bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age
Authors: Oszvald Ági , Güresir Erdem , Setzer Matthias , Vatter Hartmut , Senft Christian , Seifert Volker , Franz Kea 
Published: September 2011

Object
The objective of this study was to analyze whether age influences the outcome of patients with glioblastoma and whether elderly patients with glioblastoma can tolerate the same aggressive treatment as younger patients.

Methods
Data from 361 consecutive patients with newly diagnosed cerebral glioblastoma (2000–2006) who underwent regular follow-up evaluation from initial diagnosis until death were prospectively entered into a database. Patients underwent resection (complete, subtotal, or partial) or biopsy, depending on tumor size, location, and Karnofsky Performance Scale score. Following surgery, all patients underwent adjuvant treatment consisting of radiotherapy, chemotherapy, or combined treatment. Patients older than 65 years of age were defined as elderly (146 total).

Results
Two hundred thirty-four patients underwent tumor resection (complete 26%, subtotal 29%, and partial 45%). One hundred twenty-seven underwent biopsy. Mean patient age was 61 years, and overall survival was 11.6 ± 12.1 months. The overall survival of elderly patients (9.1 ± 11.6 months) was significantly lower than that of younger patients (14.9 ± 16.7 months; p = 0.0001). Stratifying between resection or biopsy, age was a negative prognostic factor in patients undergoing biopsy (4.0 ± 7.1 vs 7.9 ± 8.7 months; p = 0.007), but not in patients undergoing tumor resection (13.0 ± 8.5 vs 13.3 ± 14.5 months; p = 0.86). Survival of elderly patients undergoing complete tumor resection was 17.7 ± 8.1 months.

Conclusions
In this series of patients with glioblastoma, age was a prognostic factor in patients undergoing biopsy, but not in patients undergoing resection. Tumor location and patient clinical status may prohibit extensive resection, but resection should not be withheld from patients only on the basis of age. In elderly patients with glioblastoma, undergoing resection to the extent feasible, followed by adjuvant therapies, is warranted.
Multicenter validation of a formula predicting postoperative spinopelvic alignment
Authors: Lafage Virginie , Bharucha Neil J. , Schwab Frank , Hart Robert A. , Burton Douglas , Boachie-Adjei Oheneba , Smith Justin S. , Hostin Richard , Shaffrey Christopher , Gupta Munish , Akbarnia Behrooz A. , Bess Shay 
Published: September 2011

ObjectSagittal spinopelvic imbalance is a major contributor to pain and disability for patients with adult spinal deformity (ASD). Preoperative planning is essential for pedicle subtraction osteotomy (PSO) candidates; however, current methods are often inaccurate because no formula to date predicts both postoperative sagittal balance and pelvic alignment. The authors of this study aimed to evaluate the accuracy of 2 novel formulas in predicting postoperative spinopelvic alignment after PSO.MethodsThis study is a multicenter retrospective consecutive PSO case series. Adults with spinal deformity (> 21 years old) who were treated with a single-level lumbar PSO for sagittal imbalance were evaluated. All patients underwent preoperative and a minimum of 6-month postoperative radiography. Two novel formulas were used to predict the postoperative spinopelvic alignment. The results predicted by the formulas were then compared with the actual postoperative radiographic values, and the formulas' ability to identify successful (sagittal vertical axis [SVA] ≤ 50 mm and pelvic tilt [PT] ≤ 25°) and unsuccessful (SVA > 50 mm or PT > 25°) outcomes was evaluated.ResultsNinety-nine patients met inclusion criteria. The median absolute error between the predicted and actual PT was 4.1° (interquartile range 2.0°–6.4°). The median absolute error between the predicted and actual SVA was 27 mm (interquartile range 11–47 mm). Forty-one of 54 patients with a formula that predicted a successful outcome had a successful outcome as shown by radiography (positive predictive value = 0.76). Forty-four of 45 patients with a formula that predicted an unsuccessful outcome had an unsuccessful outcome as shown by radiography (negative predictive value = 0.98).ConclusionsThe spinopelvic alignment formulas were accurate when predicting unsuccessful outcomes but less reliable when predicting successful outcomes. The preoperative surgical plan should be altered if an unsuccessful result is predicted. However, even after obtaining a predicted successful outcome, surgeons should ensure that the predicted values are not too close to unsuccessful values and should identify other variables that may affect alignment. In the near future, it is anticipated that the use of these formulas will lead to better surgical planning and improved outcomes for patients with complex ASD.
Evaluation of the Content Coverage of SNOMED CT Representing ICNP Seven-axis Version 1 Concepts
Authors: Lundberg C. , Coenen A. , Konicek D. , Park H. A. 
Published: September 2011

