bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diffuse bronchiolitis pattern on a computed tomography scan as a presentation of pulmonary tumor thrombotic microangiopathy: a case report
Authors: Guimarães Marcos Duarte , Almeida Maria Fernanda Arruda , Brelinger André , Barbosa Paula Nicole , Chojniak Rubens , Gross Jefferson Luiz 
Published: December 2011

Abstract

Introduction
Pulmonary tumor thrombotic microangiopathy is a rare complication of malignant diseases. The diagnosis is extremely difficult and is most often performed after death. Invariably, patients develop acute pulmonary hypertension causing right heart failure, shortness of breath and death in a few days. We describe the clinical and radiological findings of a patient who presented with this complication.

Case presentation
A 28-year-old Caucasian woman with a previous history of pelvic tumor resection two months previously, suggestive of metastatic adenocarcinoma, presented with intense shortness of breath. A computed tomography scan showed signs of acute cor pulmonale and diffuse nodular opacities associated with a tree-in-bud pattern disseminated through her lungs, suggestive of bronchiolitis. Our patient's condition worsened and she underwent a surgical biopsy. Pathologic analysis of the biopsied specimens revealed pulmonary tumor thrombotic microangiopathy. Our patient's tumor evolved from a gastric origin (Krukenberg tumor). She underwent progressive clinical deterioration and died less than 24 hours after the biopsy. None of the cases described previously in the literature had diffuse centrilobular nodular opacities associated with a tree-in-bud pattern disseminated through the lungs, as in our case.

Conclusion
Pulmonary tumor thrombotic microangiopathy should be considered in cancer patients with rapidly progressing dyspnea, chest computed tomography findings compatible with pulmonary hypertension and typical findings of inflammatory bronchiolitis.
2011 German Escherichia coli O104:H4 outbreak: whole-genome phylogeny without alignment
Authors: Cheung Man-Kit , Li Lei , Nong Wenyan , Kwan Hoi-Shan 
Published: December 2011

Abstract

Background
A large-scale Escherichia coli O104:H4 outbreak occurred in Germany from May to July 2011, causing numerous cases of hemolytic-uremic syndrome (HUS) and deaths. Genomes of ten outbreak isolates and a historical O104:H4 strain isolated in 2001 were sequenced using different new generation sequencing platforms. Phylogenetic analyses were performed using various approaches which either are not genome-wide or may be subject to errors due to poor sequence alignment. Also, detailed pathogenicity analyses on the 2001 strain were not available.

Findings
We reconstructed the phylogeny of E. coli using the genome-wide and alignment-free feature frequency profile method and revealed the 2001 strain to be the closest relative to the 2011 outbreak strain among all available E. coli strains at present and confirmed findings from previous alignment-based phylogenetic studies that the HUS-causing O104:H4 strains are more closely related to typical enteroaggregative E. coli (EAEC) than to enterohemorrhagic E. coli. Detailed re-examination of pathogenicity-related virulence factors and secreted proteins showed that the 2001 strain possesses virulence factors shared between typical EAEC and the 2011 outbreak strain.

Conclusions
Our study represents the first attempt to elucidate the whole-genome phylogeny of the 2011 German outbreak using an alignment-free method, and suggested a direct line of ancestry leading from a putative EAEC-like ancestor through the 2001 strain to the 2011 outbreak strain.
Continuous controlled-infusion of hypertonic saline solution in traumatic brain-injured patients: a 9-year retrospective study
Authors: Roquilly Antoine , Mahe Pierre Joachim , Latte Dominique Demeure Dit , Loutrel Olivier , Champin Philippe , Di Falco Christelle , Courbe Athanase , Buffenoir Kevin , Hamel Olivier , Lejus Corinne , Sebille Véronique , Asehnoune Karim 
Published: December 2011

Abstract
Introduction
Description of a continuous hypertonic saline solution (HSS) infusion using a dose-adaptation of natremia in traumatic brain injured (TBI) patients with refractory intracranial hypertension (ICH).

Methods
We performed a single-center retrospective study in a surgical intensive care unit of a tertiary hospital. Fifty consecutive TBI patients with refractory ICH treated with continuous HSS infusion adapted to a target of natremia. In brief, a physician set a target of natremia adapted to the evolution of intracranial pressure (ICP). Flow of NaCl 20% was a priori calculated according to natriuresis, and the current and target natremia that were assessed every 4 hours.

