bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pituitary adenomas in childhood and adolescence
Authors: Partington Michael D. , Davis Dudley H. , Laws Edward R. , Scheithauer Bernd W. 
Published: May 2009

✓ Pituitary adenomas are uncommon in childhood. Between 1975 and 1988, 36 patients underwent trans-sphenoidal resection at the Mayo Clinic before their 17th birthday. Fifteen (41.7%) had prolactin (PRL)-secreting tumors, 16 (44.4%) had adrenocorticotropic hormone (ACTH)-secreting tumors (including two patients with Nelson-Salassa syndrome), and three (8.3%) had tumors secreting growth hormone (GH); two patients (5.6%) had clinically nonfunctioning tumors. Of the 36 patients, 21 (58.3%) were girls, and girls predominated in every group except that with ACTH-secreting tumors, where they accounted for only 37.5% of the patients. The average age at the time of surgery was 14.7 ± 2.2 years, the youngest patient being 7.3 years old. The ACTH-secreting tumors were associated with an earlier onset of symptoms than the other tumor types: six (37.5%) of 16 patients became symptomatic before 10 years of age, compared with two (10.0%) of the 20 other patients. Presenting symptoms primarily reflected endocrine dysfunction, with neurological presentation (visual field deficits) occurring in only two patients.There were no deaths in this patient group. Significant operative morbidity included steroid-induced psychosis in one patient and diabetes insipidus in three, which resolved in two. Plurihormonal tumors, broadly defined as tumors producing more than one hormone, were common, comprising five (36%) of 14 PRL-secreting tumors, all three GH-secreting tumors, and one of two clinically nonfunctioning tumors, or 25.7% overall. Macroadenomas accounted for 89% of plurihormonal tumors. Long-term follow-up review (median > 5 years) revealed good control of PRL-secreting tumors (although five of 15 patients had received postoperative radiotherapy), contrasted with a 25% late recurrence rate for ACTH-secreting tumors, which had an 80% initial remission rate. The majority of patients had good endocrine function, including reproductive function. It is concluded that: 1) although pediatric pituitary adenomas occur primarily in adolescence, Cushing's disease is found at any age; 2) transsphenoidal surgery is feasible and safe in this age group; 3) plurihormonal tumors occur more frequently in the pediatric age group than in adults; and 4) long-term control rates in PRL- and ACTH-secreting tumors are probably similar to those seen in adults.
A new model of diffuse brain injury in rats
Authors: Abd-Elfattah Foda Montasser A. , Marmarou Anthony 
Published: May 2009

✓ A new model producing diffuse brain injury, without focal brain lesions, has been developed in rats. This has been achieved by allowing a weight of 450 gm to fall onto a metallic disc fixed to the intact skull of the animal which is supported by a foam bed. Two levels of injury were examined by adjusting the height of the falling weight to either 1 m or 2 m. Two groups of animals were studied. Group 1 animals were separated into three subgroups: 10 received a 1-m weight drop, 58 received a 2-m weight drop, and 13 served as controls; all were allowed to breathe spontaneously. Group 2 animals were separated into the same subgroups: four received a 1-m weight drop, six received a 2-m weight drop, and four served as controls; all of these were mechanically ventilated during the procedure. In Group 1, morphological studies using light and electron microscopy were performed at 1, 6, 24, or 72 hours, or 10 days after insult; all Group 2 rats were studied at 24 hours after injury.Results from Group 1 animals showed that no mortality occurred with the 1-m level injury, while 59% mortality was seen with the 2-m level injury. On the other hand, no mortality occurred in Group 2 animals regardless of the level of trauma induced. However, the morphological changes observed in both groups were similar. Gross pathological examination did not reveal any supratentorial focal brain lesion regardless of the severity of the trauma. Petechial hemorrhages were noticed in the brain stem at the 2-m level injury. Microscopically, the model produced a graded widespread injury of the neurons, axons, and microvasculature. Neuronal injury was mainly observed bilaterally in the cerebral cortex. Brain edema, in the form of pericapillary astrocytic swelling, was also noted in these areas of the cerebral cortex and in the brain stem. Most importantly, the trauma resulted in a massive diffuse axonal injury that primarily involved the corpus callosum, internal capsule, optic tracts, cerebral and cerebellar peduncles, and the long tracts in the brain stem. It is concluded that this model would be suitable for studying neuronal, axonal, and vascular changes associated with diffuse brain injury.
Study of Understanding Pharmacists' Perspectives on Remuneration and Transition toward Chronic Disease Management (SUPPORT-CDM): Results of an Alberta-Wide Survey of Community Pharmacists
Authors: Mah Ellen , Rosenthal Meagen , Tsuyuki Ross T. 
Published: May 2009

