bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatry and politicians: the ‘hubris syndrome’
Authors: Russell Gerald 
Published: March 2011

SummaryLord Owen has alerted us to the dangers of ill health in heads of government, especially if they strive to keep their illnesses secret. The description of the hubris syndrome is still at an early stage but Owen has provided psychiatrists and other physicians with useful guidance on how to recognise its appearance in persons who hold positions of power. He has also provided advice to doctors caring for such persons.
Continuing professional development for psychiatrists: surveying current practice in the UK
Authors: Bamrah J. S. , Gray D. A. , Purandare N. , Merve S. 
Published: March 2011

Aims and methodThe Royal College of Psychiatrists recommends that all psychiatrists undertake continuing professional development (CPD) as part of their personal development plan (PDP) and that, for quality assurance, all CPD activity is approved by their peer groups. We conducted a regional survey (Survey I) of consultant psychiatrists attending a regional conference of the College to assess their current CPD practice, and a more detailed national survey (Survey II) into sessional time for CPD and peer group activity of all consultant psychiatrists and staff grade, associate specialist and specialty (SASS) doctors.ResultsThe surveys showed some similarities. Survey I (n = 36) showed that 83% of consultants had a current CPD certificate and that consultants experienced significantly more difficulty in achieving their ‘internal’ compared with ‘external’ CPD requirements (39% v. 20%). Survey II (n = 2632) showed that 98% of our sample thought CPD was important for revalidation. Despite this, over 50% had difficulty accessing CPD time regularly in their timetable. In total, 97.4% of consultants and 85.7% of SASS doctors were in peer groups.Clinical implicationsA revised CPD policy must give credit to peer group meetings and set out more clearly the distinction between the types of CPD activity psychiatrists undertake. We recommend more robust job planning to enable psychiatrists to fulfil their CPD requirements in the face of competing demands on their clinical time and reducing resource.
Service line management and medical education – uncomfortable bed fellows?
Authors: Bailey Alex , Warner James P. 
Published: March 2011

SummaryThe current method of delivery of psychiatric training and education in the UK is still almost solely based on the ‘firm’ or consultant-led system. Traditionally, these units have had fairly wide-ranging loci of clinical responsibility, ensuring a broad exposure to mental health conditions for both undergraduate students and psychiatric trainees. However, changes over the past decade, particularly in terms of functional splits within psychiatric services, have led to some limitation of this exposure. Various strategies have been employed by those responsible for educational provision within services, such as assigning trainees and students to in-patient and community ‘pairs' of teams. Although this has had some success, the introduction of more fundamental restructuring of mental health services and the advent of service lines will have even greater and more wide-ranging implications on education. This editorial examines some of these implications and looks at potential solutions to ensure that training is not forgotten in the wave of far-reaching and strategically driven reorganisations occurring within the National Health Service and more globally.
Risk-Adapted Management of Differentiated Thyroid Cancer Assessed by a Sensitive Measurement of Basal Serum Thyroglobulin
Authors: Malandrino Pasqualino , Latina Adele , Marescalco Salvatore , Spadaro Angela , Regalbuto Concetto , Fulco Rosa Anna , Scollo Claudia , Vigneri Riccardo , Pellegriti Gabriella 
Published: March 2011

Context:
Treatment and follow-up of patients thyroidectomized for differentiated thyroid carcinoma (DTC) mainly depends on the identification of the patient's risk of recurrence. Thyroglobulin (Tg) is the most important marker of persistent/recurrent disease. The recent introduction of a new, more sensitive Tg measurement allows for the early detection of the disease by measuring the basal (under l-T4 therapy) serum Tg level without TSH stimulation.

Objective:
The goal of this study is to identify the basal serum Tg threshold value that indicates recurrent disease by using a second-generation Tg assay.

Design and Patients:
A continuous series of 425 DTC patients, all thyroidectomized and treated with 131I after surgery and having basal Tg of no more than 1.0 ng/ml, negative anti-Tg antibodies, and a recombinant human TSH-stimulated Tg measurement was retrospectively analyzed.

Setting:
The study took place at an academic hospital.

