bluuebunny/crossref_metadata_2025_split huggingface dataset:
The patient's choice of androgen‐deprivation therapy in locally advanced prostate cancer: bicalutamide, a gonadotrophin‐releasing hormone analogue or orchidectomy
Authors: Nyman Claes R. , Andersen Jesper T. , Lodding Per , Sandin Thorsten , Varenhorst Eberhard 
Published: October 2005

OBJECTIVETo investigate patient preference for three established androgen‐deprivation therapies for locally advanced prostate cancer; the patient's capacity to decide his therapy; the reasons for selecting a certain mode of therapy; and patient satisfaction with the chosen therapy 3 months after initiation.PATIENTS AND METHODSIn all, 150 patients (mean age 75 years, range 57–89) with previously untreated locally advanced prostate cancer from 13 hospitals were consecutively given the chance to choose between the antiandrogenic oral drug bicalutamide, a gonadotrophin‐releasing hormone analogue (GnRH) by injection, or surgical orchidectomy. After discussing the nature of their disease the patients took home written information about prostate cancer and the three different treatment options. After 1 week they were assessed using a questionnaire for biographical data, their attitude towards the different treatment alternatives and their choice of therapy. Three months later the patients completed a questionnaire about the treatment they had undergone.RESULTSSixty‐three patients (42%) chose bicalutamide, 51 (34%) the GnRH analogue and 36 (24%) orchidectomy; 87% of those choosing bicalutamide, 84% GnRH and 94% orchidectomy, respectively, were sure about their choice but 12%, 17% and 3% of the patients, respectively, had some difficulty in deciding. The most important reasons for the therapy chosen were avoidance of injections and surgery, and a lower risk of impotence (bicalutamide), negative attitude to surgery and tablets (GnRH), and avoidance of injections and tablets (orchidectomy). Almost all patients (98%, 98% and 97%, respectively) were satisfied with their choice after 3 months of treatment.CONCLUSIONThere are three equally effective forms of androgen deprivation for locally advanced prostate cancer without known metastases. There are major differences among these treatments in the mode of application and the likelihood and impact of side‐effects. When patients are fully informed and play an active role in the treatment decision they are satisfied with their decision 3 months later.
Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology
Authors: Raman Jay D. , Ng Casey K. , Boorjian Stephen A. , Vaughan E. Darracott , Sosa R. Ernest , Scherr Douglas S. 
Published: October 2005

OBJECTIVETo evaluate patients with a history of transitional cell carcinoma (TCC) of the upper urinary tract (UUT) to determine the incidence, pathological distribution, and risk factors for developing subsequent bladder tumours.PATIENTS AND METHODSBetween 1993 and 2003, 103 patients were treated at our institution for UUT‐TCC. We reviewed demographic, clinical, surgical, and pathological data from these patients at a median follow‐up of 38.7 months, and used univariate and multivariate analyses with logistic regression modelling to determine prognostic variables for bladder recurrences.RESULTSIn all, 51 (49.5%) patients developed bladder tumours after treatment for UUT‐TCC, at a mean interval of 13.2 months. Patient age (P = 0.01), UUT tumour size (P = 0.03), UUT tumour multifocality (P = 0.05), a history of bladder tumours (P = 0.03), and the number of previous bladder tumours (P = 0.05) predicted the development of bladder recurrences on univariate analysis. On multivariate analysis, only a previous history of bladder tumours (odds ratio 2.6, P = 0.05) remained significant. Over 90% of the recurrent bladder tumours were superficial, with two‐thirds of these being low to moderate grade. Six patients had muscle‐invasive disease, and five had a cystectomy.CONCLUSIONBladder tumours occurred in half the patients after treatment for UUT‐TCC; >60% of these subsequent bladder tumours were superficial, low‐ to moderate‐grade lesions. Neither the pathology of the UUT tumours nor the method of treatment for the UUT disease was associated with recurrent bladder tumours. Only a history of bladder cancer predicted the development of subsequent bladder tumours.
Sperm concentration and normal sperm morphology decrease and follicle‐stimulating hormone level increases with age
Authors: Pasqualotto Fábio F. , Sobreiro Bernardo P. , Hallak Jorge , Pasqualotto Eleonora B. , Lucon Antônio M. 
Published: October 2005