Background: Strong evidence supports the benefits of pharmacist intervention and chronic disease management (CDM) for patients, yet most pharmacists are not providing such services. The purpose of this study was to better understand pharmacists' perceptions of CDM and potential remuneration models. Methods: We developed and tested a web-based survey based on the issues identified in a series of focus groups involving pharmacists: current practice setting, education, remuneration models, current practice environment and implementation. An invitation to complete the survey was e-mailed to registered pharmacists and was included in a weekly newsletter to Alberta pharmacists in January 2008, with 3 subsequent reminders to complete the survey. Results: Responses from 140 pharmacists were included. Pharmacists were most interested in providing CDM for diabetes (79%), although only 49% were presently comfortable with managing diabetes. The top enablers for provision of CDM included pharmacists' desire to change their scope of practice, a supportive work environment and patient demand. The top barriers included a lack of time to engage in CDM, lack of remuneration and staffing issues. Interestingly, relatively few identified pharmacists' resistance to change and difficulty finding eligible patients (38% and 25%, respectively) as important barriers. The majority of pharmacists agreed that payment should be shared between the pharmacy and the pharmacist as a fee-for-service. The average amount pharmacists expected for this model was $44.23/service. Conclusions: Pharmacists showed interest but may lack the confidence to provide CDM services to patients. Many of the facilitators and barriers point toward the need for a sustainable remuneration model for pharmacists' clinical care. We plan to use these results to help develop such a model.
Rheumatoid Atlantoaxial Subluxation Can Be Prevented by Intensive Use of Traditional Disease Modifying Antirheumatic Drugs
Authors: KAUPPI MARKKU J. , NEVA MARKO H. , LAIHO KARI , KAUTIAINEN HANNU , LUUKKAINEN REIJO , KARJALAINEN ANNA , HANNONEN PEKKA J. , LEIRISALO-REPO MARJATTA , KORPELA MARKKU , ILVA KIRSTI , MÖTTÖNEN TIMO ,   for the FIN-RACo Trial Group
Published: May 2009

Objective.To evaluate the 5-year incidence of cervical spine disorders in patients with early rheumatoid arthritis (RA) treated by 2 different disease modifying antirheumatic drug (DMARD) strategies.Methods.In a national, multicenter, prospective FIN-RACo-trial, a cohort of 199 patients with early, clinically active RA was randomly assigned to treatment with a combination of 3 DMARD and prednisolone (Combi group) or with a single DMARD (Single group) with or without prednisolone, aiming to induce remission. After 2 years, the DMARD therapy was unrestricted. Lateral view cervical spine radiographs during full flexion and extension were taken at the 5-year followup visits. The presence of anterior atlantoaxial subluxation (aAAS), atlantoaxial impaction (AAI), and subaxial subluxation (SAS) was assessed in the 149 patients with radiographs available (80 Single and 69 Combi).Results.At the 5-year visits, aAAS, AAI, and SAS were found in 13 (9%), 6 (4%), and 9 (6%) patients, respectively. The corresponding Single/Combi group ratios were 11/2, 5/1, and 5/4. Of the baseline data, only poor physical function [Health Assessment Questionnaire (HAQ); p = 0.024] and Single treatment strategy (p = 0.019) were significantly associated with aAAS. Worse HAQ scores and Disease Activity Score 28 values were found in patients who developed aAAS during the 5-year followup.Conclusion.RA patients with sustained clinical disease activity and poor HAQ are at increased risk of developing aAAS. The development of aAAS during the first 5 years of RA was rare among the patients treated with a combination of DMARD for at least 2 years from the diagnosis. Intensive treatment with traditional DMARD prevents or retards the development of aAAS in patients with recentonset RA.
The Minimally Important Difference for the Health Assessment Questionnaire in Rheumatoid Arthritis Clinical Practice Is Smaller Than in Randomized Controlled Trials
Authors: POPE JANET E. , KHANNA DINESH , NORRIE DEBORAH , OUIMET JANINE M. 
Published: May 2009