SummaryObjectives: The purpose of this study is to evaluate the ability of SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) to represent the concepts of the ICNP version 1 – the seven-axis model.Methods: The first author mapped 1658 concepts of the ICNP version 1 to SNOMED CT using CLUE browser 5.0. The second author from SNOMED Terminology Solutions – with a team of SNOMED CT experts – and the third author from the ICN with a team of ICNP experts validated the mapping result. If there was any disagreement during the validation process, the three of us convened online meetings to reach a consensus.Results: In total, SNOMED CT covered 1331 out of 1658 (80%) ICNP seven-axis model concepts ranging from a 61% coverage rate of the Actions Axis concepts to a 94% coverage rate of the Judgment axis concepts.Conclusions: SNOMED CT can represent most (80%) of the ICNP version 1 concepts. However, improvements in the ICNP version 1 in terms of concept naming and definition, and the addition of missing concepts to SNOMED CT, would lead to a greater harmonization of the ICNP seven-axis model version 1 concepts with SNOMED CT.
Testing mechanisms and context dependence of costs of plastic shade avoidance responses inImpatiens capensis(Balsaminaceae)
Authors: Huber Heidrun , von Wettberg Eric J. , Aguilera Anna , Schmitt Johanna 
Published: September 2011

•Premise of the study:Many plant species elongate their shoots in response to neighbor proximity and neighbor height. Although these plastic responses may be beneficial in terms of enhancing light interception, they also may have costs in terms of increased risk of mechanical failure (i.e., lodging or breaking) because of thinner stems. This trade‐off between light acquisition and stability may shape the evolution of plastic elongation responses to foliage shade.•Methods:In a field experiment manipulating elongation phenotypes and densities, we tested two hypotheses. We predicted that the risks of mechanical failure depend on plastic elongation and/or on characteristics of the immediate neighborhood, such as density and neighbor height. Further, we predicted that plants that fail mechanically would have reduced fitness.•Key results:Mechanical failure was earlier and more frequent at high density and showed a complex interaction with neighborhood characteristics such as relative height of the neighbors and the expression of early plasticity. Plants that broke earlier had shorter lifespan and lower reproductive output.•Conclusions:Our results show that depending on the height and density of the group, plastic elongation responses can remain advantageous despite costs of increased risk of mechanical failure of the taller stems, as mechanical failure was not associated with strong costs in terms of reduced lifespan or seed production. The overall benefits of elongation outweigh the costs resulting in selection for elongation at the population level.
The Magnitude of the T Cell Response to a Clinically Significant Dose of Influenza Virus Is Regulated by TRAIL
Authors: Brincks Erik L. , Gurung Prajwal , Langlois Ryan A. , Hemann Emily A. , Legge Kevin L. , Griffith Thomas S. 
Published: September 2011

AbstractAn immune response of appropriate magnitude should be robust enough to control pathogen spread but not simultaneously lead to immunopathology. Primary infection with influenza A virus (IAV) results in a localized pulmonary infection and inflammation and elicits an IAV-specific CD8 T cell immune response necessary for viral clearance. Clearance of IAV-infected cells, and recovery from infection, is mediated by perforin/granzyme B- and Fas/FasL-mediated mechanisms. We recently reported that TRAIL is another means by which IAV-specific CD8 T cells can kill IAV-infected cells. The current study examined the role of TRAIL in the pulmonary CD8 T cell response to a clinically significant IAV [A/PR/8/34 (PR8; H1N1)] infection (i.e., leads to observable, but limited, morbidity and mortality in wild-type [WT] mice). Compared with WT mice, IAV-infected Trail−/− mice experienced increased morbidity and mortality despite similar rates of viral clearance from the lungs. The increased morbidity and mortality in Trail−/− mice correlated with increased pulmonary pathology and inflammatory chemokine production. Analysis of lung-infiltrating lymphocytes revealed increased numbers of IAV-specific CD8 T cells in infected Trail−/− mice, which correlated with increased pulmonary cytotoxic activity and increased pulmonary expression of MIG and MIP-1α. In addition, there was decreased apoptosis and increased proliferation of IAV-specific CD8 T cells in the lungs of Trail−/− mice compared with WT mice. Together, these data suggest that TRAIL regulates the magnitude of the IAV-specific CD8 T cell response during a clinically significant IAV infection to decrease the chance for infection-induced immunopathology.
Initial PET/CT Staging for Choroidal Melanoma: AJCC Correlation and Second Nonocular Primaries in 333 Patients
Authors: Freton Aurélien , Chin Kimberly J. , Raut Robert , Tena Lawrence B. , Kivelä Tero , Finger Paul T. 
Published: September 2011