Results
The HSS infusion was initiated for a duration of 7 (5 to 10) (8 ± 4) days. ICP decreased from 29 (26 to 34) (31 ± 9) mm Hg at H0 to 20 (15 to 26) (21 ± 8) mm Hg at H1 (P < 0.05). Cerebral perfusion pressure increased from 61 (50 to 70) (61 ± 13) mm Hg at H0 up to 67 (60 to 79) (69 ± 12) mm Hg at H1 (P < 0.05). No rebound of ICH was reported after stopping continuous HSS infusion. Natremia increased from 140 (138 to 143) (140 ± 4) at H0 up to 144 (141 to 148) (144 ± 4) mmol/L at H4 (P < 0.05). Plasma osmolarity increased from 275 (268 to 281) (279 ± 17) mmol/L at H0 up to 290 (284 to 307) (297 ± 17) mmol/L at H24 (P < 0.05). The main side effect observed was an increase in chloremia from 111 (107 to 119) (113 ± 8) mmol/L at H0 up to 121 (117 to 124) (121 ± 6) mmol/L at H24 (P < 0.05). Neither acute kidney injury nor pontine myelinolysis was recorded.

Conclusions
Continuous HSS infusion adapted to close biologic monitoring enables long-lasting control of natremia in TBI patients along with a decreased ICP without any rebound on infusion discontinuation.
Identification of candidate serum biomarkers for severe septic shock-associated kidney injury via microarray
Authors: Basu Rajit K , Standage Stephen W , Cvijanovich Natalie Z , Allen Geoffrey L , Thomas Neal J , Freishtat Robert J , Anas Nick , Meyer Keith , Checchia Paul A , Lin Richard , Shanley Thomas P , Bigham Michael T , Wheeler Derek S , Devarajan Prasad , Goldstein Stuart L , Wong Hector R 
Published: December 2011

Abstract
Introduction
Septic-shock-associated acute kidney injury (SSAKI) carries high morbidity in the pediatric population. Effective treatment strategies are lacking, in part due to poor detection and prediction. There is a need to identify novel candidate biomarkers of SSAKI. The objective of our study was to determine whether microarray data from children with septic shock could be used to derive a panel of candidate biomarkers for predicting SSAKI.

Methods
A retrospective cohort study compared microarray data representing the first 24 hours of admission for 179 children with septic shock with those of 53 age-matched normal controls. SSAKI was defined as a >200% increase of baseline serum creatinine, persistent to 7 days after admission.

Results
Patients with SSAKI (n = 31) and patients without SSAKI (n = 148) were clinically similar, but SSAKI carried a higher mortality (45% vs. 10%). Twenty-one unique gene probes were upregulated in SSAKI patients versus patients without SSAKI. Using leave-one-out cross-validation and class prediction modeling, these probes predicted SSAKI with a sensitivity of 98% (95% confidence interval (CI) = 81 to 100) and a specificity of 80% (95% CI = 72 to 86). Serum protein levels of two specific genes showed high sensitivity for predicting SSAKI: matrix metalloproteinase-8 (89%, 95% CI = 64 to 98) and elastase-2 (83%, 95% CI = 58 to 96). Both biomarkers carried a negative predictive value of 95%. When applied to a validation cohort, although both biomarkers carried low specificity (matrix metalloproteinase-8: 41%, 95% CI = 28 to 50; and elastase-2: 49%, 95% CI = 36 to 62), they carried high sensitivity (100%, 95% CI = 68 to 100 for both).

Conclusions
Gene probes upregulated in critically ill pediatric patients with septic shock may allow for the identification of novel candidate serum biomarkers for SSAKI prediction.
Accuracy and precision of end-expiratory lung-volume measurements by automated nitrogen washout/washin technique in patients with acute respiratory distress syndrome
Authors: Dellamonica Jean , Lerolle Nicolas , Sargentini Cyril , Beduneau Gaetan , Di Marco Fabiano , Mercat Alain , Richard Jean-Christophe M , Diehl Jean-Luc , Mancebo Jordi , Rouby Jean-Jacques , Lu Qin , Bernardin Gilles , Brochard Laurent 
Published: December 2011

Abstract
Introduction
End-expiratory lung volume (EELV) is decreased in acute respiratory distress syndrome (ARDS), and bedside EELV measurement may help to set positive end-expiratory pressure (PEEP). Nitrogen washout/washin for EELV measurement is available at the bedside, but assessments of accuracy and precision in real-life conditions are scant. Our purpose was to (a) assess EELV measurement precision in ARDS patients at two PEEP levels (three pairs of measurements), and (b) compare the changes (Δ) induced by PEEP for total EELV with the PEEP-induced changes in lung volume above functional residual capacity measured with passive spirometry (ΔPEEP-volume). The minimal predicted increase in lung volume was calculated from compliance at low PEEP and ΔPEEP to ensure the validity of lung-volume changes.

