bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcome of stage Ia1 squamous cell carcinoma of the uterine cervix and pathological findings of initial conization
Authors: Yoshinaga Mitsuhiro , Hamada Tomonori , Orita Yuji , Yoshitomi (Shintomo) Nao , Matsuo Takashi , Tsuji Takahiro , Tabata Kazuhiro , Douchi Tsutomu 
Published: July 2011

AbstractAim:  The present study investigated the clinical outcome of stage Ia1 squamous cell carcinoma (SCC) of the uterine cervix at a single institute.Materials and Methods:  Subjects were 84 patients with cervical SCC, International Federation of Gynecology and Obstetrics stage Ia1 diagnosed according to conization findings between January 2000 and June 2009. Correlations between clinical outcome and pathological findings on initial conization were investigated.Results:  Of 65 hysterectomy (without pelvic lymphadenectomy) patients, two (3.1%) showed metastasis to the vaginal wall, and two (3.1%) to the pelvic lymph nodes. Five patients (6.0%) showed lymphovascular invasion, and three (3.6%) showed confluent patterns of stromal invasion (confluent invasion) on initial conization findings. All of these five patients were included in the hysterectomy group. Of 19 patients with conization alone, two showed vaginal metastasis. Of four patients with vaginal metastasis, two showed lymphovascular invasion and one showed confluent invasion despite negative conization margin. In patients with nodal metastasis, stromal invasion of 3.0 mm and 2.8 mm, and horizontal spread of 6.8 mm and 6.9 mm were observed on conization, respectively. All patients are currently alive due to adequate therapy including chemo‐radiation for six patients with recurrent disease.Conclusions:  In patients showing stromal invasion of nearly 3.0 mm and horizontal spread of nearly 7.0 mm in stage Ia1 cervical SCC, pelvic lymphadenectomy may be considered. Even for patients showing a negative conization margin, careful follow up is necessary, because vaginal metastasis sometimes occurs.
Three‐dimensional volume‐rendered imaging of normal and abnormal fetal fluid‐filled structures using inversion mode
Authors: Hata Toshiyuki , Mori Nobuhiro , Tenkumo Chiaki , Hanaoka Uiko , Kanenishi Kenji , Tanaka Hirokazu 
Published: July 2011

AbstractA total of six normal and eight abnormal fetuses at 16–38 weeks of gestation were studied using transabdominal three‐dimensional sonography with an inversion mode. In normal fetuses, the stomach, gallbladder and bladder could be depicted. In particular, peristalsis of the stomach was noted. In the case of holoprosencephaly, fused hemispheres were evident. In the case of hydrocephalus, the enlargement of ventricular cavities was noted. In the case of bilateral pleural effusion, the spatial relationship and size of the effusions were depicted. In the case of meconium peritonitis, the spatial relationship between the dilated intestines and ascites was depicted. In two cases of hydronephrosis, the dilated renal pelvis and calyces were clearly shown. In the case of multicystic dysplastic kidney, the number and size of cysts were clearly identified. In the case of left ovarian cyst, the anatomical relationships among the ovarian cyst, kidney, stomach and bladder could be easily understood.
Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: A randomized study
Authors: Sesti Francesco , Ruggeri Velia , Pietropolli Adalgisa , Piancatelli Raffaella , Piccione Emilio 
Published: July 2011