OBJECTIVETo assess hormone levels, testicular volume, and semen characteristics of fertile men of various age groups.PATIENTS AND METHODSThe records of 889 men who sought a vasectomy between September 1999 and March 2003 were reviewed. Patients were divided into five groups by age; we evaluated semen volume, sperm concentration, motility, morphology and complex sperm motion variables. Follicle‐stimulating hormone (FSH), luteinizing hormone (LH), testosterone levels and both testicular volumes were compared.RESULTSThere were no differences among the groups in the levels of LH, testosterone, or right and left testicular volumes. There were differences among the five groups in FSH levels, semen volume, sperm concentration and motility. Normal morphology according to the World Health Organisation criteria was significantly lower in patients aged >45 years. From a linear regression analysis, semen volume, sperm concentration and motility decreased by 0.01 mL, 2.1%, and 0.27%, respectively, per year, and the FSH level increased by 0.27%.CONCLUSIONSSperm concentration and motility decrease and FSH levels increase with age. Normal sperm morphology decreases from 45 years old. Thus, the ageing effect should be considered when proposing standard values for semen characteristics in routine semen analysis.
Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi
Authors: Marguet Charles G. , Springhart W. Patrick , Tan Yeh H. , Patel Anup , Undre Shabnam , Albala David M. , Preminger Glenn M. 
Published: October 2005

In a joint study between Duke University, North Carolina and London, a simultaneous combination of flexible ureteroscopy and percutaneous nephrolithotomy was used to reduce the number of access tracts required to manage complex renal calculi. This was found to be an effective method which reduced morbidity and blood loss, without increasing operating time, but without increasing stone‐free rates.Authors from the USA carried out an experimental study to determine whether an electrode array with a bipolar radiofrequency ablation energy source could be used for partial nephrectomy, simultaneously ablating and coagulating renal tissue. They found that this system could indeed be used in a bloodless fashion with no collecting system injury.OBJECTIVETo present early experience in managing complex renal calculi using a combined ureteroscopic and percutaneous approach, as complex and branched renal calculi often require multiple access tracts during percutaneous nephrolithotomy (PNL), and the combined use of flexible ureteroscopy and PNL has the potential to reduce the inherent morbidity of several tracts.PATIENTS AND METHODSThe study included seven patients (mean age 54 years) with multiple, branched, large‐volume renal calculi suitable for management with PNL. Preoperative data, including patient demographics, stone location and stone surface area, were recorded. After informed consent, the patients underwent combined PNL and ureteroscopy in one session. Intraoperative data, including the location of PNL puncture sites, operative duration and complications, were analysed. Stone‐free rates were determined by follow‐up imaging at 3 months.RESULTSAll patients had either two or more stones in separate locations in the collecting system, or staghorn stones involving multiple calyces. The mean stone burden was 666 mm2. All patients had only one percutaneous access tract. The mean operative duration was 142 min and the mean blood loss 79 mL. Two patients had small residual stones (<3 mm), that required ureteroscopic intervention as they failed to pass spontaneously by 3 months after the initial combined procedure. The convalescence was similar to that in our current PNL practice; imaging showed that five of the patients were stone‐free.CONCLUSIONSCombined PNL and ureteroscopic management can effectively reduce the number of percutaneous access tracts which would otherwise be required for managing complex and branched renal calculi, as stones in an unfavourable location relative to the access tract can be relocated and fragmented within easy reach of the single nephrostomy tract. This manoeuvre reduces potential patient morbidity and blood loss but with no significant effect on stone‐free rates and operative durations.
Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya
Authors: Krieger John N. , Bailey Robert C. , Opeya John , Ayieko Benard , Opiyo Felix , Agot Kawango , Parker Corette , Ndinya‐Achola Jeckoniah O. , Magoha George A.O. , Moses Stephen 
Published: October 2005

