bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of a strategy for implementing a guideline for the control of cardiovascular risk in a primary healthcare setting: the SIRVA2 study a controlled, blinded community intervention trial randomised by clusters
Authors: Rodríguez-Salvanés Francisco , Novella Blanca , Fernández Luque María Jesús , Sánchez-Gómez Luis María , Ruiz-Díaz Lourdes , Sánchez-Alcalde Rosa , Sierra-García Belén , Mayayo Soledad , Ruiz-López Marta , Loeches Pilar , López-Gónzález Javier , González-Gamarra Amelia 
Published: May 2011

Abstract
This work describes the methodology used to assess a strategy for implementing clinical practice guidelines (CPG) for cardiovascular risk control in a health area of Madrid.

Background

The results on clinical practice of introducing CPGs have been little studied in Spain. The strategy used to implement a CPG is known to influence its final use. Strategies based on the involvement of opinion leaders and that are easily executed appear to be among the most successful.

Aim

The main aim of the present work was to compare the effectiveness of two strategies for implementing a CPG designed to reduce cardiovascular risk in the primary healthcare setting, measured in terms of improvements in the recording of calculated cardiovascular risk or specific risk factors in patients' medical records, the control of cardiovascular risk factors, and the incidence of cardiovascular events.

Methods

This study involved a controlled, blinded community intervention in which the 21 health centres of the Number 2 Health Area of Madrid were randomly assigned by clusters to be involved in either a proposed CPG implementation strategy to reduce cardiovascular risk, or the normal dissemination strategy. The study subjects were patients ≥ 45 years of age whose health cards showed them to belong to the studied health area. The main variable examined was the proportion of patients whose medical histories included the calculation of their cardiovascular risk or that explicitly mentioned the presence of variables necessary for its calculation. The sample size was calculated for a comparison of proportions with alpha = 0.05 and beta = 0.20, and assuming that the intervention would lead to a 15% increase in the measured variables. Corrections were made for the design effect, assigning a sample size to each cluster proportional to the size of the population served by the corresponding health centre, and assuming losses of 20%. This demanded a final sample size of 620 patients. Data were analysed using summary measures for each cluster, both in making estimates and for hypothesis testing. Analysis of the variables was made on an intention-to-treat basis.

Trial Registration

ClinicalTrials.gov: NCT01270022
Angiopoietin-1 is associated with cerebral vasospasm and delayed cerebral ischemia in subarachnoid hemorrhage
Authors: Fischer Marlene , Broessner Gregor , Dietmann Anelia , Beer Ronny , Helbok Raimund , Pfausler Bettina , Chemelli Andreas , Schmutzhard Erich , Lackner Peter 
Published: May 2011

AbstractBackgroundAngiopoietin-1 (Ang-1) and -2 (Ang-2) are keyplayers in the regulation of endothelial homeostasis and vascular proliferation. Angiopoietins may play an important role in the pathophysiology of cerebral vasospasm (CVS). Ang-1 and Ang-2 have not been investigated in this regard so far.Methods20 patients with subarachnoid hemorrhage (SAH) and 20 healthy controls (HC) were included in this prospective study. Blood samples were collected from days 1 to 7 and every other day thereafter. Ang-1 and Ang-2 were measured in serum samples using commercially available enzyme-linked immunosorbent assay. Transcranial Doppler sonography was performed to monitor the occurrence of cerebral vasospasm.ResultsSAH patients showed a significant drop of Ang-1 levels on day 2 and 3 post SAH compared to baseline and HC. Patients, who developed Doppler sonographic CVS, showed significantly lower levels of Ang-1 with a sustained decrease in contrast to patients without Doppler sonographic CVS, whose Ang-1 levels recovered in the later course of the disease. In patients developing cerebral ischemia attributable to vasospasm significantly lower Ang-1 levels have already been observed on the day of admission. Differences of Ang-2 between SAH patients and HC or patients with and without Doppler sonographic CVS were not statistically significant.ConclusionsAng-1, but not Ang-2, is significantly altered in patients suffering from SAH and especially in those experiencing CVS and cerebral ischemia. The loss of vascular integrity, regulated by Ang-1, might be in part responsible for the development of cerebral vasospasm and subsequent cerebral ischemia.
Relevance of circulating nucleosomes and oncological biomarkers for predicting response to transarterial chemoembolization therapy in liver cancer patients
Authors: Kohles Nikolaus , Nagel Dorothea , Jüngst Dietrich , Durner Jürgen , Stieber Petra , Holdenrieder Stefan 
Published: May 2011

Abstract

Background
Transarterial chemoembolization (TACE) therapy is an effective locoregional treatment in hepatocellular cancer (HCC) patients. For early modification of therapy, markers predicting therapy response are urgently required.

