bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lead Extraction in Pediatric and Congenital Heart Disease Patients
Authors: Cecchin Frank , Atallah Joseph , Walsh Edward P. , Triedman John K. , Alexander Mark E. , Berul Charles I. 
Published: August 2010

Background—
Transvenous pacemaker and defibrillator implantation is an expanding practice in pediatric and congenital heart disease patients, and given the finite longevity of current lead designs, lead extraction is an eventuality for a significant subset of these patients. Data on the safety and efficacy of different lead extraction techniques in this specific patient population are limited.

Methods and Results—

We report our experience from a single-center cohort study with a retrospective review of prospectively collected data on all lead extractions performed between January 2002 and December 2008. Lead extraction procedures involved a total of 144 patients and 203 leads. Of these, 61 patients (42%) were female and 86 (60%) had structural heart disease. Successful simple extraction, requiring the use of only a nonlocking stylet, was achieved in 59 (29%) leads. Of the remaining leads, 35 were abandoned and 109 underwent complex extraction techniques, including a radiofrequency-powered sheath used in 78 of 109 leads. Successful extraction was achieved in 80% (162/203) of all leads and 94% (103/109) of leads undergoing a complex extraction. On multivariable analysis, older lead age (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.48 to 0.82;
P
<0.0001), ventricular lead position (OR, 0.40; 95% CI, 0.20 to 0.79;
P
=0.015), and polyurethane insulation (OR, 0.34; 95% CI, 0.14 to 0.80;
P
=0.017) were found to be associated with a decreased likelihood of simple extraction. There were 4 major and 4 minor procedural complications involving 8 patients and no procedure-related deaths. On univariate analysis, lead age (OR, 1.28; 95% CI, 1.09 to 1.50;
P
=0.002) was the only factor associated with procedural complications.

Conclusions—
The majority of leads implanted in pediatric and congenital heart disease patients can be extracted successfully; however, the procedure carries a risk of serious complications. Older lead age, ventricular leads, and polyurethane insulation were independent predictors of the decreased likelihood of an extraction by simple traction.
Genes Within the MHC Region Have a Dramatic Influence on Radiation-Enhanced Atherosclerosis in Mice
Authors: Shi Weibin , Zhang Zhimin , Chen Mei-Hua , Angle John F. , Matsumoto Alan H. 
Published: August 2010

Background—

C3H/HeJ (C3H) mice develop much smaller atherosclerotic lesions than C57BL/6 (B6) mice when deficient in apolipoprotein E (apoE
−/−
) or fed an atherogenic diet. The 2 strains differ in H2 haplotypes, with B6 having H2
b
and C3H having H2
k
. C3.SW-H2
b
/SnJ (C3.SW) is a congenic strain of C3H/HeJ in which H2
k
is replaced with H2
b
.

Methods and Results—

We performed bone marrow transplantation and found that atherosclerosis-resistant C3.SW.apoE
−/−
mice reconstituted with bone marrow from either C3.SW.apoE
−/−
or B6.apoE
−/−
mice after lethal irradiation had significantly larger atherosclerotic lesions than B6.apoE
−/−
mice receiving identical treatments and much larger lesions than C3H.apoE
−/−
mice reconstituted with syngeneic bone marrow. For syngeneic transplantation, C3.SW.apoE
−/−
mice exhibited a 21-fold increase in lesion size over C3H.apoE
−/−
mice (152 800±21 937 versus 7060±2290 μm
2
/section) and a near 4-fold increase over B6.apoE
−/−
mice (40 529±4675 μm
2
/section). C3.SW.apoE
−/−
mice reconstituted with syngeneic marrow exhibited enhanced lesion formation relative to those reconstituted with B6 marrow (152 800±21 937 versus 107 000±9374 μm
2
/section;
P
=0.067). Sublethal irradiation led to a 6-fold increase of lesion size in C3.SW.apoE
−/−
mice (9795±2804 versus 1550±607 μm
2
/section;
P
=0.008). Wild-type C3.SW mice reconstituted with apoE
+/+
or apoE
−/−
bone marrow had significantly larger atherosclerotic lesions than C3H mice receiving identical treatments on an atherogenic diet.