AbstractAim:  To compare postoperative outcomes and effects on quality of life following thermal balloon ablation (TBA) or laparoscopic supracervical hysterectomy (LSH) in women with heavy menstrual bleeding (HMB).Material and Methods:  Sixty‐eight women requiring surgical treatment for HMB were randomly allocated into two treatment arms: TBA (n = 34) and LSH (n = 34). The randomization procedure was based on a computer‐generated list. The primary outcome was a comparison of the effects on menstrual bleeding (Pictorial Blood Loss Assessment Chart [PBAC]) between the two procedures. The secondary outcome measures were quality of life, improvement of bleeding patterns, intensity of postoperative pain, and early postoperative complications. Continuous outcome variables were analyzed using Student's t‐test. Discrete variables were analyzed with the χ2 test or Fisher's exact test. P < 0.05 was considered statistically significant.Results:  The PBAC score was significantly reduced in both treatment groups. After LSH all women had amenorrhea. After TBA there was a significant improvement of bleeding frequency and length. The postoperative pain intensity at 24 h was significantly minor in women treated with TBA rather than with LSH. The Medical Outcomes Survey Short Form 36 (SF‐36) score improved in both groups. However, LSH showed a negative impact on the emotional state. No intraoperative complications occurred, and no case was returned to the theatre in either group.Conclusion:  The effectiveness of TBA as a possible treatment of HMB is confirmed. However, LSH showed a definitive improvement of the symptoms, and a better life quality profile. Further controlled prospective studies are required for identifying the best surgical approach in women with HMB.
Massive postpartum hemorrhage after chemotherapy in a patient with acute promyelocytic leukemia
Authors: Aoki Aiko , Yoneda Noriko , Yoneda Satoshi , Miyazono Takayoshi , Sugiyama Toshiro , Saito Shigeru 
Published: July 2011

AbstractA pregnant woman was diagnosed with acute promyelocytic leukemia at 38 weeks of gestation. Induction of labor was successful, and the patient delivered a healthy male baby. Soon after delivery, she was treated with chemotherapy using all‐trans‐retinoic acid (ATRA). The number of white blood cells was increased on the fifth postpartum day and retinoic acid syndrome (RAS) was considered a concern. On the sixth postpartum day, remission induction chemotherapy with idarubicin and cytosine arabinoside was started. On the seventh postpartum day, massive uterine bleeding of more than 1300 mL suddenly occurred. As administration of cytotoxic agents may induce disseminated intravascular coagulation, we should take care to avoid uterine bleeding after chemotherapy in acute promyelocytic leukemia cases treated soon after delivery.
THEORY AND PRACTICE OF CLINICAL ETHICS SUPPORT SERVICES: NARRATIVE AND HERMENEUTICAL PERSPECTIVES
Authors: PORZ ROUVEN , LANDEWEER ELLEKE , WIDDERSHOVEN GUY 
Published: July 2011

ABSTRACTIn this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of ‘theory’ and show how it is interwoven with ‘practice’ as we go along. First, we look at theory in its foundational role: in our case ‘narrative ethics’ and ‘philosophical hermeneutics’ provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like ‘story’, ‘responsibility’, or ‘vulnerability’ to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice‐versa.
MONOLOGICAL VERSUS DIALOGICAL CONSCIOUSNESS – TWO EPISTEMOLOGICAL VIEWS ON THE USE OF THEORY IN CLINICAL ETHICAL PRACTICE
Authors: OHNSORGE KATHRIN , WIDDERSHOVEN GUY 
Published: July 2011

ABSTRACTIn this article, we argue that a critical examination of epistemological and anthropological presuppositions might lead to a more fruitful use of theory in clinical‐ethical practice. We differentiate between two views of conceptualizing ethics, referring to Charles Taylors' two epistemological models: ‘monological’ versus ‘dialogical consciousness’. We show that the conception of ethics in the model of ‘dialogical consciousness’ is radically different from the classical understanding of ethics in the model of ‘monological consciousness’. To reach accountable moral judgments, ethics cannot be conceptualized as an individual enterprise, but has to be seen as a practical endeavor embedded in social interactions within which moral understandings are being negotiated. This view has specific implications for the nature and the role of ethical theory. Theory is not created in the individual mind of the ethicist; the use of theory is part of a joint learning process and embedded in a cultural context and social history. Theory is based upon practice, and serves practical purposes. Thus, clinical ethics support is both practical and theoretical.
THE ROLE OF EMOTIONS IN MORAL CASE DELIBERATION: THEORY, PRACTICE, AND METHODOLOGY
Authors: MOLEWIJK BERT , KLEINLUGTENBELT DICK , WIDDERSHOVEN GUY 
Published: July 2011