Methods
Here, sera of 50 prospectively and consecutively included HCC patients undergoing 71 TACE therapies were taken before and 3 h, 6 h and 24 h after TACE application to analyze concentrations of circulating nucleosomes, cytokeratin-19 fragments (CYFRA 21-1), alpha fetoprotein (AFP), C-reactive protein (CRP) and several liver biomarkers, and to compare these with radiological response to therapy.

Results
While nucleosomes, CYFRA 21-1, CRP and some liver biomarkers increased already 24 h after TACE, percental changes of nucleosome concentrations before and 24 h after TACE and pre- and posttherapeutic values of AFP, gamma-glutamyl-transferase (GGT) and alkaline phosphatase (AP) significantly indicated the later therapy response (39 progression versus 32 no progression). In multivariate analysis, nucleosomes (24 h), AP (24 h) and TACE number were independent predictive markers. The risk score of this combination model achieved an AUC of 81.8% in receiver operating characteristic (ROC) curves and a sensitivity for prediction of non-response to therapy of 41% at 97% specificity, and of 72% at 78% specificity.

Conclusion
Circulating nucleosomes and liver markers are valuable tools for early estimation of the efficacy of TACE therapy in HCC patients.
Interleukin-11-induced capillary leak syndrome in primary hepatic carcinoma patients with thrombocytopenia
Authors: Kai-Feng Wang , Hong-Ming Pan , Hai-Zhou Lou , Li-Rong Shen , Xi-Yan Zhu 
Published: May 2011

Abstract

Background
Capillary leak syndrome (CLS) is a rare condition characterized by recurrent episodes of generalized edema and severe hypotension associated with hypoproteinemia. Interleukin-11 (IL-11) is a promising therapeutic agent for thrombocytopenia. A direct correlation between IL-11 and CLS has never been reported previously, particularly in patients with hepatic carcinoma.

Case presentation
We describe two cases of CLS after IL-11 administration in two males with thrombocytopenia. Case 1 was a 46-year-old man with recurrence of hepatic carcinoma who was treated with IL-11 (3 mg per day). After four days of therapy, hypotension and hypoproteinemia were detected. The chest X-ray and B ultrasound of the abdomen showed pleural effusion and ascites. IL-11 was then discontinued, fluid resuscitation was performed, and fresh frozen plasma and packed red blood cells were transfused into this patient. The patient had recovered after 19 days of treatment.
Case 2 was a 66-year-old man who had undergone radiofrequency ablation (RFA) for hepatic carcinoma. He was treated with IL-11 (3 mg per day) for thrombocytopenia. After two days of therapy, this patient complained of dyspnea with bilateral edema of the hands. Laboratory values showed hypoproteinemia. IL-11 was stopped and human albumin was transfused at a rate of 10 g per day. On the 4th day, fluid resuscitation was performed. The patient had recovered after treatment for two weeks.

Conclusions
The detection of IL-11-induced CLS supports the hypothesis that CLS could be a severe side effect of IL-11 treatment in some patients. These two case reports also demonstrate that patients with hepatic carcinoma who experience this rare form of CLS after treatment with IL-11 seem to respond to a therapeutic regimen that involves hydroxyethyl starch, albumin, and diuretic therapy. Liver cancer patients might be more susceptible to CLS because of poor liver function and hypersplenia. In addition, bleeding after RFA might be a further inducer of CLS.
Health-related quality of life in French adolescents and adults: norms for the DUKE Health Profile
Authors: Baumann Cédric , Erpelding Marie-Line , Perret-Guillaume Christine , Gautier Arnaud , Régat Stéphanie , Collin Jean-François , Guillemin Francis , Briançon Serge 
Published: May 2011

Abstract

Background
The continual monitoring of population health-related quality of life (HRQoL) with validated instruments helps public health agencies assess, protect, and promote population health. This study aimed to determine norms for the French adolescent and adult general population for the Duke Health Profile (DUKE) questionnaire in a large representative community sample.