Conclusions—
These results indicate that gene(s) within the H2 region have a dramatic impact on radiation-enhanced atherosclerosis, and their effect is conveyed partially through bone marrow–derived cells.
The Effects of Critical Thinking Instruction on Training Complex Decision Making
Authors: Helsdingen Anne S. , van den Bosch Karel , van Gog Tamara , van Merriënboer Jeroen J. G. 
Published: August 2010

Objective: Two field studies assessed the effects of critical thinking instruction on training and transfer of a complex decision-making skill. Background: Critical thinking instruction is based on studies of how experienced decision makers approach complex problems. Method: Participants conducted scenario-based exercises in both simplified (Study 1) and high-fidelity (Study 2) training environments. In both studies, half of the participants received instruction in critical thinking. The other half conducted the same exercises but without critical thinking instruction. After the training, test scenarios were administered to both groups. Results: The first study showed that critical thinking instruction enhanced decision outcomes during both training and the test. In the second study, critical thinking instruction benefited both decision outcomes and processes, specifically on the transfer to untrained problems. Conclusion:The results suggest that critical thinking instruction improves decision strategy and enhances understanding of the general principles of the domain. Application: The results of this study warrant the implementation of critical thinking instruction in training programs for professional decision makers that have to operate in complex and highly interactive, dynamic environments.
Successful clinical trial research in nursing homes: the Improving Decision-Making Study
Authors: Hanson Laura C , Gilliam Robin , Tae Joon Lee  
Published: August 2010

Background One in four Americans, and 70% of people who have dementia, will spend their final days in nursing home care. Clinical research, particularly clinical trials, rarely includes this population due to unique challenges in research methods and ethics. Families of advanced dementia patients make choices about tube feeding and other feeding options with limited access to information or communication. The cluster randomized trial, Improving Decision Making about Feeding Options for Dementia Patients, tests a decision aid intervention to improve the quality of decision making for this choice. Purpose Our objectives are (1) to describe the methods used in this trial; (2) to describe challenges and strategies for effective nursing home and nursing home resident recruitment and retention; and (3) to describe research ethics approaches to minimize harms and maximize benefits for this population. Methods The study is a cluster randomized trial of a decision aid to inform and support the choice between tube feeding and assisted oral feeding in advanced dementia. Study subjects are paired surrogate decision makers and residents with advanced dementia and feeding problems, enrolled from nursing homes in North Carolina. Results This trial enrolled 256 paired surrogate decision makers and residents in 24 nursing home sites, and 99% completed participation through the 3-month study period. The research team had prior clinical and investigative experience in this setting, and used multiple strategies to recruit and retain nursing home sites, providers, surrogates, and the residents for whom they spoke. Informed consent and human subjects’ protections were designed to address the vulnerability of this population. Limitations Cluster randomization was necessary to avoid contamination between control and intervention subjects, but may introduce confounding by site and intracluster correlation effects in analyses. Conclusions Strategies that facilitate nursing home recruitment, participant recruitment and protection of human subjects for a vulnerable population may be used by future investigators to expand the research evidence base for nursing home and dementia care. Clinical Trials 2010; 7: 735—743. http:// ctj.sagepub.com
Acquired genomic copy number aberrations and survival in adult acute myelogenous leukemia
Authors: Parkin Brian , Erba Harry , Ouillette Peter , Roulston Diane , Purkayastha Anjali , Karp Judith , Talpaz Moshe , Kujawski Lisa , Shakhan Sajid , Li Cheng , Shedden Kerby , Malek Sami N. 
Published: August 2010