Objective.Patient-reported outcomes are used in clinical practice and trials. We studied a large clinical practice to determine the minimally important difference (MID) estimates for (1) the Health Assessment Questionnaire–Damage Index (HAQ-DI): improvement and worsening using patient global assessment anchor; and (2) pain using a patient-reported pain anchor.Methods.Patients with rheumatoid arthritis (RA; N = 225) had clinic visits at 2 timepoints within 1 year, completed the HAQ-DI and pain visual analog scale (VAS; 0–100 mm), and answered the question, “How would you describe your overall status/overall pain since the last visit?”, as much worsened, somewhat worsened, the same, somewhat improved, or much improved. If rated as somewhat improved or worsened, they were defined as the minimally changed subgroups.Results.Eighty-three percent were women, mean age 60 years, with disease duration 11.7 ± 10.7 years. The baseline HAQ-DI was 0.97 ± SD 0.76, and at followup 1.0 ± 0.77 (mean change +0.03 ± 0.40). The baseline pain VAS was 42.3 ± 28.8, and at followup 38.5 ± 27.9 (mean change −2.8 ± 25.9). The mean (SD) HAQ-DI change score was −0.09 (0.42) for somewhat improved and 0.15 (0.33) for somewhat worsened. The HAQ-DI change for somewhat/much better was −0.20 ± 0.52, and for somewhat/much worse +0.21 ± 0.33. For pain, somewhat improved changed by −11.9 mm on the VAS, and somewhat worsened by 6.8 mm. Estimates for HAQ-DI and pain were larger than the for no-change group, 0.03 (0.32) and −3.2 (20.9).Conclusion.The MID for HAQ-DI in clinical practice is smaller than it is in trials. This may have implications for observational studies and clinical care.
Access to Pediatric Rheumatology Subspecialty Care in British Columbia, Canada
Authors: SHIFF NATALIE J. , ABDWANI REEM , CABRAL DAVID A. , HOUGHTON KRISTIN M. , MALLESON PETER N. , PETTY ROSS E. , ESPINOSA VICTOR M. , TUCKER LORI B. 
Published: May 2009

Objective.Early recognition and treatment of pediatric rheumatic diseases is associated with improved outcome. We documented access to pediatric rheumatology subspecialty care for children in British Columbia (BC), Canada, referred to the pediatric rheumatology clinic at BC Children’s Hospital, Vancouver.Methods.An audit of new patients attending the outpatient clinic from May 2006 to February 2007 was conducted. Parents completed a questionnaire through a guided interview at the initial clinic assessment. Referral dates were obtained from the referral letters. Patients were classified as having rheumatic disease, nonrheumatic disease, or a pain syndrome based on final diagnosis by a pediatric rheumatologist.Results.Data were collected from 124 of 203 eligible new patients. Before pediatric rheumatology assessment, a median of 3 healthcare providers were seen (range 1–11) for a median of 5 visits (range 1–39). Overall, the median time interval from symptom onset to pediatric rheumatology assessment was 268 days (range 13–4989), and the median time interval from symptom onset to referral to pediatric rheumatology was 179 days (range 3–4970). Among patients ultimately diagnosed with rheumatic diseases (n = 53), there was a median of 119 days (range 3–4970) from symptom onset to referral, and 169 days (range 31–4989) from onset to pediatric rheumatology assessment.Conclusion.Children and adolescents with rheumatic complaints see multiple care providers for multiple visits before referral to pediatric rheumatology, and there is often a long interval between symptom onset and this referral.
Angiotensin-Converting Enzyme Gene Does Not Contribute to Genetic Susceptibility to Systemic Sclerosis in European Caucasians
Authors: WIPFF JULIEN , GALLIER GUILLAUME , DIEUDE PHILIPPE , AVOUAC JEROME , TIEV KIET , HACHULLA ERIC , GRANEL BRIGITTE , DIOT ELISABETH , SIBILIA JEAN , MOUTHON LUC , MEYER OLIVIER , KAHAN ANDRE , VARRET MATHILDE , BOILEAU CATHERINE , ALLANORE YANNICK 
Published: May 2009