Methods
We randomly selected 17,733 French people aged 12 to 75 years old in 2 steps, by households and individuals, from the National Health Barometer 2005, a periodic population study by the French National Institute for Prevention and Health Education. Quality of life and other data were collected by computer-assisted telephone interview.

Results
Normative data for the French population were analyzed by age, gender and self-reported chronic disease. Globally, function scores (best HRQoL=100) for physical, mental, social, and general health, as well as perceived health and self-esteem, were 72.3 (SEM 0.2), 74.6 (0.2), 66.8 (0.1), 71.3 (0.1), 71.3 (0.3), 76.5 (0.1), respectively. Dysfunction scores (worst HRQoL=100) for anxiety, depression, pain and disability domains were 30.9 (0.1), 27.6 (0.2), 34.3 (0.3), 3.1 (0.1), respectively.

Conclusion
The French norms for adolescents and adults for the DUKE could be used as a reference for other studies assessing HRQoL, for specific illnesses, in France and for international comparisons.
Crystal structure of alkyl hydroperoxidase D like protein PA0269 from Pseudomonas aeruginosa: Homology of the AhpD-like structural family
Authors: Clarke Teresa E , Romanov Vladimir , Chirgadze Yuri N , Klomsiri Chananat , Kisselman Gera , Wu-Brown Jean , Poole Leslie B , Pai Emil F , Chirgadze Nickolay Y 
Published: May 2011

Abstract

Background
Alkyl hydroperoxidase activity provides an important antioxidant defense for bacterial cells. The catalytic mechanism requires two peroxidases, AhpC and AhpD, where AhpD plays the role of an essential adaptor protein.

Results
The crystal structure of a putative AhpD from Pseudomonas aeruginosa has been determined at 1.9 Å. The protein has an all-helical fold with a chain topology similar to a known AhpD from Mycobacterium tuberculosis despite a low overall sequence identity of 9%. A conserved two α-helical motif responsible for function is present in both. However, in the P. aeruginosa protein, helices H3, H4 of this motif are located at the N-terminal part of the chain, while in M. tuberculosis AhpD, the corresponding helices H8, H9 are situated at the C-terminus. Residues 24-62 of the putative catalytic region of P. aeruginosa have a higher sequence identity of 33% where the functional activity is supplied by a proton relay system of five residues, Glu36, Cys48, Tyr50, Cys51, and His55, and one structural water molecule. A comparison of five other related hypothetical proteins from various species, assigned to the alkyl hydroperoxidase D-like protein family, shows they contain the same conserved structural motif and catalytic sequence Cys-X-X-Cys. We have shown that AhpD from P. aeruginosa exhibits a weak ability to reduce H2O2 as tested using a ferrous oxidation-xylenol orange (FOX) assay, and this activity is blocked by thiol alkylating reagents.

Conclusion
Thus, this hypothetical protein was assigned to the AhpD-like protein family with peroxidase-related activity. The functional relationship of specific oligomeric structures of AhpD-like structural family is discussed.
PKC isoforms interact with and phosphorylate DNMT1
Authors: Lavoie Geneviève , Estève Pierre-Olivier , Laulan Nathalie Bibens , Pradhan Sriharsa , St-Pierre Yves 
Published: May 2011

Abstract

Background
DNA methyltransferase 1 (DNMT1) has been shown to be phosphorylated on multiple serine and threonine residues, based on cell type and physiological conditions. Although recent studies have suggested that protein kinase C (PKC) may be involved, the individual contribution of PKC isoforms in their ability to phosphorylate DNMT1 remains unknown. The PKC family consists of at least 12 isoforms that possess distinct differences in structure, substrate requirement, expression and localization.

Results
Here we show that PKCα, βI, βII, δ, γ, η, ζ and μ preferentially phosphorylate the N-terminal domain of human DNMT1. No such phosphorylation of DNMT1 was observed with PKCε. Using PKCζ as a prototype model, we also found that PKC physically interacts with and phosphorylates DNMT1. In vitro phosphorylation assays conducted with recombinant fragments of DNMT1 showed that PKCζ preferentially phosphorylated the N-terminal region of DNMT1. The interaction of PKCζ with DNMT1 was confirmed by GST pull-down and co-immunoprecipitation experiments. Co-localization experiments by fluorescent microscopy further showed that endogenous PKCζ and DNMT1 were present in the same molecular complex. Endogenous PKCζ activity was also detected when DNMT1 was immunoprecipitated from HEK-293 cells. Overexpression of both PKCζ and DNMT1 in HEK-293 cells, but not of either alone, reduced the methylation status of genes distributed across the genome. Moreover, in vitro phosphorylation of DNMT1 by PKCζ reduced its methytransferase activity.

