bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary ostia obstruction after replacement of aortic valve prostesis
Authors: Turillazzi Emanuela , Di Giammarco Gabriele , Neri Margherita , Bello Stefania , Riezzo Irene , Fineschi Vittorio 
Published: August 2011

Abstract
Aortic valve replacement (AVR) is the gold standard for the treatment of severe symptomatic aortic stenosis. Complications directly related to surgical procedure are relatively infrequent. Coronary ostial stenosis is, generally, referred as late complication. Anecdotal reports concern coronary ostial stenosis as acute complication. A unique fatal case of intraoperative, bilateral coronary ostial obstruction by prosthetic valve leading to an extensive myocardial infarction is reported. Surgeons must have a high level of vigilance regarding the occurrence of acute myocardial ischemia and sudden death soon after AVR.

Virtual Slides

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Computerized clinical decision support systems for primary preventive care: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes
Authors: Souza Nathan M , Sebaldt Rolf J , Mackay Jean A , Prorok Jeanette C , Weise-Kelly Lorraine , Navarro Tamara , Wilczynski Nancy L , Haynes R Brian ,   the CCDSS Systematic Review Team
Published: August 2011

Abstract

Background
Computerized clinical decision support systems (CCDSSs) are claimed to improve processes and outcomes of primary preventive care (PPC), but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs) assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs.

Methods
We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.

Results
We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63%) RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34%) trials assessed patient outcomes, and four (29%) reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15%) and two (5%) trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects.

Conclusions
Evidence supports the effectiveness of CCDSSs for screening and treatment of dyslipidaemia in primary care with less consistent evidence for CCDSSs used in screening for cancer and mental health-related conditions, vaccinations, and other preventive care. CCDSS effects on patient outcomes, safety, costs of care, and provider satisfaction remain poorly supported.
Computerized clinical decision support systems for therapeutic drug monitoring and dosing: A decision-maker-researcher partnership systematic review
Authors: Nieuwlaat Robby , Connolly Stuart J , Mackay Jean A , Weise-Kelly Lorraine , Navarro Tamara , Wilczynski Nancy L , Brian Haynes R ,   the CCDSS Systematic Review Team
Published: August 2011

Abstract

Background
Some drugs have a narrow therapeutic range and require monitoring and dose adjustments to optimize their efficacy and safety. Computerized clinical decision support systems (CCDSSs) may improve the net benefit of these drugs. The objective of this review was to determine if CCDSSs improve processes of care or patient outcomes for therapeutic drug monitoring and dosing.

Methods
We conducted a decision-maker-researcher partnership systematic review. Studies from our previous review were included, and new studies were sought until January 2010 in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Inspec databases. Randomized controlled trials assessing the effect of a CCDSS on process of care or patient outcomes were selected by pairs of independent reviewers. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.

Results
Thirty-three randomized controlled trials were identified, assessing the effect of a CCDSS on management of vitamin K antagonists (14), insulin (6), theophylline/aminophylline (4), aminoglycosides (3), digoxin (2), lidocaine (1), or as part of a multifaceted approach (3). Cluster randomization was rarely used (18%) and CCDSSs were usually stand-alone systems (76%) primarily used by physicians (85%). Overall, 18 of 30 studies (60%) showed an improvement in the process of care and 4 of 19 (21%) an improvement in patient outcomes. All evaluable studies assessing insulin dosing for glycaemic control showed an improvement. In meta-analysis, CCDSSs for vitamin K antagonist dosing significantly improved time in therapeutic range.

Conclusions
CCDSSs have potential for improving process of care for therapeutic drug monitoring and dosing, specifically insulin and vitamin K antagonist dosing. However, studies were small and generally of modest quality, and effects on patient outcomes were uncertain, with no convincing benefit in the largest studies. At present, no firm recommendation for specific systems can be given. More potent CCDSSs need to be developed and should be evaluated by independent researchers using cluster randomization and primarily assess patient outcomes related to drug efficacy and safety.
Decrease of energy spilling in Escherichia coli continuous cultures with rising specific growth rate and carbon wasting
Authors: Valgepea Kaspar , Adamberg Kaarel , Vilu Raivo 
Published: August 2011

Abstract

Background
Growth substrates, aerobic/anaerobic conditions, specific growth rate (μ) etc. strongly influence Escherichia coli cell physiology in terms of cell size, biomass composition, gene and protein expression. To understand the regulation behind these different phenotype properties, it is useful to know carbon flux patterns in the metabolic network which are generally calculated by metabolic flux analysis (MFA). However, rarely is biomass composition determined and carbon balance carefully measured in the same experiments which could possibly lead to distorted MFA results and questionable conclusions. Therefore, we carried out both detailed carbon balance and biomass composition analysis in the same experiments for more accurate quantitative analysis of metabolism and MFA.