In a combined study from the USA and Kenya, the safety of adult male circumcision in the latter country was reviewed, particularly with the purported association between this procedure and a lower incidence of HIV and other sexually‐transmitted infections. It was found that safe and acceptable adult male circumcision services could be delivered in developing countries should this be advocated as a public health measure.OBJECTIVETo develop a standard procedure for male circumcision in a resource‐poor medical setting and prospectively evaluate the outcome in a randomized, controlled trial with the incidence of human immunodeficiency virus (HIV) as the main outcome, as studies suggest that circumcision is associated with a lower incidence of HIV and other sexually transmitted infections in high‐risk populations.SUBJECTS AND METHODSHealthy, uncircumcised, HIV‐seronegative men aged 18–24 years from Kisumu District, Kenya, were offered participation in a clinical trial using a standard circumcision procedure based on ‘usual’ medical procedures in Western Kenya. The follow‐up included visits at 3, 8 and 30 days after circumcision, with additional visits if necessary. Healing, satisfaction and resumption of activities were assessed at these visits and 3 months from randomization.RESULTSOverall, 17 (3.5%) of the 479 circumcisions were associated with adverse events judged definitely, probably or possibly related to the procedure. The most common adverse events were wound infections (1.3%), bleeding (0.8%), and delayed wound healing or suture line disruption (0.8%). After 30 days, 99% of participants reported being very satisfied with the procedure; ≈ 23% reported having had sex and 15% reported that their partners had expressed an opinion, all of whom were very satisfied with the outcome. About 96% of the men resumed normal general activities within the first week after the procedure.CONCLUSIONSafe and acceptable adult male circumcision services can be delivered in developing countries should male circumcision ultimately be advocated as a public‐health measure.
The effects of α1A‐adrenoceptor antagonists on the urethral perfusion pressure of the female rat
Authors: Bae Jae‐Hyun , Jung Phil‐Bum , Lee Jeong‐Gu 
Published: October 2005

OBJECTIVETo assess the effects of α1A‐adrenoceptor antagonists on urethral perfusion pressure (UPP) in the female rate and their therapeutic potential for treating female bladder outlet obstruction (BOO).MATERIALS AND METHODSA cannula was inserted into the femoral arteries of female rats to administer tamsulosin (group I), doxazosin (group II) or phentolamine (group III) and to monitor systemic blood pressure. Tamsulosin was also administered to male rats (group IV). UPP and vesical pressures (Pves) were monitored using a triple‐lumen catheter.RESULTSAfter administration of tamsulosin to group I the frequency of bladder contractions decreased significantly and the duration of minimal urethral relaxation with high‐frequency oscillations (HFOs) was significantly prolonged. Except for mean arterial blood pressure (MAP), none of the variables in group I differed significantly from those in group II and group III. The change in MAP after tamsulosin treatment was significantly lower than after doxazosin or phentolamine. Except for the maximum Pves, which was significantly higher in males (group IV) than in females of group I, the UPP and Pves curves of male rats were similar to those of females before giving tamsulosin. The prolonged frequency and duration of HFO in group IV (with tamsulosin) were significantly different from those of females.CONCLUSIONSThe α1A‐adrenergic receptor may be a functional subtype in the female rat urethra. α1A‐adrenoceptor antagonists prolonged the duration of HFOs and decreased the frequency of involuntary bladder contraction. It is possible that treatment with α1A‐adrenoceptor antagonists would not only improve obstructive symptoms, but also ameliorate irritative symptoms by prolonging HFOs and the frequency of involuntary bladder contractions.
Operations Research in passenger railway transportation
Authors: Huisman Dennis , Kroon Leo G. , Lentink Ramon M. , Vromans Michiel J. C. M. 
Published: October 2005

In this paper we give an overview of state‐of‐the‐art Operations Research models and techniques used in passenger railway transportation. For each planning phase (strategic, tactical and operational), we describe the planning problems arising there and discuss some models and algorithms to solve them. We do not only consider classical, well‐known topics such as timetabling, rolling stock scheduling and crew scheduling, but we also discuss some recently developed topics such as shunting and reliability of timetables.Finally, we focus on several practical aspects for each of these problems at the largest Dutch railway operator, NS Reizigers.
Left Ventricular Epicardial Activation Increases Transmural Dispersion of Repolarization in Healthy, Long QT, and Dilated Cardiomyopathy Dogs
Authors: BAI RONG , LÜ JIAGAO , PU JUN , LIU NIAN , ZHOU QIANG , RUAN YANFEI , NIU HUIYAN , ZHANG CUNTAI , WANG LIN , KAM RUTH 
Published: October 2005