Methods
Thirty-four patients with ARDS were prospectively included in five university-hospital intensive care units. ΔEELV and ΔPEEP volumes were compared between 6 and 15 cm H2O of PEEP.

Results
After exclusion of three patients, variability of the nitrogen technique was less than 4%, and the largest difference between measurements was 81 ± 64 ml. ΔEELV and ΔPEEP-volume were only weakly correlated (r
2
= 0.47); 95% confidence interval limits, -414 to 608 ml). In four patients with the highest PEEP (≥ 16 cm H2O), ΔEELV was lower than the minimal predicted increase in lung volume, suggesting flawed measurements, possibly due to leaks. Excluding those from the analysis markedly strengthened the correlation between ΔEELV and ΔPEEP volume (r
2
= 0.80).

Conclusions
In most patients, the EELV technique has good reproducibility and accuracy, even at high PEEP. At high pressures, its accuracy may be limited in case of leaks. The minimal predicted increase in lung volume may help to check for accuracy.
Prognostic Effect of Circulating Adiponectin in a Randomized 2 × 2 Trial of Low-Dose Tamoxifen and Fenretinide in Premenopausal Women at Risk for Breast Cancer
Authors: Macis Debora , Gandini Sara , Guerrieri-Gonzaga Aliana , Johansson Harriet , Magni Paolo , Ruscica Massimiliano , Lazzeroni Matteo , Serrano Davide , Cazzaniga Massimiliano , Mora Serena , Feroce Irene , Pizzamiglio Maria , Sandri Maria Teresa , Gulisano Marcella , Bonanni Bernardo , DeCensi Andrea 
Published: December 2011

Adipokines are linked to obesity and insulin sensitivity and have recently been related to breast cancer risk and prognosis. We investigated the associations of plasma leptin and adiponectin with mammographic density and disease status and assessed their prognostic effect on recurrence-free survival in premenopausal women at risk for breast cancer. Patients and Methods We measured circulating lipids, insulin-like growth factor 1, glucose, insulin and insulin sensitivity (calculated by homeostasis model assessment [HOMA] index), leptin, adiponectin, and leptin-to-adiponectin ratio in 235 premenopausal women with pT1mic/pT1a breast cancer (n = 21), intraepithelial neoplasia (n = 160), or 5-year Gail risk of 1.3% or greater (n = 54) who participated in a 2 × 2 trial of low-dose tamoxifen, fenretinide, both agents, or placebo over a 2-year period. Results At baseline, adiponectin levels were directly associated with mammographic density and HDL cholesterol and negatively associated with leptin, leptin-to-adiponectin ratio, body mass index (BMI), and HOMA index. Median adiponectin levels were lower in affected than in unaffected women (P = .006). After a median of 7.2 years and total of 57 breast neoplastic events, there was a 12% reduction in the risk of breast neoplastic events per unit increase of adiponectin (adjusted hazard ratio, 0.88; 95% CI, 0.81 to 0.96; P = .03). There was no interaction between treatment and adiponectin levels. Conclusion Low adiponectin levels are associated with a history of prior intraepithelial neoplasia or pT1mic/pT1a breast cancer and higher risk of second breast neoplastic events in premenopausal women. The associations are independent of BMI, mammographic density, and treatment. Our findings support the role of adiponectin as a potential target for premenopausal breast cancer prevention and treatment.
Evaluation of diffusion parameters and T2 values of the masseter muscle during jaw opening, clenching, and rest
Authors: Shiraishi Tomoko , Chikui Toru , Inadomi Daisuke , Kagawa Toyohiro , Yoshiura Kazunori , Yuasa Kenji 
Published: December 2011