Conclusions
Our results indicate that phosphorylation of human DNMT1 by PKC is isoform-specific and provides the first evidence of cooperation between PKCζ and DNMT1 in the control of the DNA methylation patterns of the genome.
An interesting journey of an ingested needle: a case report and review of the literature on extra-abdominal migration of ingested Foreign bodies
Authors: Ozkan Zeynep , Kement Metin , Kargı Ahmet B , Censur Zafer , Gezen Fazli C , Vural Selahattin , Oncel Mustafa 
Published: May 2011

Abstract
Swallowed foreign bodies encounter a major problem especially in children, but fortunately they mostly do not cause any related complication and are easily passed with the stool. In this paper, an interesting journey of a needle is presented. A 20-year old female admitted to our emergency service after she had swallowed a sewing machine needle, which is initially observed in the stomach in the plain abdominal radiography. During the follow-up period, the needle traveled through bowels, and surprisingly was observed in the left lung on 10th day of the follow-up. It was removed with a thoracotomy and pneumotomy under the fluoroscopic guidance. The postoperative period was uneventful and the patient was discharged from the hospital on the day 5. We also review the literature on interesting extra-abdominal migrations of swallowing foreign bodies.
Recent advances in nanoparticle formulation of oleanolic acid
Authors: Chen Meiwan , Zhong Zhangfeng , Tan Wen , Wang Shengpeng , Wang Yitao 
Published: May 2011

Abstract
Oleanolic acid (OA) is a natural triterpenoid possessing anti-inflammatory, antitumor, antiviral, hepatoprotective and antihyperlipidemic effects. Research on the pharmacological activities and clinical applications of OA has made significant progress in the past decade, particularly in the areas such as isolation and purification, chemical modifications, pharmacological research, toxicity studies and clinical use of OA. However, due to its poor aqueous solubility, instability and low bioavailability, OA's clinical applications are still rather limited. Recently, nanoparticulate drug delivery as the biological dimension of nanotechnology has been developed, which may help generate useful formulations of OA for clinical applications. Nanoparticulate drug delivery system enhances the dissolution rate and bioavailability of OA, providing a feasible formulation method for clinical applications.
Path finding methods accounting for stoichiometry in metabolic networks
Authors: Pey Jon , Prada Joaquín , Beasley John E , Planes Francisco J 
Published: May 2011

AbstractGraph-based methods have been widely used for the analysis of biological networks. Their application to metabolic networks has been much discussed, in particular noting that an important weakness in such methods is that reaction stoichiometry is neglected. In this study, we show that reaction stoichiometry can be incorporated into path-finding approaches via mixed-integer linear programming. This major advance at the modeling level results in improved prediction of topological and functional properties in metabolic networks.
Suturing the Wound: Derrida's “on Forgiveness” And Schlink'sThe Reader
Authors: Worthington Kim L. 
Published: May 2011

This essay urges a reconsideration of Bernhard Schlink's The Reader and the familiar, if far from transparent, moral terminology of his admirers and detractors alike. It focuses on conceptions of forgiveness in particular, considering these through the lens of Jacques Derrida's essay “On Forgiveness”/“Le Siècle et le Pardon.” Derrida concedes his is a “mad” conception of forgiveness: “what there is to forgive must be, and must remain, unforgivable — such is the logical aporia.” He argues that losing sight of the impossible absolute (forgiveness that forgives the unforgivable) opens the rhetoric of “ordinary” forgiveness to personal and political abuse, to hypocrisy and calculation. Forgiveness might suture a wound, enabling healing and reconciliation, but its closure also ushers in, if not forgetting, an attenuation or weakening of the suffering of victims of unforgiveable crime and the silencing or appropriation of their voices.Contra critics who argue that Schlink offers an exculpatory, because explanatory, portrayal of his Nazi protagonist and second-generation German narrator, I argue that The Reader exposes the potential for abuse that characterizes the rhetoric of “ordinary” forgiveness. Schlink does not excuse his Nazi perpetrator or invite forgiveness of her, but rather portrays a narrator invested — personally and politically — in the process of exculpation. Reading The Reader alongside Derrida's essay enables reexamination of critical responses to the novel, invites consideration of the invested nature of forgiveness and the “work of mourning” that is reconciliation, and points us towards a better understanding of Derrida's conception of “pure” forgiveness, possible (only) as impossible.
Economic Impact of Clostridium difficile Infection in a Multihospital Cohort of Academic Health Centers
Authors: Pakyz Amy , Carroll Norman V. , Harpe Spencer E. , Oinonen Michael , Polk Ronald E. 
Published: May 2011