ABSTRACTIn clinical moral decision making, emotions often play an important role. However, many clinical ethicists are ignorant, suspicious or even critical of the role of emotions in making moral decisions and in reflecting on them. This raises practical and theoretical questions about the understanding and use of emotions in clinical ethics support services. This paper presents an Aristotelian view on emotions and describes its application in the practice of moral case deliberation.According to Aristotle, emotions are an original and integral part of (virtue) ethics. Emotions are an inherent part of our moral reasoning and being, and therefore they should be an inherent part of any moral deliberation. Based on Aristotle's view, we examine five specific aspects of emotions: the description of emotions, the attitude towards emotions, the thoughts present in emotions, the reliability of emotions, and the reasonable principle that guides an emotion. We then discuss three ways of dealing with emotions in the process of moral case deliberation. Finally, we present an Aristotelian conversation method, and present practical experiences using this method.
EVIDENCE – COMPETENCE – DISCOURSE: THE THEORETICAL FRAMEWORK OF THE MULTI‐CENTRE CLINICAL ETHICS SUPPORT PROJECT METAP
Authors: REITER‐THEIL STELLA , MERTZ MARCEL , SCHÜRMANN JAN , STINGELIN GILES NICOLA , MEYER‐ZEHNDER BARBARA 
Published: July 2011

ABSTRACTIn this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist in North‐America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how‐to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end‐of‐life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi‐centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES.
Effects of a Punitive Environment on Children's Executive Functioning: A Natural Experiment
Authors: Talwar Victoria , Carlson Stephanie M. , Lee Kang 
Published: July 2011

AbstractFew studies have examined the influence of environmental factors on children's executive functioning (EF) performance. The present study examined the effects of a punitive vs. non‐punitive school environment on West African children's EF skills. Tasks included a ‘cool’ (relatively non‐affective) and ‘hot’ (relatively affective/motivational) version of three EF tasks: delay of gratification; gift delay; and dimensional change card sort. Children had more difficulties with the hot versions of the tasks than the cool versions, and older children outperformed younger children. After controlling for verbal ability (Peabody picture vocabulary test‐third edition), a consistent pattern of interaction between school and grade level emerged. Overall, kindergarten children in the punitive school performed no differently than their counterparts in the non‐punitive school. However, in grade 1, children in the punitive school performed significantly worse than their counterparts in the non‐punitive school. These results point to the need to consider interactions among discipline style, age, and internalization processes of self‐regulation to better understand environmental influences on EF development.
A study on the prognostic value of clinical and surgical features of dermatofibrosarcoma protuberans in Korean patients
Authors: Kim M. , Huh C.H. , Cho K.H. , Cho S. 
Published: July 2011

AbstractBackground  Dermatofibrosarcoma protuberans (DFSP) is a rare spindle cell tumour with locally aggressive characteristics. Only few studies on the epidemiology of DFSP in Asians have been reported.Objectives  The purpose of the study was to evaluate the epidemiological and clinical characteristics of DFSP in Korean patients and determine the prognostic factors that affect disease‐free survival.Methods  We conducted a retrospective review of patients diagnosed with primary or recurrent DFSP between 2000 and 2009 at three Seoul National University Hospitals. Patient, tumour and treatment factors were analysed for local recurrence‐free survival.Results  We analysed data for 65 patients, of whom 36 (55.4%) were female. The mean age at disease onset was 34.4 years with 50% aged between 20 and 40 years. Involved sites were most often on the trunk (66.1%). Among the 65 patients, 60 patients underwent wide excision; seven patients (10.8%) experienced local recurrence during 3.6 years of follow‐up. The recurrence‐free survival was significantly related to the microscopic resection margins (P = 0.005), clinical presentation (P = 0.002) and frequency of recurrence (P = 0.014) in the univariate analysis. There were three cases with metastasis, two of whom died because of progression of the disease despite continuous chemotherapy with imatinib mesylate.Conclusions  We report the epidemiologic and clinical characteristics of DFSP in Korea. Patients with recurrent disease at presentation and frequent recurrence have a high risk of recurrence and metastasis, and therefore close observation is needed in these patients.
Preserving genetic diversity in threatened species reintroductions: how many individuals should be released?
Authors: Tracy L. N. , Wallis G. P. , Efford M. G. , Jamieson I. G. 
Published: July 2011