Objective.To determine whether angiotensin-converting enzyme (ACE) polymorphisms including I/D and 2 single-nucleotide polymorphisms (SNP) affect susceptibility to systemic sclerosis (SSc) in a large French Caucasian population.Methods.A case-control study was performed in 494 patients with SSc and 280 healthy controls for I/D polymorphism. Two supplementary exonic SNP of ACE gene (rs4309, rs4362) were genotyped in 659 patients with SSc and 511 matched healthy controls. Among the whole SSc population, 453 (67%) patients with SSc had the limited cutaneous subtype, 47 (7%) had precapillary pulmonary arterial hypertension, 209 (32%) had digital ulcers, and 10 (1.5%) had renal crisis. A combined analysis of the available results for ACE I/D genotypes in Caucasians was also performed.Results.There was no association between the 3 polymorphic markers and SSc for allelic and genotype frequencies. No association was observed for the different vascular subsets of the disease. Haplotype analyses did not detect any association. The lack of association for ACE I/D was confirmed by the combined analysis.Conclusion.These results in a large cohort of European Caucasian patients with SSc do not support that the ACE gene is implicated in the pathogenesis of SSc and its vascular damage.
Low Molecular Weight Heparin and Aspirin for Recurrent Pregnancy Loss: Results from the Randomized, Controlled HepASA Trial
Authors: LASKIN CARL A. , SPITZER KAREN A. , CLARK CHRISTINE A. , CROWTHER MARK R. , GINSBERG JEFF S. , HAWKER GILLIAN A. , KINGDOM JOHN C. , BARRETT JON , GENT MICHAEL 
Published: May 2009

Objective.To compare live birth rates in women with recurrent pregnancy loss (RPL) and either autoantibodies or a coagulation abnormality, treated with low molecular weight heparin plus aspirin (LMWH/ASA) or ASA alone, and to place our results in context with other randomized clinical trials (RCT) with similar cohorts.Methods.The HepASA Trial was an RCT including patients with a history of RPL and at least 1 of the following: antiphospholipid antibody (aPL), an inherited thrombophilia, or antinuclear antibody. Treatment groups were stratified by aPL status and history of early versus late pregnancy losses. Patients received either LMWH/ASA or ASA alone. The primary outcome was live birth; secondary outcomes included adverse events and bone loss at the spine and femoral neck. Literature over the past 20 years was reviewed to identify comparable RCT.Results.Over 4 years, 859 women with RPL were screened: 88 (10.2%) fulfilled inclusion criteria, became pregnant and were randomized to receive either LMWH/ASA or ASA alone. aPL were present in 42 (47.7%) patients in each group. The trial was stopped after 4 years when an interim analysis showed no difference in live birth rates in the 2 groups, and a lower rate of pregnancy loss in the ASA only group than expected. In the LMWH/ASA group, 35/45 (77.8%) had a live birth versus 34/43 (79.1%) in the ASA only group (p = 0.71). Neither number of prior losses nor aPL status was correlated with pregnancy outcome. There were no cases of pregnancy related thrombosis in either group. Mean change in BMD did not differ by treatment group at either the lumbar spine (p = 0.57) or femoral neck (p = 0.15). RCT since 2000 for aPL positive women with RPL and similar inclusion criteria report a mean live birth rate of 75% with either LMWH or ASA.Conclusion.LMWH/ASA did not confer incremental benefit compared to ASA alone for this population. Regardless of treatment regimen, number of prior losses, or aPL positivity, almost 80% of women in our RPL cohort had a successful pregnancy outcome. These findings contribute to a growing body of literature that contests the emerging standard of care comprising LMWH/ASA for this population.
Simultaneous determination of anti‐diabetes/anti‐obesity drugs by LC/PDA, and targeted analysis of sibutramine analog in dietary supplements by LC/MS/MS
Authors: Kim So Hyun , Lee Jeongmi , Yoon Taehyung , Choi Jangduck , Choi Dongmi , Kim Deukjoon , Kwon Sung Won 
Published: May 2009

AbstractThe safety of dietary supplements is questionable as there have been occasional reports of products contaminated with illegal adulterants. The present study was carried out to develop trustworthy methodologies to screen for six anti‐diabetic drugs (phenformin, rosiglitazone, glipizide, glimepiride, glybenclamide and gliclazide) and six anti‐obesity drugs (ephedrine, fenfluramine, T3, T4, fluoxetine and sibutramine) in dietary supplements. A simultaneous determination method of the 12 drugs by liquid chromatography coupled with a photodiode array (LC/PDA) was established and was validated for linearity (r2 > 0.99), precision (RSD <13.3%), recoveries (88.8–115.9%) and reproducibility. Sibutramine and its analogs, N‐desmethylsibutramine, were subject to further investigation by LC/MS/MS because they were one of the major illegal adulterants. Our proposed method to monitor illegal drug adulterations in dietary supplements using LC/PDA is a simple and reliable, and therefore applicable to routine drug‐adulteration screening. Copyright © 2009 John Wiley & Sons, Ltd.
Radiosensitivity translates into excellent local control in extremity myxoid liposarcoma
Authors: Chung Peter W. M. , Deheshi Benjamin M. , Ferguson Peter C. , Wunder Jay S. , Griffin Anthony M. , Catton Charles N. , Bell Robert S. , White Lawrence M. , Kandel Rita A. , O'Sullivan Brian 
Published: May 2009