Background Diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI) can be used to evaluate changes that accompany skeletal muscle contraction. Purpose To investigate whether jaw opening or closure affect the diffusion parameters of the masseter muscles (MMs). Material and Methods Eleven healthy volunteers were evaluated. Diffusion-tensor images were acquired to obtain the primary (λ1), secondary (λ2), and tertiary eigenvalues (λ3). We estimated these parameters at three different locations: at the level of the mandibular notch for the superior site, the level of the mandibular foramen for the middle site, and the root apex of the mandibular molars for the inferior site. Results Both λ2 and λ3 during jaw opening were significantly lower than that at rest at the superior ( P = 0.006, P < 0.0001, respectively) and middle site ( P = 0.004, P = 0.0001, respectively); however, the change in λ1 was not significant. At the lower site, no parameter was significantly different at rest and during jaw opening. There was no significant difference in T2 between at rest (40.3 ± 4.4 ms) and during jaw opening (39.2 ± 2.7 ms; P = 0.12). The changes induced by jaw closure were marked at the inferior site. In the middle and inferior sites, the three eigenvalues were increased by jaw closure, and the changes in λ1 ( P = 0.0145, P = 0.0107, respectively) and λ2 ( P = 0.0003, P = 0.0001) were significant (especially λ2). Conclusion The eigenvalues for diffusion of the MM were sensitive to jaw position. The recruitment of muscle fibers, specific to jaw position, reflects the differences in changes in muscle diffusion parameters.
Simultaneous bilateral contrast injection in computed tomography pulmonary angiography
Authors: Bulla Stefan , Pache Gregor , Bley Thorsten , Langer Mathias , Blanke Philipp 
Published: December 2011

Background Computed tomography pulmonary angiography (CTPA) has evolved as the gold standard for diagnosing pulmonary embolism. However, subsegmental arteries are often not assessed to do insufficient attenuation. Purpose To evaluate the influence of simultaneous bilateral versus unilateral injection of a fixed amount of contrast media on pulmonary artery opacification and image quality in CTPA. Material and Methods In this institutional review board-approved prospective study, 180 patients (91 women, mean age 61.9 ± 16.5 years) referred for CTPA (100 kV) due to suspected pulmonary embolism were randomized in groups of 45 patients each, with either unilateral (A:4 mL/s; B:6 mL/s) or bilateral (C: 6 mL/s; D: 8 mL/s) (Y-shaped line) injection of 50 mL contrast media. Attenuation was assessed including the subsegmental arteries (4th order). Image quality was evaluated by two readers in consensus using a three-point grading scale (3 = excellent image quality, no artifacts, 1 = non-diagnostic). Results Mean pulmonary artery attenuation was significantly higher with bilateral injection (1st to 3rd order: A: 303.6 ± 8.8HU; B: 371.1 ± 11.0HU vs. C: 443.2 ± 24.1HU; D: 562.3 ± 15.3HU, P < 0.001). Evaluation of subsegmental arteries was feasible for all patients in groups B–D, but only in 36/45 (80%) patients in group A. Subsegmental attenuation was significantly higher with bilateral injection (A: 284.7 ± 12.1HU; B: 367.4 ± 12.1HU vs. C: 494.2 ± 21.5HU; D: 562.3 ± 26.7HU, P < 0.001). Image quality was diagnostic for all patients but best for group C (A: 2.15 ± 0.4; B: 2.14 ± 0.5; C: 2.92 ± 0.3, and D: 2.51 ± 0.5). Conclusion Using the same amount of contrast media, bilateral injection yields higher pulmonary artery attenuation and better image quality than unilateral injection. This technique may improve subsegmental pulmonary artery assessment.
Adapted Choi response criteria for prediction of clinical outcome in locally advanced gastric cancer patients following preoperative chemotherapy
Authors: Liu Kun , Li Guoli , Fan Chaogang , Zhou Changsheng , Li Jieshou 
Published: December 2011