AbstractReintroduction guidelines recommend that ‘adequate’ numbers of individuals be released to minimize loss of genetic diversity, but these numbers are rarely quantified. We present a framework for assessing the number of individuals required for an island reintroduction that takes account of allele loss both during the founding event and in the following establishment phase with a low population size. This is the first attempt to model release numbers for reintroductions in order to preserve alleles with a specified initial frequency, while taking post‐release mortality rates, population growth rates and site carrying capacity into account. Probability of allele retention was sensitive to both release number and post‐release demography. The rate of allele loss was strongly influenced by both environmental stochasticity and delayed population growth but was little affected by increasing the annual turnover rate of the breeding population. We illustrate the model's application using parameter estimates from a threatened New Zealand passerine, the mohua Mohoua ochrocephala, for which reintroduction is a common management tool. Our modelling indicates that when population growth is moderate (λ=1.3), c. 60 individuals would need to be released to achieve at least 95% certainty that alleles at an initial frequency of 0.05 would be retained after 20 years (five overlapping generations), which is double the number typically released in translocations of mohua and other threatened forest passerines in New Zealand.
Propofol post‐conditioning induced long‐term neuroprotection and reduced internalization of AMPAR GluR2 subunit in a rat model of focal cerebral ischemia/reperfusion
Authors: Wang Haiyun , Luo Mengqiang , Li Cui , Wang Guolin 
Published: July 2011

J. Neurochem. (2011) 119, 210–219.AbstractWe previously reported that propofol (20 mg/kg/h) post‐conditioning provided acute (up to 24 h) neuroprotection in rats with transient middle cerebral artery occlusion. In this study, we extend these data by examining long‐term protection and exploring underlying mechanisms involving AMPA receptor GluR2 subunit internalization. Rats were treated with propofol 20 mg/kg/h after 60 min of occlusion (beginning of reperfusion for 4 h). Propofol post‐conditioning reduced infarct volume and improved spatial memory deficiencies (up to 28 days) induced by ischemia/reperfusion injury. Additionally, Propofol post‐conditioning promoted neurogenesis in the dentate gyrus of hippocampus, as measured by bromodeoxyuridine and neuron‐specific nuclear protein immunofluorescence‐double staining at day 28 after reperfusion. Finally, propofol post‐conditioning increased the surface expression of AMPA receptor GluR2 subunit, thus inhibited the internalization of this part until 28 days after stroke. In conclusion, our data suggest that propofol post‐conditioning provides long‐term protection against focal cerebral ischemia/reperfusion injury in rats. Furthermore, we found that the inhibition of AMPA receptor GluR2 subunit internalization may contributed to this long‐term neuroprotection.
Azelnidipine is a calcium blocker that attenuates liver fibrosis and may increase antioxidant defence
Authors: Ohyama T , Sato K , Kishimoto K , Yamazaki Y , Horiguchi N , Ichikawa T , Kakizaki S , Takagi H , Izumi T , Mori M 
Published: July 2011