AbstractBACKGROUND:Myxoid liposarcoma has been reported to be more radiosensitive compared with other soft tissue sarcomas (STS). The authors report the results of multidisciplinary treatment of extremity myxoid liposarcoma compared with a contemporary cohort of other STS subtypes with an emphasis on the role of radiotherapy (RT) in improving local control.METHODS:Between 1989 and 2004, 691 patients were identified from a prospective STS database who underwent combined management for localized extremity STS and were followed for a minimum of 12 months or until death. All patients underwent surgery together with pre or postoperative RT, depending on their presenting characteristics and resection margins. Demographics and outcomes were compared between patients with myxoid liposarcoma and other STS subtypes (other‐STS).RESULTS:Of 691 patients, 88 patients had myxoid liposarcoma and 603 had other STS subtypes (other‐STS). Median age was 48 and 60 years for the myxoid liposarcoma and other‐STS groups, respectively. Median follow‐up was 86 and 61 months, respectively. For myxoid liposarcoma and other‐STS groups, preoperative RT was used in 57% versus 61% of patients and postoperative RT in 43% versus 39%, respectively. The 5‐year local recurrence‐free survival was 97.7% for patients with myxoid liposarcoma compared with 89.6% for patients with other‐STS tumors (P = .008). High‐grade tumors were present in 7% and 59% of myxoid liposarcoma and other‐STS patients, respectively (P = .0003). Two myxoid liposarcoma patients with local recurrence had positive resection margins, whereas only 33% of patients in the other‐STS group who developed a local recurrence had positive resection margins. No patients with myxoid liposarcoma required amputation as primary management, whereas 8 (1.3%) required amputation as primary management in the other‐STS group. Systemic disease control was superior in myxoid liposarcoma compared with other‐STS patients, with 5‐year overall and metastasis‐free survival rates of 93.9% versus 76.4% (P = .0008) and 89.1% versus 66.0% (P = .0001) respectively. Of 12 myxoid liposarcoma patients with distant metastases, 7 appeared in nonpulmonary sites. In comparison, 205 (34%) patients with other‐STS tumors developed systemic disease but 78% had pulmonary metastases.CONCLUSIONS:Multidisciplinary management of extremity STS achieves high rates of local control. Myxoid liposarcoma is associated with higher rates of local control compared with other STS subtypes, after combined surgery and radiation, suggesting a particular radiosensitivity that can be exploited to improve oncologic outcome in appropriate cases. Cancer 2009. © 2009 American Cancer Society.
Gemcitabine and oxaliplatin combination chemotherapy for metastatic well‐differentiated neuroendocrine carcinomas
Authors: Cassier Philippe A. , Walter Thomas , Eymard Beatrice , Ardisson Philippe , Perol Maurice , Paillet Carole , Chayvialle Jean‐Alain , Scoazec Jean‐Yves , Hervieu Valerie , Bohas Catherine Lombard 
Published: May 2009

AbstractBACKGROUND:Beyond the usual regimens based on streptozocin and doxorubicin or 5‐fluorouracil, no second‐line therapy of metastatic neuroendocrine tumor has gained wide acceptance. Gemcitabine and oxaliplatin are generally well tolerated and have shown activity against a wide range of malignancies. The authors assessed the efficacy of gemcitabine‐oxaliplatin combination (GEMOX) in the treatment of patients with metastatic neuroendocrine tumors.METHODS:Twenty consecutive patients with progressive disease were treated with GEMOX, in most cases after failure of other chemotherapy regimens (median = 2). Patients were followed for evidence of toxicity, response, and survival. Two patients were chemotherapy‐naive at treatment initiation and were excluded from the efficacy analysis.RESULTS:Toxicity was manageable overall; however, 6 (30%) patients had to discontinue treatment because of oxaliplatin‐induced neurotoxicity (grade 2). Three (17%) of 18 patients had a partial response, median progression‐free survival was 7.0 months, and median overall survival was 23.4 months.CONCLUSIONS:Gemcitabine‐oxaliplatin combination shows interesting activity and is well tolerated in pretreated patients with neuroendocrine tumors. Cancer 2009. © 2009 American Cancer Society.