Results:
The most accurate basal Tg value for predicting the presence of recurrent/residual disease was more than 0.15 ng/ml (sensitivity 87%, specificity 91%, negative predictive value 98.6%, and positive predictive value 47.8%). When the basal Tg level was no more than 0.15 ng/ml, the risk of disease presence was very low, even in patients classified at an intermediate or high risk. In contrast, when the basal Tg level was more than 0.15 ng/ml, the percentage of recurrent disease was relatively high (12.5% or one in eight cases) in low-risk patients.

Conclusions:
Basal Tg, measured using a second-generation Tg assay allows for the identification of DTC patients who are likely to remain disease free with great accuracy. This simple measurement, therefore, may be sufficient to assess the risk-adapted management of DTC patients.
Study of Platinum Dissolution Mechanism Using a Highly Sensitive Electrochemical Quartz Crystal Microbalance
Authors: Sakurai Takara , Shibata Masayo , Horiuchi Reiko , Yagi Ichizo , Kondo Toshihiro 
Published: March 2011

Abstract
Platinum (Pt) dissolution during oxidation/reduction cycle in various potential cycle ranges and in various pHs of the oxygen-saturated and deaerated H2SO4 and HClO4 electrolyte solutions was monitored by the highly sensitive electrochemical quartz crystal microbalance (EQCM) system. It was found that the Pt mass reduction depended on the potential cycle range and pH of the electrolyte solution with dissolved oxygen. Based on these results, it can be suggested that the dissolution of Pt requires one proton per one Pt and that it also requires dissolved oxygen, and then we can conclude that the dissolution reaction of Pt is as followings; PtO + H+ + 1/2O2 + H2O → Pt(OH)3+ and/or PtOH + H+ + 3/4O2 + 1/2H2O → Pt(OH)3+.
Central washout sign in computer-aided evaluation of breast MRI: preliminary results
Authors: Ko Eun Sook , Choi Hye Young , Lee Byung Hee , Noh Woo-Chul , Kim Rock Bum 
Published: March 2011

Background Although computer-aided evaluation (CAE) programs were introduced to help differentiate benign tumors from malignant ones, the set of CAE-measured parameters that best predict malignancy have not yet been established. Purpose To assess the value of the central washout sign on CAE color overlay images of breast MRI. Material and Methods We evaluated the frequency of the central washout sign using CAE. The central washout sign was determined so that thin, rim-like, persistent kinetics were seen in the periphery of the tumor. Then, sequentially, plateau and washout kinetics appeared. Two additional CAE-delayed kinetic variables were compared with the central washout sign for assessment of diagnostic utility: the predominant enhancement type (washout, plateau, or persistent) and the most suspicious enhancement type (any washout > any plateau > any persistent kinetics). Results One hundred and forty-nine pathologically proven breast lesions (130 malignant, 19 benign) were evaluated. A central washout sign was associated with 87% of malignant lesions but only 11% of benign lesions. Significant differences were found when delayed-phase kinetics were categorized by the most suspicious enhancement type ( P < 0.001) and the presence of the central washout sign ( P < 0.001). Under the criteria of the most suspicious kinetics, 68% of benign lesions were assigned as plateau or washout pattern. Conclusion The central washout sign is a reliable indicator of malignancy on CAE color overlay images of breast MRI.
High-resolution TOF MR angiography at 4.7 Tesla for volumetric and morphologic evaluation of coiled aneurysm neck remnants in a rat model
Authors: Marjamaa Johan , Antell Henrik , Abo-Ramadan Usama , Hernesniemi Juha A , Niemelä Mika R , Kangasniemi Marko 
Published: March 2011