BACKGROUND AND PURPOSEOxidative stress plays a critical role in liver fibrogenesis. Reactive oxygen species (ROS) stimulate hepatic stellate cells (HSCs), and ROS‐mediated increases in calcium influx further increase ROS production. Azelnidipine is a calcium blocker that has been shown to have antioxidant effects in endothelial cells and cardiomyocytes. Therefore, we evaluated the anti‐fibrotic and antioxidative effects of azelnidipine on liver fibrosis.EXPERIMENTAL APPROACHWe used TGF‐β1‐activated LX‐2 cells (a human HSC line) and mouse models of fibrosis induced by treatment with either carbon tetrachloride (CCl4) or thioacetamide (TAA).KEY RESULTSAzelnidipine inhibited TGF‐β1 and angiotensin II (Ang II)‐activated α1(I) collagen mRNA expression in HSCs. Furthermore, TGF‐β1‐ and Ang II‐induced oxidative stress and TGF‐β1‐induced p38 and JNK phosphorylation were reduced in HSCs treated with azelnidipine. Azelnidipine significantly decreased inflammatory cell infiltration, pro‐fibrotic gene expressions, HSC activation, lipid peroxidation, oxidative DNA damage and fibrosis in the livers of CCl4‐ or TAA‐treated mice. Finally, azelnidipine prevented a decrease in the expression of some antioxidant enzymes and accelerated regression of liver fibrosis in CCl4‐treated mice.CONCLUSIONS AND IMPLICATIONSAzelnidipine inhibited TGF‐β1‐ and Ang II‐induced HSC activationin vitroand attenuated CCl4‐ and TAA‐induced liver fibrosis, and it accelerated regression of CCl4‐induced liver fibrosis in mice. The anti‐fibrotic mechanism of azelnidipine against CCl4‐induced liver fibrosis in mice may have been due an increased level of antioxidant defence. As azelnidipine is widely used in clinical practice without serious adverse effects, it may provide an effective new strategy for anti‐fibrotic therapy.
Myocardial Contractility and Relaxation After Deep Hypothermic Circulatory Arrest in a Neonatal Piglet Model
Authors: Tirilomis Theodor , Popov Aron‐Frederik , Liakopoulos Oliver J. , Schmitto Jan D. , Bensch Marc , Steinke Katja , Coskun K. Oguz , Schoendube Friedrich A. 
Published: July 2011

AbstractCooling before circulatory arrest or ischemic arrest has been reported to influence myocardial performance in isolated neonatal hearts. The aim of the present study was to analyze indices of myocardial contractility and relaxation in an in vivo neonatal model after deep hypothermic circulatory arrest (DHCA). DHCA (18°C; DHCA group; n = 8) or mild hypothermic cardiopulmonary bypass ([MH‐CPB] 32°C; MH‐CPB group; n = 10) was applied in newborn piglets. After reperfusion (60 and 120 min), left ventricular dP/dtmax increased in DHCA and MH‐CPB, while −dP/dtmax decreased slightly in DHCA and increased in MH‐CPB. Nevertheless, the differences between the two groups did not reach statistical significance. In conclusion, left ventricular contractility remained stable after reperfusion following DHCA, to some degree at the expense of the diastolic function.
Experience of Sternal Secondary Closure by Means of a Titanium Fixation System After Transverse Thoracosternotomy
Authors: Motomura Tadashi , Bruckner Brian , La Francesca Saverio , Mittelhaus Sebastian , Chike‐Obi Chuma , Leon‐Becerril Joel , Ngo Uy , Loebe Matthias 
Published: July 2011

AbstractSternal dehiscence is a common complication after transverse thoracosternotomy in patients undergoing bilateral sequential lung transplantation (BSLT). These patients can be treated with conservative therapy, but severe dehiscence requires surgical reapproximation and secondary closure of the sternum. Seventy‐one cases of patients who underwent BSLT between January 2007 and May 2009 were reviewed retrospectively. Out of 71 patients, the sternum was intact in two cases due to the use of bilateral anterolateral thoracotomy, and a clamshell incision had been utilized in 69 patients. Four patients (6.8%) presented with persistent chest pain with severe sternal dehiscence diagnosed by chest X‐ray and/or chest computed tomography, and underwent sternal reapproximation using the Synthes Titanium Sternal Fixation System for longitudinal sternal plating. All four patients had successful sternal realignment and resolution of their preoperative clinical symptoms. No perioperative or postoperative complications were observed. The Synthes Titanium Sternal Fixation System is an appropriate and effective method for internal fixation of the sternum when used for symptomatic severe sternal dehiscence after sequential BSLT via transverse thoracosternotomy.