Results
We applied advanced continuous cultivation methods (A-stat and D-stat) to continuously monitor E. coli K-12 MG1655 flux and energy metabolism dynamic responses to change of μ and glucose-acetate co-utilisation. Surprisingly, a 36% reduction of ATP spilling was detected with increasing μ and carbon wasting to non-CO2 by-products under constant biomass yield. The apparent discrepancy between constant biomass yield and decline of ATP spilling could be explained by the rise of carbon wasting from 3 to 11% in the carbon balance which was revealed by the discovered novel excretion profile of E. coli pyrimidine pathway intermediates carbamoyl-phosphate, dihydroorotate and orotate. We found that carbon wasting patterns are dependent not only on μ, but also on glucose-acetate co-utilisation capability. Accumulation of these compounds was coupled to the two-phase acetate accumulation profile. Acetate overflow was observed in parallel with the reduction of TCA cycle and glycolysis fluxes, and induction of pentose phosphate pathway.

Conclusions
It can be concluded that acetate metabolism is one of the major regulating factors of central carbon metabolism. More importantly, our model calculations with actual biomass composition and detailed carbon balance analysis in steady state conditions with -omics data comparison demonstrate the importance of a comprehensive systems biology approach for more advanced understanding of metabolism and carbon re-routing mechanisms potentially leading to more successful metabolic engineering.
Inferring causal genomic alterations in breast cancer using gene expression data
Authors: Tran Linh M , Zhang Bin , Zhang Zhan , Zhang Chunsheng , Xie Tao , Lamb John R , Dai Hongyue , Schadt Eric E , Zhu Jun 
Published: August 2011

Abstract

Background
One of the primary objectives in cancer research is to identify causal genomic alterations, such as somatic copy number variation (CNV) and somatic mutations, during tumor development. Many valuable studies lack genomic data to detect CNV; therefore, methods that are able to infer CNVs from gene expression data would help maximize the value of these studies.

Results
We developed a framework for identifying recurrent regions of CNV and distinguishing the cancer driver genes from the passenger genes in the regions. By inferring CNV regions across many datasets we were able to identify 109 recurrent amplified/deleted CNV regions. Many of these regions are enriched for genes involved in many important processes associated with tumorigenesis and cancer progression. Genes in these recurrent CNV regions were then examined in the context of gene regulatory networks to prioritize putative cancer driver genes. The cancer driver genes uncovered by the framework include not only well-known oncogenes but also a number of novel cancer susceptibility genes validated via siRNA experiments.

Conclusions
To our knowledge, this is the first effort to systematically identify and validate drivers for expression based CNV regions in breast cancer. The framework where the wavelet analysis of copy number alteration based on expression coupled with the gene regulatory network analysis, provides a blueprint for leveraging genomic data to identify key regulatory components and gene targets. This integrative approach can be applied to many other large-scale gene expression studies and other novel types of cancer data such as next-generation sequencing based expression (RNA-Seq) as well as CNV data.
Metabolic myopathy presenting with polyarteritis nodosa: a case report
Authors: Vishwanath Sahana , Abdullah Mishal , Elbalkhi Amro , Ambrus Julian L 
Published: August 2011

AbstractIntroductionTo the best of our knowledge, we describe for the first time a patient in whom an unusual metabolic myopathy was identified after failure to respond to curative therapy for a systemic vasculitis, polyarteritis nodosa. We hope this report will heighten awareness of common metabolic myopathies that may present later in life. It also speculates on the potential relationship between metabolic myopathy and systemic vasculitis.Case presentationA 78-year-old African-American woman with a two-year history of progressive fatigue and exercise intolerance presented to our facility with new skin lesions and profound muscle weakness. Skin and muscle biopsies demonstrated a medium-sized artery vasculitis consistent with polyarteritis nodosa. Biochemical studies of the muscle revealed diminished cytochrome C oxidase activity (0.78 μmol/minute/g tissue; normal range 1.03 to 3.83 μmol/minute/g tissue), elevated acid maltase activity (23.39 μmol/minute/g tissue; normal range 1.74 to 9.98 μmol/minute/g tissue) and elevated neutral maltase activity (35.89 μmol/minute/g tissue; normal range 4.35 to 16.03 μmol/minute/g tissue). Treatment for polyarteritis nodosa with prednisone and cyclophosphamide resulted in minimal symptomatic improvement. Additional management with a diet low in complex carbohydrates and ubiquinone, creatine, carnitine, folic acid, α-lipoic acid and ribose resulted in dramatic clinical improvement.ConclusionsOur patient's initial symptoms of fatigue, exercise intolerance and progressive weakness were likely related to her complex metabolic myopathy involving both the mitochondrial respiratory chain and glycogen storage pathways. Management of our patient required treatment of both the polyarteritis nodosa as well as metabolic myopathy. Metabolic myopathies are common and should be considered in any patient with exercise intolerance. Metabolic myopathies may complicate the management of various disease states.
Phase II Study of Cetuximab As First-Line Single-Drug Therapy in Patients With Unresectable Squamous Cell Carcinoma of the Skin
Authors: Maubec Eve , Petrow Peter , Scheer-Senyarich Isabelle , Duvillard Pierre , Lacroix Ludovic , Gelly Julien , Certain Agnès , Duval Xavier , Crickx Béatrice , Buffard Valérie , Basset-Seguin Nicole , Saez Pierre , Duval-Modeste Anne-Bénédicte , Adamski Henri , Mansard Sandrine , Grange Florent , Dompmartin Anne , Faivre Sandrine , Mentré France , Avril Marie-Françoise 
Published: August 2011