Purpose To report on whole body positron emission tomography/computed tomography (PET/CT) screening for metastasis at diagnosis of primary uveal melanoma. Methods Since August 2003, 333 consecutive patients were diagnosed with uveal melanoma and underwent whole body screening for metastatic disease with PET/CT along with liver function tests and physical examination. Abnormal findings prompted further biopsies, blood tests, imaging, or clinical evaluations for confirmation. The presence of metastatic disease and second cancers were evaluated. Results Using the American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) 7th edition criteria, 104 tumors were classified T1 (31%), 162 T2 (49%), 37 T3 (11%), and 30 T4 (9%). Seven of 333 (2.1%; 95% confidence interval [CI] 0.8-4.3) patients had metastatic melanoma. One tumor was a T3 and 6 were T4. Thus, 3% of T3 and 20% of T4 melanomas were found to have metastases at the time of initial diagnosis. Ten patients (3.3%; 95% CI 0.9-5.5) had synchronous second cancers and 28 (8.4%) concurrent benign lesions. The most common metastatic sites were liver (7/7) and bone (2/7). Discussion This study suggests that PET/CT improves the yield of detecting both extrahepatic metastases, especially from tumors defined as AJCC-T4, and synchronous primary cancers, irrespective of the size of the uveal melanoma. With respect to liver metastases, PET/CT demonstrated high sensitivity and positive predictive values, indicating an overall better performance than conventional screening procedures.
Fluorescence Cystoscopy with Hexaminolevulinate: Our Preliminary Experience of 184 Procedures
Authors: Fanari Massimiliano , Serra Simona , Corona Andrea , De Lisa Antonello 
Published: September 2011

Introduction Fluorescence cystoscopy (FC) with hexaminolevulinate (HAL) is a recently introduced technique of photodynamic diagnosis (PDD), which aims to improve the accuracy of white light cystoscopy (WLC) in the diagnosis of superficial bladder tumors (NMIBC), and especially of flat urothelial lesions (dysplasia and Ca in situ). We report our experience of a number of cases of WLC and FC in a single moment with HAL in the diagnosis and follow-up of NMIBC. Materials and Methods The method was applied to 184 selected patients with a diagnosis or clinical suspicion - instrumental or early recurrence of bladder neoplasia. The lesions found in white light (WL) and/or blue light (FC) were sampled separately for histological examination. We evaluated the results in terms of diagnostic gain compared to treatment with one WL, false positivity and recurrence-free survival compared to historical reference group treated with WL only. Results 26.1% of the lesions were found only by the PDD method. The false positivity due to the method adopted was 21.2%. The gain in terms of recurrence-free survival (compared with historical reference group treated only with WL) was 22.3% at 12 months and 24.4% at 20 months. It did not show any systemic side effects. Discussion The PDD is a technique that can significantly increase the diagnostic accuracy of NMIBC.
Combatendo as DCNT: uma abordagem diferente é necessária*
Authors: De Maeseneer Jan , Roberts Richard G , Demarzo Marcelo Marcos Piva , Heath Iona , Sewankambo Nelson , Kidd Michael R , Van Weel Chris , Egilman David , Boelen Charles , Willems Sara 
Published: September 2011