Study Objective. To assess the economic impact of Clostridium difficile infection (CDI) in a large multihospital cohort.Design. Retrospective case‐control study.Data Source. Administrative claims data from 45 academic medical centers.Patients. A total of 10,857 patients who developed health care‐associated CDI and were discharged between April 1, 2002, and March 31, 2007 (cases); each case patient was matched by hospital, age, quarter and year of hospital discharge, and diagnosis related group to at least one control patient who did not develop health care‐associated CDI (19,214 controls).Measurements and Main Results. Patients with health care‐associated CDI were identified by using a previously validated method combining the International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI with specific CDI drug therapy (oral or intravenous metronidazole, or oral vancomycin). Costs were determined from charges by using standardized cost:charges ratios and were adjusted for age, All Patient Refined‐Diagnosis Related Group (APR‐DRG) severity of illness level, race, and sex with use of multivariable linear regression. The adjusted mean cost for cases was significantly higher than that for controls ($55,769 vs $28,609), and adjusted mean length of stay was twice as long (21.1 vs 10.0 days). The interaction between CDI and APR‐DRG severity of illness level was significant; the effect of CDI on costs and length of stay decreased as severity of illness increased.Conclusion. This large CDI economic evaluation confirms that health care‐associated cases of CDI are associated with significantly higher mean cost and longer length of stay than those of matched controls, with the greatest effect on costs at the lowest level of severity of illness.
Induction Treatment with Rabbit Antithymocyte Globulin versus Basiliximab in Renal Transplant Recipients with Planned Early Steroid Withdrawal
Authors: Martin Spencer T. , Roberts Keri L. , Malek Sayeed K. , Tullius Stefan G. , Vadivel Nidyanandh , De Serres Sacha , Grafals Monica , Elsanjak Abdelaziz , Filkins Beth Anne , Chandraker Anil , Gabardi Steven 
Published: May 2011

Study Objective. To compare the safety and efficacy of rabbit antithymocyte globulin (r‐ATG) with basiliximab in renal transplant recipients for whom an early steroid withdrawal (ESW) regimen was planned.Design. Single‐center, retrospective, cohort study.Setting. Tertiary care medical center, including inpatient hospital stays and outpatient nephrology clinics.Patients. Ninety‐nine consecutive adult recipients of living‐ or deceased‐donor renal transplants between January 1, 2004, and December 31, 2007, in whom ESW was planned and who received either r‐ATG or basiliximab; patients receiving an extended‐criteria kidney donation or a donation after cardiac death were excluded.Measurements and Main Results. All patients received mycophenolate mofetil and tacrolimus as maintenance therapy with planned ESW. Induction therapy was either r‐ATG 1.5 mg/kg/day for 4 days (68 patients) or basiliximab 20 mg on postoperative days 0 and 4 (31 patients). The primary composite end point of biopsy‐proven acute rejection (BPAR), graft loss, and death occurred in 6 patients (9%) and 9 patients (29%) in the r‐ATG and basiliximab groups at 1 year after transplantation, respectively (p=0.01), with rates of 7% (5/68 patients) and 26% (8/31 patients) for BPAR (p=0.02), 0% and 3% (1/31 patients) for graft loss (p=0.31), and 2% (1/68 patients) and 0% for patient death (p>0.99). Average time to first BPAR was significantly longer in the r‐ATG group (mean ± SD 151.4 ± 82.9 vs 53.6 ± 68.4 days, p<0.01). Kidney function at 12 months was similar between the two groups.Conclusion. Rabbit‐ATG was associated with a lower frequency and delayed onset of BPAR compared with basiliximab in renal transplant recipients who received an ESW regimen.