Background Detection of morphologic and volumetric changes in aneurysm necks is important when evaluating the effects of endovascular devices for aneurysm occlusion. Purpose To optimize high-resolution 3D-TOF MRA at 4.7 T in order to achieve the best aneurysm-to-background contrast in experimental rat aneurysms, and to quantify the volume of the aneurysm neck by imaging. Material and Methods Saccular aneurysms in the abdominal aorta of rats were coiled with platinum coils. Tissue relaxation times were measured, and used in a mathematical simulation. To optimize 3D-TOF angiography, imaging parameters were varied within the range obtained from the simulations. Tissue contrast and contrast-to-noise ratio were measured from MR images. TOF images were compared to conventional spin echo and gradient echo images and to endoscopic and histological analyses. Results Parameters yielding the best aneurysm-to-background contrast and contrast-to-noise ratio were determined. The agreement between the results from in vivo imaging and simulation was good. The optimized 3D-TOF MRA sequence (TR/TE/FA = 60 ms/6.6 ms/20°) had an isotropic voxel size of 117 µm, which enabled measurement of the aneurysm neck volume. Conclusion High-resolution 3D-TOF angiography enables non-invasive quantification of changes in neck remnants of endovascularly coiled experimental aneurysms. In this model innovations like bioactive coils can be accurately tested for their efficacy for aneurysm occlusion.
Contrast-enhanced ultrasonographic findings of different histopathologic types of breast cancer
Authors: Wang Xiaohong , Xu Ping , Wang Yi , Grant Edward G 
Published: March 2011

Background The new application of contrast-enhanced ultrasonography (CEUS) in the diagnosis of breast masses has evolved quickly only in recent years. Nevertheless, mixed results owing to the overlap in characteristics of benign and malignant lesions are simultaneously discovered by most studies, partially attributed to different histopathologic characteristics of breast cancer. Purpose To explore the characteristics of different histopathologic types of breast cancer at real-time gray-scale CEUS and evaluate its diagnostic value. Material and Methods One hundred and one histopathologically confirmed malignant lesions were included. We retrospectively reviewed the contrast-enhanced ultrasonographic findings including morphologic features, quantitative parameters, and correlated them with histopathology. True-positive rate was calculated to assess the diagnostic performance of CEUS. Results The 101 malignancies displayed irregular shape (72 [71%]), poorly-defined margin (73 [72%]), penetrating or tortuous surrounding vessels (79 [78%]), heterogeneous enhancement (84 [83%]), including focal perfusion defects (24 [24%]). For each histopathologic type, 87% (58/67) of invasive ductal carcinoma (IDC) showed heterogeneous enhancement. Of all the 24 perfusion defects, IDC account for 88% (21/24). Low average peak intensity (PI) of 4.9 was detected in this type. Ductal carcinoma in situ (DCIS) excellently showed the features of irregular shape (82% [14/17]), poorly-defined margin (82% [14/17]), heterogeneous enhancement (94% [16/17]). While 83% (5/6) of medullary carcinoma exhibited regular shape, well-defined margin, homogenous enhancement, and high average PI value of 9.6. Invasive lobular carcinoma showed similar enhancement pattern to that of IDC. Intraductal papillary carcinoma displayed high average PI value of 8.1. The overall true-positive rate for conventional US and CEUS was 88%, 86%, respectively. DCIS, medullary carcinoma, and intraductal papillary carcinoma achieved an improved true-positive rate (94%, 100% and 100%, respectively). Conclusion The imaging characteristics of CEUS are variable in different histopathologic types of breast cancer. CEUS does not appear to be superior to conventional ultrasound as a diagnostic tool overall, however, it is a useful adjunct to conventional ultrasound in diagnosing some special types of breast cancer.
Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome?
Authors: Köroğlu Mert , Eriş Hüseyin Naim , Aktaş Aykut Recep , Kayan Mustafa , Yeşildağ Ahmet , Çetin Meltem , Parlak Cem , Gürses Cemil , Akhan Okan 
Published: March 2011