A “Aliança DCNT” (“NCD Alliance”)1 visa colocar as doenças crônicas não transmissíveis (DCNT) na agenda global de saúde, a fim de enfrentar a chamada “crise das DCNT”. Melhorar os indicadores de morbidade e mortalidade em 2015 dependerá, em grande medida, da prevenção e controle das DCNT, especialmente nos países em desenvolvimento2. *Reprinted with permission from Elsevier (The Lancet, 2011, 6 September 2011, online first) - Reprodução autorizada do original em inglês, publicado no periódico The Lancet, detentor dos copyrights:http://dx.doi.org/10.1016/S0140-6736(11)61135-5
Emergency Medical Service Agency Practices and Cardiac Arrest Survival
Authors: Girotra Saket , Dukes Kimberly C. , Sperling Jessica , Kennedy Kevin , Del Rios Marina , Crowe Remle , Panchal Ashish R. , Rea Thomas , McNally Bryan F. , Chan Paul S. 
Published: June 2024

ImportanceSurvival for out-of-hospital cardiac arrest (OHCA) varies widely across emergency medical service (EMS) agencies in the US. However, little is known about which EMS practices are associated with higher agency-level survival.ObjectiveTo identify resuscitation practices associated with favorable neurological survival for OHCA at EMS agencies.Design, Setting, and ParticipantsThis cohort study surveyed EMS agencies participating in the Cardiac Arrest Registry to Enhance Survival (CARES) with 10 or more OHCAs annually during January 2015 to December 2019; data analyses were performed from April to October 2023.ExposureSurvey of resuscitation practices at EMS agencies.Main Outcomes and MeasuresRisk-standardized rates of favorable neurological survival for OHCA at each EMS agency were estimated using hierarchical logistic regression. Multivariable linear regression then examined the association of EMS practices with rates of risk-standardized favorable neurological survival.ResultsOf 577 eligible EMS agencies, 470 agencies (81.5%) completed the survey. The mean (SD) rate of risk-standardized favorable neurological survival was 8.1% (1.8%). A total of 7 EMS practices across 3 domains (training, cardiopulmonary resuscitation [CPR], and transport) were associated with higher rates of risk-standardized favorable neurological survival. EMS agencies with higher favorable neurological survival rates were more likely to use simulation to assess CPR competency (β = 0.54; P = .05), perform frequent reassessment (at least once every 6 months) of CPR competency in new staff (β = 0.51; P = .04), use full multiperson scenario simulation for ongoing skills training (β = 0.48; P = .01), perform simulation training at least every 6 months (β = 0.63; P &amp;lt; .001), and conduct training in the use of mechanical CPR devices at least once annually (β = 0.43; P = .04). EMS agencies with higher risk-standardized favorable neurological survival were also more likely to use CPR feedback devices (β = 0.58; P = .007) and to transport patients to a designated cardiac arrest or ST-segment elevation myocardial infarction receiving center (β = 0.57; P = .003). Adoption of more than half (≥4) of the 7 practices was more common at EMS agencies in the highest quartile of favorable neurological survival rates (70 of 118 agencies [59.3%]) vs the lowest quartile (42 of 118 agencies [35.6%]) (P &amp;lt; .001).Conclusions and RelevanceIn a national registry for OHCA, 7 practices associated with higher rates of favorable neurological survival were identified at EMS agencies. Given wide variability in neurological survival across EMS agencies, these findings provide initial insights into EMS practices associated with top-performing EMS agencies in OHCA survival. Future studies are needed to validate these findings and identify best practices for EMS agencies.
Neighborhood Social Vulnerability and Premature Cardiovascular Disease in Haiti
Authors: Roberts Nicholas L. S. , Sufra Rodney , Yan Lily D. , St. Sauveur Reichling , Inddy Joseph , Macius Youry , Théard Michel , Lee Myung Hee , Mourra Nour , Rasul Rehana , Nash Denis , Deschamps Marie M. , Safford Monika M. , Pape Jean W. , Rouzier Vanessa , McNairy Margaret L. 
Published: June 2024