AbstractGenomic aberrations are of predominant importance to the biology and clinical outcome of patients with acute myelogenous leukemia (AML), and conventional karyotype-based risk classifications are routinely used in clinical decision making in AML. One of the known limitations of cytogenetic analysis is the inability to detect genomic abnormalities less than 5 Mb in size, and it is currently unclear whether overcoming this limitation with high-resolution genomic single-nucleotide polymorphism (SNP) array analysis would be clinically relevant. Furthermore, given the heterogeneity of molecular mechanisms/aberrations that underlie the conventional karyotype-based risk classifications, it is likely that further refinements in genomic risk prognostication can be achieved. In this study, we analyzed flow cytometer–sorted, AML blast-derived, and paired, buccal DNA from 114 previously untreated prospectively enrolled AML patients for acquired genomic copy number changes and loss of heterozygosity using Affymetrix SNP 6.0 arrays, and we correlated genomic lesion load and specific chromosomal abnormalities with patient survival. Using multivariate analyses, we found that having ≥ 2 genomic lesions detected through SNP 6.0 array profiling approximately doubles the risk of death when controlling for age- and karyotype-based risk. Finally, we identified an independent negative prognostic impact of p53 mutations, or p53 mutations and 17p-loss of heterozygosity combined on survival in AML.
Down syndrome and GATA1 mutations in transient abnormal myeloproliferative disorder: mutation classes correlate with progression to myeloid leukemia
Authors: Kanezaki Rika , Toki Tsutomu , Terui Kiminori , Xu Gang , Wang RuNan , Shimada Akira , Hama Asahito , Kanegane Hirokazu , Kawakami Kiyoshi , Endo Mikiya , Hasegawa Daisuke , Kogawa Kazuhiro , Adachi Souichi , Ikeda Yasuhiko , Iwamoto Shotaro , Taga Takashi , Kosaka Yoshiyuki , Kojima Seiji , Hayashi Yasuhide , Ito Etsuro 
Published: August 2010

Abstract
Twenty percent to 30% of transient abnormal myelopoiesis (TAM) observed in newborns with Down syndrome (DS) develop myeloid leukemia of DS (ML-DS). Most cases of TAM carry somatic GATA1 mutations resulting in the exclusive expression of a truncated protein (GATA1s). However, there are no reports on the expression levels of GATA1s in TAM blasts, and the risk factors for the progression to ML-DS are unidentified. To test whether the spectrum of transcripts derived from the mutant GATA1 genes affects the expression levels, we classified the mutations according to the types of transcripts, and investigated the modalities of expression by in vitro transfection experiments using GATA1 expression constructs harboring mutations. We show here that the mutations affected the amount of mutant protein. Based on our estimates of GATA1s protein expression, the mutations were classified into GATA1s high and low groups. Phenotypic analyses of 66 TAM patients with GATA1 mutations revealed that GATA1s low mutations were significantly associated with a risk of progression to ML-DS (P < .001) and lower white blood cell counts (P = .004). Our study indicates that quantitative differences in mutant protein levels have significant effects on the phenotype of TAM and warrants further investigation in a prospective study.
Increasing outpatient treatment of mild community-acquired pneumonia: systematic review and meta-analysis
Authors: Chalmers J.D. , Akram A.R. , Hill A.T. 
Published: August 2010

In order to identify, synthesise and interpret the evidence relating to strategies to increase the proportion of low-risk patients with community-acquired pneumonia treated in the community, we conducted a systematic review of intervention studies conducted between 1981–2010.Articles were included if they compared strategies to increase outpatient care with usual care. Outcomes were: the proportion of patients treated as outpatients, mortality, hospital readmissions, health related quality of life, return to usual activities and patient satisfaction with care.The main analysis included six studies. The interventions in these studies were generally complex, but all involved the use of a severity score to identify low-risk patients. Overall, a significantly larger numbers of patients were treated in the community with these interventions (OR 2.31, 95% CI 2.03–2.63). The interventions appear safe, with no significant differences in mortality (OR 0.83, 95% CI 0.59–1.17), hospital readmissions (OR 1.08, 95% CI 0.82–1.42) or patient satisfaction with care (OR 1.21, 95% CI 0.97–1.49) between the intervention and control groups. There was insufficient data regarding quality of life or return to usual activities. All studies had significant limitations.The available evidence suggests that interventions to increase the proportion of patients treated in the community are safe, effective and acceptable to patients.
Increased expression of cysteine cathepsins in ovarian tissue from chickens with ovarian cancer
Authors: Ahn Suzie E , Choi Jin Won , Rengaraj Deivendran , Seo Hee Won , Lim Whasun , Han Jae Yong , Song Gwonhwa 
Published: August 2010

Abstract

Background
Cysteine cathepsins (CTSs) are involved in the degradation and remodeling of the extracellular matrix and are associated with cell transformation, differentiation, motility, and adhesion. These functions are also related to cancer cell invasion and metastasis. Chickens spontaneously develop epithelial ovarian cancer and are therefore a good animal model for human ovarian cancer. However, no studies have investigated the expression of CTSs in chickens with ovarian cancer.