Background Superficial venous insufficiency is a common problem associated with varicose veins. Endovenous laser ablation (EVLA) and concomitant ultrasound (US)-guided foam sclerotherapy are recent treatment methods alternative to surgery in the treatment of superficial venous insufficiency. Purpose To compare the effectiveness of EVLA and concomitant US-guided foam sclerotherapy prospectively in two different subgroups of the disease (isolated truncal vs. truncal with perforating vein insufficiency). Material and Methods The study was approved by the institutional review board. Fifty-five patients with symptomatic saphenous vein insufficiency and varicose veins were included in the study. Seventy-three EVLA and concomitant foam sclerotherapy were performed for 60 lower extremities. To determine the severity of the venous disease, Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were carried out before and 6 months after the treatment. Patients were followed up clinically and with Doppler ultrasonography for 6 months after the procedures. Results At the sixth month of the follow-up; the total occlusion rate for the saphenous veins was 98.64% (72/73), and re-canalization rate was 1.36% (1/73). The total occlusion rate for the perforating veins was 75% (18/24), re-canalization rate was 25% (6/24). There was no notable major complication. VCSS and VAS scores were decreased significantly following the treatment (p < 0.05). The patients who had isolated saphenous vein insufficiency (Group I: 36/60) and those who had saphenous and perforating vein reflux (Group II: 24/60) were compared. VAS scores were more prominently decreased after the treatment in the isolated saphenous vein insufficiency group (p < 0.05). VCSS were also decreased more prominently in Group I when compared to Group II. Conclusion EVLA and concomitant US-guided foam sclerotherapy are effective, safe, and minimally invasive treatment options, yielding good cosmetic and clinical results in both isolated truncal and truncal with perforating vein insufficiency groups. However, clinical results and satisfaction of the patients were remarkably superior in cases with isolated truncal vein insufficiency compared to truncal and perforating vein insufficiency.
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging of bone marrow in healthy individuals
Authors: Hillengass Jens , Stieltjes Bram , Bäuerle Tobias , McClanahan Fabienne , Heiss Christiane , Hielscher Thomas , Wagner-Gund Barbara , Habetler Verena , Goldschmidt Hartmut , Schlemmer Heinz-Peter , Delorme Stefan , Zechmann Christian M 
Published: March 2011

BackgroundDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) displays microcirculation and permeability by application of contrast-media and diffusion-weighted imaging (DWI) is a tool for quantification of cellularity in the investigated area. Recently published examples cover breast cancer, CNS tumors, head and neck cancer, gastrointestinal cancer, prostate cancer as well as hematologic malignancies.PurposeTo investigated the influence of age, sex, and localization of the investigated region on findings of DCE-MRI and DWI.Material and MethodsDCE-MRI-parameters amplitude A and exchange rate constant kep as well as the DWI-parameter ADC of the bone marrow of the lumbar vertebral column of 30 healthy individuals covering the typical range of age of tumor patients were evaluated. ADC was calculated using b=0 and a maximal b value of either 400 or 750 s/mm2.ResultsAmplitude A of DCE-MRI decreased with age ( P = 0.01) and amplitude A, exchange rate constant kep as well as ADC based on b = 400 s/mm2and b = 750 s/mm2,respectively, decreased significantly from the first to the fifth lumbar vertebra with P = 0.02, P = 0.05, P = 0.003, and P = 0.002, respectively.ConclusionQuantitative parameters of functional imaging techniques in bone marrow are influenced by the age of the examined individual and the anatomical location of the investigated region.
Outcome and prognostic factors of spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization
Authors: Shin Byung Seok , Park Mi-Hyun , Jeon Gyeong Sik 
Published: March 2011

Background Rupture of hepatocellular carcinoma (HCC) is a life-threatening condition accompanied by hemorrhage. Transarterial embolization/chemoembolization (TAE/TACE) can be used as the first-line treatment to achieve initial homeostasis. Purpose To investigate the outcome of TAE/TACE for spontaneous ruptured HCC and to determine the prognostic factors affecting survival. Material and Methods We retrospectively reviewed the clinicoradiologic data of 47 patients (8 women, 39 men; median age 64.4 years) with serum bilirubin levels <3.0 mg/dL that underwent TAE/TACE for ruptured HCC between January 2004 and June 2010. Survival rates were estimated using the Kaplan-Meier method and prognostic factors of poor survival were obtained by univariate and multivariate analyses. Results The clinical success rate of TAE/TACE was 94% (44/47). The median survival time was 179.6 days. The 1-month, 3-month, 6-month, and 12-month survival rates were 75%, 54%, 48%, and 43%, respectively. Old age, a previous history of TACE for HCC, low initial hemoglobin level, higher blood transfusion requirement, Child-Pugh class C, high serum bilirubin level, low serum albumin level, prolonged prothrombin time, high serum creatinine level on admission, presence of encephalopathy, severe ascites, lobar TAE/TACE, presence of portal vein thrombosis, and tumors involving both lobes were associated with poor survival. Multivariate analysis revealed that higher blood transfusion requirement, Child-Pugh class C, presence of portal vein thrombosis, and tumors involving both lobes were significant predictors of poor survival. Conclusion TAE/TACE is effective for achieving initial hemostasis, which is critical to survival. Regardless of successful TAE/TACE, the survival rate in patients with Child-Pugh class C remains poor. Portal vein thrombosis and tumor extent are significant image parameters for predicting survival after TAE/TACE for ruptured HCC.
MRI features of intraductal papilloma of the breast: sheep in wolf's clothing?
Authors: Kurz Kathinka D , Roy Sumit , Saleh Andreas , Diallo-Danebrock Raihana , Skaane Per 
Published: March 2011