ImportanceHigher social vulnerability is associated with premature cardiovascular disease (CVD) and mortality but is understudied in low-income countries that have both the highest magnitude of social vulnerability and a growing CVD epidemic.ObjectiveTo evaluate the association between social vulnerability and hypertension, CVD, and CVD subtypes in Haiti as a model for similar low-income countries.Design, Setting, and ParticipantsThis population-based cohort study used enrollment data from adults participating in the Haiti Cardiovascular Disease Cohort Study. Recruitment occurred via multistage random sampling throughout slum and urban neighborhoods in Port-au-Prince, Haiti, from March 2019 to August 2021. Data were analyzed from May 2022 to December 2023.ExposuresA modified Haitian Social Vulnerability Index (SVI-H) was created following the US Centers for Disease Control and Prevention Social Vulnerability Index method. Twelve variables across the domains of socioeconomic status, household characteristics, and social and community context were included. The SVI-H was calculated for each study neighborhood block and then stratified into SVI-H quartiles (quartile 1 was the least vulnerable; quartile 4, the most vulnerable).Main Outcomes and MeasuresPrevalent hypertension and total CVD, defined as heart failure (HF), stroke, transient ischemic attack (TIA), angina, or myocardial infarction (MI). Age-adjusted Poisson regression analysis yielded prevalence ratios (PRs) comparing the prevalence of hypertension, total CVD, and CVD subtypes across SVI-H quartiles.ResultsAmong 2925 adults (1704 [58.3%] female; mean [SD] age, 41.9 [15.9] years), the prevalence of hypertension was 32.8% (95% CI, 31.1%-34.5%) and the prevalence of CVD was 14.7% (95% CI, 13.5%-16.0%). Hypertension prevalence ranged from 26.2% (95% CI, 23.1%-29.3%) to 38.4% (95% CI, 34.8%-42.0%) between quartiles 1 and 4, while CVD prevalence ranged from 11.1% (95% CI, 8.8%-13.3%) to 19.7% (95% CI, 16.8%-22.6%). SVI-H quartile 4 vs 1 was associated with a greater prevalence of hypertension (PR, 1.17; 95% CI, 1.02-1.34) and CVD (PR, 1.48; 95% CI, 1.16-1.89). Among CVD subtypes, SVI-H was significantly associated with HF (PR, 1.64; 95% CI, 1.23-2.18) but not with combined stroke and TIA or combined angina and MI.Conclusions and RelevanceIn urban Haiti, individuals living in neighborhoods with the highest social vulnerability had greater prevalence of hypertension and HF. Understanding CVD disparities in low-income countries is essential for targeting prevention and treatment interventions toward populations at highest risk globally.
Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery
Authors: Min Jihee , Kim Jee Ye , Ryu Jiin , Park Seho , Courneya Kerry S. , Ligibel Jennifer , Kim Seung Il , Jeon Justin Y. 
Published: June 2024

ImportanceRecovery of shoulder function following breast cancer surgery is crucial for physical functioning and quality of life. While early implementation of shoulder rehabilitation exercises may enhance recovery, the optimal timing and exercise program remain unclear.ObjectiveTo investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for 1 month through subsequent visits, could improve shoulder range of motion (ROM) and strength in patients with breast cancer.Design, Setting, and ParticipantsA parallel-group, 2-arm randomized clinical trial was conducted between June 2020 and October 2021 at the Breast Cancer Center in Seoul, South Korea. Fifty-six patients (of 119 screened) with early-stage breast cancer who were scheduled for partial or total mastectomy were randomized into a tailored resistance exercise group (n = 28) or a usual care group (n = 28). Data were analyzed from November 2021 to June 2022.InterventionsThe exercise intervention commenced 1 day postsurgery and consisted of 4 supervised exercise education sessions corresponding with surgeon visits and daily home-based exercises for the first postoperative month. Tailored programs, including stretching and strength exercises, were adjusted based on individual shoulder function recovery status.Main Outcomes and MeasuresPrimary end points were shoulder ROM and strength at 1 and 6 months postsurgery. Physical activity, body composition, and quality of life were assessed at 6 months.ResultsOf 56 patients randomized (mean [SD] age, 50.3 [6.6] years), 54 completed the trial (96%), with 100% and 97% compliance to supervised and home-based exercise sessions, respectively. At 1 month postsurgery, 19 (67.9%) in the exercise group had fully recovered shoulder strength compared to 1 (3.6%) in the usual care group (P &amp;lt; .001). At 6 months, 22 (78.6%) in the exercise group had fully recovered shoulder ROM and 24 (85.7%) had fully recovered strength compared to 6 (21.4%) and 5 (17.9%), respectively, in the usual care group (P &amp;lt; .001). The exercise group exhibited less loss in muscle mass and improved physical activity and quality of life compared to the usual care group.Conclusion and RelevanceIn this trial, 1-month tailored exercise program, initiated immediately after breast cancer surgery and supplemented with supervised sessions coinciding with surgeon visits, significantly improved shoulder function in patients with breast cancer.Trial RegistrationWHO International Clinical Trials Registry identifier: KCT0006997