over-expression in the mdx heart. Untreated mdx mice showed characteristic tachycardia, PR interval reduction and QT interval prolongation. AAV-9 SERCA2a treatment corrected these ECG abnormalities.

Conclusions
Our results suggest that AAV SERCA2a therapy may hold great promise in treating dystrophin-deficient heart disease.
Characterization and targeting of phosphatidylinositol-3 kinase (PI3K) and mammalian target of rapamycin (mTOR) in renal cell cancer
Authors: Elfiky Aymen A , Aziz Saadia A , Conrad Patricia J , Siddiqui Summar , Hackl Wolfgang , Maira Michel , Robert Camp L , Kluger Harriet M 
Published: August 2011

Abstract

Background
PI3K and mTOR are key components of signal transduction pathways critical for cell survival. Numerous PI3K inhibitors have entered clinical trials, while mTOR is the target of approved drugs for metastatic renal cell carcinoma (RCC). We characterized expression of p85 and p110α PI3K subunits and mTOR in RCC specimens and assessed pharmacologic co-targeting of these molecules in vitro.

Methods
We employed tissue microarrays containing 330 nephrectomy cases using a novel immunofluorescence-based method of Automated Quantitative Analysis (AQUA) of in situ protein expression. In RCC cell lines we assessed synergism between PI3K and mTOR inhibitors and activity of NVP-BEZ235, which co-targets PI3K and mTOR.

Results
p85 expression was associated with high stage and grade (P < 0.0001 for both). High p85 and high mTOR expression were strongly associated with decreased survival, and high p85 was independently prognostic on multi-variable analysis. Strong co-expression of both PI3K subunits and mTOR was found in the human specimens. The PI3K inhibitor LY294002 and rapamycin were highly synergistic in all six RCC cell lines studied. Similar synergism was seen with all rapamycin concentrations used. NVP-BEZ235 inhibited RCC cell growth in vitro with IC50s in the low ηM range and resultant PARP cleavage.

Conclusions
High PI3K and mTOR expression in RCC defines populations with decreased survival, suggesting that they are good drug targets in RCC. These targets tend to be co-expressed, and co-targeting these molecules is synergistic. NVP-BEZ235 is active in RCC cells in vitro; suggesting that concurrent PI3K and mTOR targeting in RCC warrants further investigation.
Partial response to anakinra in life-threatening Henoch-Schönlein purpura: case report
Authors: Boyer Erynn M , Turman Martin , O'Neil Kathleen M 
Published: August 2011

Abstract
Henoch-Schönlein purpura is one of the most common forms of systemic vasculitis of childhood. We report the response to anakinra, the interleukin-1 receptor antagonist, in a 9 year old girl without prior medical problems who developed life-threatening Henoch-Schönlein vasculitis that produced renal failure, pulmonary hemorrhage and vasculitis of the brain. Her response supports the theory that interleukin-1 may be an important mediator in this disease. Further study of interleukin-1 antagonists in severe Henoch-Schönlein purpura may be warranted.
Radial breathing mode of carbon nanotubes subjected to axial pressure
Authors: Lei Xiao-Wen , Ni Qing-Qing , Shi Jin-Xing , Natsuki Toshiaki 
Published: August 2011

AbstractIn this paper, a theoretical analysis of the radial breathing mode (RBM) of carbon nanotubes (CNTs) subjected to axial pressure is presented based on an elastic continuum model. Single-walled carbon nanotubes (SWCNTs) are described as an individual elastic shell and double-walled carbon nanotubes (DWCNTs) are considered to be two shells coupled through the van der Waals force. The effects of axial pressure, wave numbers and nanotube diameter on the RBM frequency are investigated in detail. The validity of these theoretical results is confirmed through the comparison of the experiment, calculation and simulation. Our results show that the RBM frequency is linearly dependent on the axial pressure and is affected by the wave numbers. We concluded that RBM frequency can be used to characterize the axial pressure acting on both ends of a CNT.
Adaptive antenna selection and Tx/Rx beamforming for large-scale MIMO systems in 60 GHz channels
Authors: Dong Ke , Prasad Narayan , Wang Xiaodong , Zhu Shihua 
Published: August 2011

Abstract
We consider a large-scale MIMO system operating in the 60 GHz band employing beamforming for high-speed data transmission. We assume that the number of RF chains is smaller than the number of antennas, which motivates the use of antenna selection to exploit the beamforming gain afforded by the large-scale antenna array. However, the system constraint that at the receiver, only a linear combination of the receive antenna outputs is available, which together with the large dimension of the MIMO system makes it challenging to devise an efficient antenna selection algorithm. By exploiting the strong line-of-sight property of the 60 GHz channels, we propose an iterative antenna selection algorithm based on discrete stochastic approximation that can quickly lock onto a near-optimal antenna subset. Moreover, given a selected antenna subset, we propose an adaptive transmit and receive beamforming algorithm based on the stochastic gradient method that makes use of a low-rate feedback channel to inform the transmitter about the selected beams. Simulation results show that both the proposed antenna selection and the adaptive beamforming techniques exhibit fast convergence and near-optimal performance.
Systems of general nonlinear set-valued mixed variational inequalities problems in Hilbert spaces
Authors: Agarwal Ravi P , Cho Yeol JE , Petrot Narin 
Published: August 2011

AbstractIn this paper, the existing theorems and methods for finding solutions of systems of general nonlinear set-valued mixed variational inequalities problems in Hilbert spaces are studied. To overcome the difficulties, due to the presence of a proper convex lower semi-continuous function, φ and a mapping g, which appeared in the considered problem, we have used some applications of the resolvent operator technique. We would like to point out that although many authors have proved results for finding solutions of the systems of nonlinear set-valued (mixed) variational inequalities problems, it is clear that it cannot be directly applied to the problems that we have considered in this paper because of φ and g.2000 AMS Subject Classification: 47H05; 47H09; 47J25; 65J15.
Identification of specificity determining residues in peptide recognition domains using an information theoretic approach applied to large-scale binding maps
Authors: Yip Kevin Y , Utz Lukas , Sitwell Simon , Hu Xihao , Sidhu Sachdev S , Turk Benjamin E , Gerstein Mark , Kim Philip M 
Published: August 2011

Abstract

Background
Peptide Recognition Domains (PRDs) are commonly found in signaling proteins. They mediate protein-protein interactions by recognizing and binding short motifs in their ligands. Although a great deal is known about PRDs and their interactions, prediction of PRD specificities remains largely an unsolved problem.

Results
We present a novel approach to identifying these Specificity Determining Residues (SDRs). Our algorithm generalizes earlier information theoretic approaches to coevolution analysis, to become applicable to this problem. It leverages the growing wealth of binding data between PRDs and large numbers of random peptides, and searches for PRD residues that exhibit strong evolutionary covariation with some positions of the statistical profiles of bound peptides. The calculations involve only information from sequences, and thus can be applied to PRDs without crystal structures. We applied the approach to PDZ, SH3 and kinase domains, and evaluated the results using both residue proximity in co-crystal structures and verified binding specificity maps from mutagenesis studies.

Discussion
Our predictions were found to be strongly correlated with the physical proximity of residues, demonstrating the ability of our approach to detect physical interactions of the binding partners. Some high-scoring pairs were further confirmed to affect binding specificity using previous experimental results. Combining the covariation results also allowed us to predict binding profiles with higher reliability than two other methods that do not explicitly take residue covariation into account.

Conclusions
The general applicability of our approach to the three different domain families demonstrated in this paper suggests its potential in predicting binding targets and assisting the exploration of binding mechanisms.