Background Intraductal papillomas often present as small, smooth masses, dilated ducts or microcalcifications at mammography and as smooth, hypoechoic masses at sonography. At magnetic resonance imaging (MRI), intraductal papillomas often present as small smooth masses, however, often with strong enhancement with type 2 or 3 time intensity curves. The result of the MR analysis is therefore not infrequently inconclusive in order to characterize the mass as benign or malignant. Purpose To characterize the appearance of intraductal papillomas of the breast at MRI, and determine whether the application of diagnostic rules described in literature could contribute to correctly classifying the lesions as benign. Material and Methods Twenty patients with histologically proven intraductal papillomas were included. Two radiologists independently reviewed the MR images of the breast. The BI-RADS® nomenclature was used to describe morphology and contrast-enhancement kinetics. Interobserver agreement in the interpretation of the MR images by the two investigators was performed. Kappa coefficient was calculated as index for the level of agreement. Subsequently, three sets of diagnostic rules, including the Göttinger score described by Fischer and the interpretation flowcharts according to Kinkel and to Tozaki were applied to characterize whether a biopsy should be recommended or not. Results All papillomas presented as masses on dynamic contrast-enhanced MRI. Only five papillomas showed a round, oval, or lobulated shape combined with smooth margins and continuous rise of the time intensity curve. Using the Göttingen score, biopsy would be recommended in 16 patients. Based on the interpretation flowcharts of Kinkel and of Tozaki, an additional 13 and 10 papillomas, respectively, were correctly classified as benign. Dilated ducts were visible in 10 patients. The interobserver agreement was good or excellent for all included variables. Conclusion Including systematic analysis of breast MRI to the diagnostic protocol and interpreting the images according to predetermined diagnostic rules, most solitary intraductal papillomas of the breast may be correctly characterized as benign.
Using intervention mapping to develop a family-based childhood weight management programme
Authors: Pittson Helen , Wallace1 Louise 
Published: April 2011

Objectives To develop, implement and evaluate a family-based childhood weight management programme. Methods Programme development utilized Bartholomew's Intervention Mapping framework. This six step structured approach provides planners with a framework that links determinants of health behaviours with performance objectives and strategies to be incorporated into programme design. Using this process a needs analysis and literature review were undertaken, a steering group formed, six focus groups (with a total of n = 47 pupils) were completed and six interviews took place with parents. The determinants were combined with relevant theories to develop the programme. Y W8? is a 12 week course for families with children aged 8-13 years designed to assist with weight management. Participants’ height, weight and physical activity levels along with self-esteem scores for children are recorded pre- and post-intervention and at three, six and 12 month follow-up. This paper documents post-course results at 12 weeks. Results Preliminary results showed children (mean pre-BMI = 28.48 (+4.44), mean post-BMI = 27.48 (+4.45; P = <0.001) and parents (mean pre-BMI = 30.77 (+6.21), mean post-BMI = 30.41 (+6.17; P = 0.017) decreased their BMI over the 12 weeks. These results compare favourably with similar programmes in the UK. Conclusions Intervention mapping was a useful approach for developing a theory based intervention. Results suggest Y W8? improves the body mass index (BMI) of children and parents at 12 weeks. Further work, including a randomized controlled trial (RCT), will confirm this, investigate the longer-term effectiveness and determine how the effects are mediated by psychological processes.