Methods
Cancerous (n = 5) and normal (n = 3) ovaries were collected from 2-to 3-year-old hens, and ovarian tissue samples were collected for study. Ovarian cancers were evaluated with hematoxylin and eosin staining. Reverse transcriptase and quantitative PCR analyses, in situ hybridization analysis were performed to examine the mRNA expression pattern of three CTSs in detail, and protein expression of CTSB was evaluated.

Results
The CTSB, CTSC, and CTSS genes were highly expressed in cancerous chicken ovaries. Messenger RNAs for the three CTSs were localized to a nodule area, a major characteristic of cancerous ovaries, but the three CTSs showed no specific localization in normal ovaries. Immunoreactive CTSB protein was present in the nodule area of cancerous ovaries.

Conclusion
Our results suggest that CTSB, CTSC, and CTSS have important functions in the development of epithelial ovarian cancer.
A single dose of DNA vaccine based on conserved H5N1 subtype proteins provides protection against lethal H5N1 challenge in mice pre-exposed to H1N1 influenza virus
Authors: Chang Haiyan , Huang Chaoyang , Wu Jian , Fang Fang , Zhang Wenjie , Wang Fuyan , Chen Ze 
Published: August 2010

AbstractBackgroundHighly pathogenic avian influenza virus subtype H5N1 infects humans with a high fatality rate and has pandemic potential. Vaccination is the preferred approach for prevention of H5N1 infection. Seasonal influenza virus infection has been reported to provide heterosubtypic immunity against influenza A virus infection to some extend. In this study, we used a mouse model pre-exposed to an H1N1 influenza virus and evaluated the protective ability provided by a single dose of DNA vaccines encoding conserved H5N1 proteins.ResultsSPF BALB/c mice were intranasally infected with A/PR8 (H1N1) virus beforehand. Six weeks later, the mice were immunized with plasmid DNA expressing H5N1 virus NP or M1, or with combination of the two plasmids. Both serum specific Ab titers and IFN-γ secretion by spleen cells in vitro were determined. Six weeks after the vaccination, the mice were challenged with a lethal dose of H5N1 influenza virus. The protective efficacy was judged by survival rate, body weight loss and residue virus titer in lungs after the challenge. The results showed that pre-exposure to H1N1 virus could offer mice partial protection against lethal H5N1 challenge and that single-dose injection with NP DNA or NP + M1 DNAs provided significantly improved protection against lethal H5N1 challenge in mice pre-exposed to H1N1 virus, as compared with those in unexposed mice.ConclusionsPre-existing immunity against seasonal influenza viruses is useful in offering protection against H5N1 infection. DNA vaccination may be a quick and effective strategy for persons innaive to influenza A virus during H5N1 pandemic.
Aortic dissection associated with cogans's syndrome: deleterious loss of vascular structural integrity is associated with GM-CSF overstimulation in macrophages and smooth muscle cells
Authors: Weissen-Plenz Gabriele , Sezer Ömer , Vahlhaus Christian , Robenek Horst , Hoffmeier Andreas , Tjan Tonny DT , Scheld Hans H , Sindermann Jürgen R 
Published: August 2010

Abstract

Background
Cogan's syndrome is a rare disorder of unknown origin characterized by inflammatory ocular disease and vestibuloauditory symptoms. Systemic vasculitis is found in about 10% of cases.

Case presentation
A 46-year-old female with Cogans's syndrome and a history of arterial hypertension presented with severe chest pain caused by an aneurysm of the ascending aorta with a dissection membrane located a few centimeters distal from the aortic root. After surgery, histopathological analysis revealed that vascular matrix integrity and expression of the major matrix molecules was characterized by elastolysis and collagenolysis and thus a dramatic loss of structural integrity. Remarkably, exceeding matrix deterioration was associated with massively increased levels of granulocyte macrophage colony stimulating factor (GM-CSF).

Conclusion
Our data suggest that the persistently increased secretion of the inflammatory mediator GM-CSF by resident inflammatory cells but also by SMC may be the trigger of aortic wall structural deterioration.
Respecting Patient Autonomy: Understanding the Impact on Nhs Hospital In-Patients of Legislation and Guidance Relating to Patient Capacity and Consent
Authors: Redley Marcus , Keeley Helen , Clare Isabel , Hinds Dianne , Luke Lydia , Holland Anthony 
Published: August 2010