Purpose To evaluate the efficacy and safety of cetuximab, a monoclonal antibody that inhibits the epidermal growth factor receptor (EGFR), as a first-line monotherapy in patients with unresectable squamous cell carcinoma of the skin (SCCS). Patients and Methods Thirty-six patients received cetuximab (initial dose of 400 mg/m2 followed by subsequent weekly doses of 250 mg/m2) for at least 6 weeks with a 48-week follow-up. The primary end point was the disease control rate (DCR) at 6 weeks (according to Response Evaluation Criteria in Solid Tumors [RECIST] criteria). Secondary end points included best response rate, overall survival, progression-free survival (PFS), and toxicity assessment. Association of treatment efficacy with RAS mutations or FcγR genotypes was investigated. Results Median age of the study population was 79 years. DCR at 6 weeks was obtained in 25 of 36 patients (69%; 95% CI, 52% to 84%) of the intention-to-treat population. The best responses were eight partial responses and two complete responses. There were no cetuximab-related deaths. There were three related serious adverse events: two grade 4 infusion reactions and one grade 3 interstitial pneumopathy. Grade 1 to 2 acne-like rash occurred in 78% of patients and was associated with prolonged PFS. One HRAS mutation was identified. Combined FcγRIIa-131H/H and/or FcγRIIIa-158V/V polymorphisms were not associated with the clinical outcomes. Conclusion As a first-line treatment in patients with unresectable SCCS, cetuximab achieved 69% DCR. A randomized phase III trial is warranted to confirm that cetuximab may be considered as a therapeutic option especially in elderly patients. The low frequency of RAS mutations in SCCS makes SCCS tumors attractive for EGFR inhibition.
Predicting Chemotherapy Toxicity in Older Adults With Cancer: A Prospective Multicenter Study
Authors: Hurria Arti , Togawa Kayo , Mohile Supriya G. , Owusu Cynthia , Klepin Heidi D. , Gross Cary P. , Lichtman Stuart M. , Gajra Ajeet , Bhatia Smita , Katheria Vani , Klapper Shira , Hansen Kurt , Ramani Rupal , Lachs Mark , Wong F. Lennie , Tew William P. 
Published: August 2011

Purpose Older adults are vulnerable to chemotherapy toxicity; however, there are limited data to identify those at risk. The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity. Patients and Methods Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment that captured sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status). Patients were followed through the chemotherapy course to capture grade 3 (severe), grade 4 (life-threatening or disabling), and grade 5 (death) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events. Results In total, 500 patients with a mean age of 73 years (range, 65 to 91 years) with stage I to IV lung (29%), GI (27%), gynecologic (17%), breast (11%), genitourinary (10%), or other (6%) cancer joined this prospective study. Grade 3 to 5 toxicity occurred in 53% of the patients (39% grade 3, 12% grade 4, 2% grade 5). A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables, laboratory test values, and patient, tumor, and treatment characteristics. A scoring system in which the median risk score was 7 (range, 0 to 19) and risk stratification schema (risk score: percent incidence of grade 3 to 5 toxicity) identified older adults at low (0 to 5 points; 30%), intermediate (6 to 9 points; 52%), or high risk (10 to 19 points; 83%) of chemotherapy toxicity (P < .001). Conclusion A risk stratification schema can establish the risk of chemotherapy toxicity in older adults. Geriatric assessment variables independently predicted the risk of toxicity.
Compliance with compression stockings in patients with chronic venous disorders
Authors: Ziaja D , Kocełak P , Chudek J , Ziaja K 
Published: August 2011