Background Tumor response to chemotherapy has traditionally been assessed by using Response Evaluation Criteria in Solid Tumors (RECIST) based on changes in tumor size alone. However, adapted Choi criteria, which incorporate volumetric tumor attenuation in addition to tumor size, have been reported more predictive of chemotherapeutic efficacy than RECIST in some studies. Purpose To examine the usefulness of adapted Choi criteria in predicting clinical survival in locally advanced gastric cancer patients treated with cytotoxic drugs. Material and Methods A total of 48 histologically proven gastric cancer patients who received neoadjuvant chemotherapy and surgery were involved. Pre- and post-chemotherapy short-axis diameter and volumetric mean tumor attenuation of target lymph nodes on contrast-enhanced CT images were measured. Tumor response was assessed by using both RECIST and adapted Choi criteria, and was correlated with progression-free survival (PFS) and overall survival (OS). Results Significant decrease was observed in the sum of short-axis diameters and tumor attenuation of metastatic lymph nodes between baseline and post-chemotherapy CT images. The inter-observer agreement for both parameters was good. The PFS and OS of 17 RECIST responders were identical with that of 28 adapted Choi responders ( P = 0.855 and 0.913, respectively). PFS and OS of 31 RECIST non-responders were significantly prolonged compared to that of 20 adapted Choi non-responders ( P = 0.018 and 0.042, respectively). To the 11 RECIST stable disease (SD) but adapted Choi partial response (PR) patients, the PFS and OS were similar to the survival of 17 RECIST PR patients ( P = 0.785 and 0.838, respectively), but significantly prolonged compared to that of the 12 both RECIST and adapted Choi criteria SD patients ( P < 0.001 and P = 0.004, respectively). Conclusion Adapted Choi criteria might be helpful to predict PFS and OS in locally advanced gastric cancer patients following chemotherapy.
Association between cerebral microbleeds and the first onset of intracerebral hemorrhage – a 3.0 T MR study
Authors: Sun Shengjun , Gao Peiyi , Sui Binbin , Xue Jing , Wang Hui , Wang Qiong , Jing Lina , Zhai Renyou 
Published: December 2011

Background Cerebral microbleeds (CMBs) detected by gradient-echo MRI have been proven to be a potential risk factor for further bleeding, while the association between CMBs and the first onset of intracerebral hemorrhage has not been well investigated. Purpose To analyze the association between CMBs and the first onset of primary intracerebral hemorrhage (pICH). Material and Methods Two hundred and two consecutive inpatients with ICH and 234 consecutive outpatients without ICH as control group were enrolled in this study. MR imaging including T2*-GRE, T1W, T2W and fluid attenuated inversion recovery (FLAIR) sequences were performed to detect CMBs and other abnormalities. Prevalence, distribution, and grades of CMBs, as well as the location and size of the intracerebral hematoma were analyzed, respectively. Comparison was made between pICH and control group. Logistic analysis was performed to evaluate the association between CMBs and ICH. The correlation between hematoma size and CMBs grade/numbers was analyzed. Results CMBs were detected in 140 patients in pICH (69.3%) group and 62 patients in control group (26.5%). The incidence of CMBs in pICH group was significantly higher than that in control group ( P < 0.0001). As the logistic regression analysis results, CMBs was the risk factor associated with ICH, with modulation OR value of 8.363 (95% CI 5.210–13.421). The volume of ICH with CMBs was 12.57 ± 17.23 mL, and the volume of ICH without CMBs was 17.77 ± 26.97 mL. Negative correlation was demonstrated between CMBs number and ICH volume (rs = −0.1769, P = 0.0118), as well as between CMBs grade and hematoma volume (rs = −0.1185, P = 0.1557). Conclusion CMBs may be an independent risk factor for the first onset of intracerebral hemorrhage.
Intensive decongestive treatment restores ability to work in patients with advanced forms of primary and secondary lower extremity lymphoedema
Authors: Stanisić M-G , Gabriel M , Pawlaczyk K 
Published: December 2011

Objective To show that adequate therapy for lymphoedema is able to restore ability to work. Materials and Methods The population of patients with primary lymphoedema registered in the university clinical centre diagnosed with primary or secondary lymphoedema and presumed by the national social institution as completely unable to work was selected for the retrospective analysis and divided into two groups. Group 1 consisted of 25 patients treated with a complex decongestive therapy programme daily for 3–6 weeks. The study population comprised 19 women and six men from 14 to 61 years of age (mean 31.5). In all 25 patients, complete inability to work was certified by the social institution before the treatment started. Group 2 consisted of 47 patients, 14 men and 33 women, aged from 26 to 71 years (mean 39 years) treated by so-called standard methods, who resigned from the proposed intensive treatment. In all 47 patients, complete inability to work was declared by the social institution before the treatment. Ability to work and oedema reduction were assessed by the treating physician. Results The intensive phase of treatment succeeded in 3870–15,330 mL oedema reduction in Group 1. After the end of therapy, 21 patients were able to work or study without any limitation and patients returned to their regular professional activity. Among four others, two were on welfare for at least 10 years, for another one welfare was their only income and one person was receiving a social pension. In none of the patients from group 2 was any significant oedema reduction observed. Every patient from group 2 maintained the social pension due to ineffective treatment. Conclusions Complex decongestive therapy is a very efficient form of treatment in advanced primary and secondary lymphoedema. It allows returning to work after a short period of temporary disability without the necessity of a social pension.