Objectives To determine the extent and nature of the decisions individuals are asked to make as in-patients, and whether doctors, nurses, other health care practitioners, and housekeepers engaged in routine (non-emergency) medical assessments, investigations and treatments, or acts of personal care observe the Reference Guide to Consent for Examination or Treatment, the principles of the Mental Capacity Act (England and Wales) 2005, and the guidance from the Dignity in Care Campaign. Methods Hospital staff working on a general medical ward and a ward for older people in a large teaching hospital in England were observed for over 50 hours carrying out acts of medical and personal care. The observations were recorded using a semi-structured record sheet, complemented by unstructured field notes. Observations were subsequently categorized, coded and counted. Results A total of 206 acts were observed, 127 (62%) of which were acts of medical care and 79 (38%) were acts of personal care. Patients approached for acts of personal care were generally presented with choices and options (78%). In contrast, when approached for acts of medical care, they were rarely presented with a choice (6%); instead, health care practitioners either requested permission to perform a procedure (29%) or informed patients that they were about to perform a procedure (50%). Irrespective of the way in which health care practitioners approached patients about acts of medical care, in the overwhelming majority of instances, patients complied (80%, 99 cases), either by giving permission for the act to be performed, or by complying and/or cooperating with the health care practitioner. In only a minority of cases did patients either refuse or resist a proposed procedure (9%). Conclusions Patients were asked to make many varied decisions and the approaches taken by hospital staff differed depending on the nature of the decision and/or act in question. In contrast to personal care decisions, when health care practitioners approached patients in order to undertake routine acts of medical care, they generally did so in a manner that did not acknowledge that the patient had a right to exercise a choice. This is contrary to current law, policy and guidance. It seems to be rooted in the practical demands of running a hospital ward and uncertainties as to the purpose of securing patient consent before undertaking routine acts of medical care.
Health care blogs: Finding, creating, examples
Authors: Wright Kath , Harden Melissa , Light Kate , Stirk Lisa , Wright Kath 
Published: August 2010

Blogs are one of the new Web 2 tools that allow people to contribute to the Internet either by creating their own web pages or by commenting on other people's, without needing access to sophisticated software and technology. Typical features of a blog (or web log) include regular updating, chronological presentation of entries, an archive of older material, the facility for adding comment and a list of links to other websites (blogroll). Some blogs act as online diaries with personal opinions while others comment on a specific topic. Blogs can offer an alternative, less formal source of information about recent news events and current affairs that could be useful to health services researchers. This edition of ‘What's on the web’ helps you identify relevant blogs, create your own blog and reviews two blogs that focus on health services. If you would like to alert readers to useful web pages or suggest topics for this column, please send details to:
Quantification of Fetal DNA by Use of Methylation-Based DNA Discrimination
Authors: Nygren Anders OH , Dean Jarrod , Jensen Taylor J , Kruse Selena , Kwong William , van den Boom Dirk , Ehrich Mathias 
Published: August 2010

BACKGROUNDDetection of circulating cell-free fetal nucleic acids in maternal plasma has been used in noninvasive prenatal diagnostics. Most applications rely on the qualitative detection of fetal nucleic acids to determine the genetic makeup of the fetus. This method leads to an analytic dilemma, because test results from samples that do not contain fetal DNA or are contaminated with maternal cellular DNA can be misleading. We developed a multiplex approach to analyze regions that are hypermethylated in placenta relative to maternal blood to evaluate the fetal portion of circulating cell-free DNA isolated from maternal plasma.METHODSThe assay used methylation-sensitive restriction enzymes to eliminate the maternal (unmethylated) fraction of the DNA sample. The undigested fetal DNA fraction was then coamplified in the presence of a synthetic oligonucleotide to permit competitive PCR. The amplification products were quantified by single-base extension and MALDI-TOF MS analysis.RESULTSUsing 2 independent markers, (sex determining region Y)-box 14 (SOX14) and T-box 3 (TBX3), we measured a mean of 151 copies of fetal DNA/mL plasma and a mean fetal fraction of 0.13 in samples obtained from pregnant women. We investigated 242 DNA samples isolated from plasma from pregnant and nonpregnant women and observed an analytical sensitivity and specificity for the assay of 99% and 100%, respectively.CONCLUSIONSBy investigating several regions in parallel, we reduced the measurement variance and enabled quantification of circulating cell-free DNA. Our results indicate that this multiplex methylation-based reaction detects and quantifies the amount of fetal DNA in a sample isolated from maternal plasma.