Objective The aim of this large survey was to evaluate non-compliance with compression stockings in chronic venous disorder (CVD) patients. Method A total of 16,770 CVD patients participated in this study. Results Compression stockings were used by 25.6% of CVD patients and 46.6% of the patients were never prescribed compression therapy. Compression stocking use was found to increase with the clinical stage of CVD. The percentage of patients using compression stockings during control visits increased to 37.4%. Furthermore, 5.3% of the patients coming to control visits discontinued the use of compression stockings owing to high cost, sweating, itching, cosmetic reason, oedema exacerbation, exudation lesions of lower legs and application difficulty. Past episodes of vein thrombosis (OR = 0.80), of stroke (OR = 0.28) and of varicose veins surgery (OR = 0.28) were decreasing, while the management by a general practitioner was increasing the risk (OR = 1.36) of compression therapy cessation. Conclusion (1) Compression stockings are too rarely prescribed and often unaccepted at early stages of CVD; (2) The common reason for discontinuation of compression therapy is its high cost.
Chronic ischaemic leg ulcer as a late complication of post-traumatic arteriovenous fistula
Authors: Suknaic S , Erdelez L , Skopljanac A , Sef D , Novačić K 
Published: August 2011

Objective Chronic post-traumatic arteriovenous fistula (AVF) is a late complication of vascular injury and can be presented with symptoms of congestive heart failure, venous hypertension and distal ischaemia. We present an unusual case of chronic ischaemic leg ulcer in young adult caused by post-traumatic AVF. Case report A 29-year-old male patient was admitted to our hospital with symptoms of chronic ulcer located on the lateral side of the lower left leg. Arterial pulses distally from the groin were absent. His medical history revealed him to have sustained gunshot injury of the left thigh in the war conflict 18 years before. Angiography showed a large AVF between superficial femoral artery and femoral vein. The patient underwent surgical repair of AVF with reconstruction of superficial femoral artery by saphenous vein interposition under spinal anaesthesia. Completion angiography confirmed AVF exclusion. Leg ulcer healed within a month. Conclusion Chronic leg ulcer may be the only symptom of large post-traumatic AVF in young adults.
Leo III and the Anemodoulion
Authors: Anderson Benjamin 
Published: August 2011

Abstract
The Anemodoulion, a Constantinopolitan tetrapylon decorated with numerous figural reliefs and crowned by a weathervane, has traditionally been seen as an entirely late antique construction. A re-evaluation of the medieval sources shows that, while the tetrapylon itself was constructed in late antiquity, its figural decoration and conversion into a weathervane likely date to the reign of Leo III (717–741). Viewed in connection with other monuments of Leo's reign, in particular the gate of the Kontoskalion Harbor, and historical accounts of the end of the Arab siege of 717/18, the Anemodoulion may be interpreted as a triumphal monument celebrating the dispersal of the Arab fleet via a powerful storm. It thus provides new insight into the earliest efforts of the Isaurian emperors to rebuild Constantinople as a fitting capital for a medieval empire.
Private Schools and Residential Choices: Accessibility, Mobility, and Welfare
Authors: Hanushek Eric A , Sarpça Sinan , Yilmaz Kuzey 
Published: August 2011

Abstract
Private schools free households from a strict link between residential location decisions and the tax-school quality bundles they consume. In order to study the impact of private schools on educational outcomes, we develop a general equilibrium model that simultaneously incorporates locational choice built on access and locational choice built on tax-school quality attributes of jurisdictions. We conclude that private school choice enhances the welfare of all households—both those attending private schools and those attending public schools—while also working to reduce the amount of housing and school segregation in equilibrium. Investigation of alternative school policies indicates that greater choice, including using targeted school vouchers, can improve welfare and achievement. Finally, we demonstrate how the fiscal burden arising from some households paying less taxes than they consume in public services varies significantly with the structure of school choice options.
Measurement of the midpalatal suture width
Authors: Fricke-Zech Susanne , Gruber Rudolf M. , Dullin Christian , Zapf Antonia , Kramer Franz-Josef , Kubein-Meesenburg Dietmar , Hahn Wolfram 
Published: August 2011

Abstract

Objective:
To conduct a pilot study to investigate the potentiality to determine the midpalatal sutural width radiographically with a flat-panel volume computed tomography (fpVCT) in a porcine model.

Materials and Methods:
Bone samples from the midpalatal suture of five young (16 weeks) and five old (200 weeks) sus scrofa domestica were gathered. The midpalatal suture width was measured via fpVCT and compared to respective histological preparations. Results with P &lt; .05 were considered significant.

Results:
The data obtained by fpVCT and by histomorphometric analysis reveal a highly significant age dependency of the measured suture width (both P &lt; .0001), with lower suture width values in older subjects compared to the younger group. The averaged suture widths measured in the fpVCT images shows a distinctively higher mean compared to the histomorphometric data with high statistical significance (P &lt; .0001). The evaluated difference between both methods was almost constant.

Conclusion:
fpVCT is a powerful tool for determining midpalatal sutural width.