Background: Benefits of cardiac resynchronization therapy (CRT) are well established. However, less is understood concerning its effects on myocardial repolarization and the potential proarrhythmic risk.
Methods and Results: Healthy dogs (n = 8) were compared to a long QT interval (LQT) model (n = 8, induced by cesium chloride, CsCl) and a dilated cardiomyopathy with congestive heart failure (DCM‐CHF, induced by rapid ventricular pacing, n = 5). Monophasic action potential (MAP) recordings were obtained from the subendocardium, midmyocardium, subepicardium, and the transmural dispersion of repolarization (TDR) was calculated. The QT interval and the interval from the peak to the end of the T wave (Tp‐e) were measured. All these characteristics were compared during left ventricular epicardial (LV‐Epi), right ventricular endocardial (RV‐Endo), and biventricular (Bi‐V) pacing. In healthy dogs, TDR prolonged to 37.54 ms for Bi‐V pacing and to 47.16 ms for LV‐Epi pacing as compared to 26.75 ms for RV‐Endo pacing (P < 0.001), which was parallel to an augmentation in Tp‐e interval (Bi‐V pacing, 64.29 ms; LV‐Epi pacing, 57.89 ms; RV‐Endo pacing, 50.29 ms; P < 0.01). During CsCl exposure, Bi‐V and LV‐Epi pacing prolonged MAPD, TDR, and Tp‐e interval as compared to RV‐Endo pacing. The midmyocardial MAPD (276.30 ms vs 257.35 ms, P < 0.0001) and TDR (33.80 ms vs 27.58 ms, P=0.002) were significantly longer in DCM‐CHF dogs than those in healthy dogs. LV‐Epi and Bi‐V pacing further prolonged the MAPD and TDR in this model.
Conclusions: LV‐Epi and Bi‐V pacing result in prolongation of ventricular repolarization time, and increase of TDR accounted for a parallel augmentation of the Tp‐e interval, which provides evidence that Tp‐e interval accurately represents TDR. These effects are magnified in the LQT and DCM‐CHF canine models in addition to their intrinsic transmural heterogeneity in the intact heart. This mechanism may contribute to the development of malignant ventricular arrhythmias, such as torsades de pointes (TdP) in congestive heart failure (CHF) patients treated with CRT.
Artificial Attenuation of ECG Voltage Produces Shortening of the Corresponding QRS Duration: Clinical Implications for Patients with Edema
Authors: MADIAS JOHN E. , MACFARLANE PETER W. 
Published: October 2005

Background: Prolonged QRS duration (QRSd) is a useful index for the management of patients with congestive heart failure (CHF). QRSd is affected by changes in the ECG voltage (ECGV) in the context of development and amelioration of peripheral edema (PERE), independent of underlying pathology. Nowadays, physicians accept QRSd measured by computer techniques. The latter offers the possibility of testing the hypothesis that artificial alteration of the ECGV, simulating effects of PERE, could lead to changes in the QRSd.
Methods: To this end, voltage was attenuated by 25%, 50%, and 75% in 100 digital ECGs recorded from normal subjects and in 20 patients with complete left bundle branch block (LBBB), by merely increasing the calibration strength by 4/3, 2, and 4, respectively, and by using the same data.
Results: All ECGs were analyzed by the same computer program and this led to a reduction of global QRSd by 2.3 ± 2.9%, 5.7 ± 4.0%, and 11.9 ± 6.2%, respectively, in the normal subjects, and 1.6 ± 1.4%, 3.4 ± 1.7%, and 8.2 ± 3.6%, respectively, in the patients with LBBB. Correlation of the percent change in the global QRSd and the percent change in ECGV was good with an r = 0.65, and P = 0.00005 in the normal subjects, and an r = 0.74 and P = 0.00005 in the patients with LBBB.
Conclusions: Apparent shortening in QRSd as a function of ECGV attenuation due to PERE could have implications in the follow‐up of patients with CHF, and their selection for implantable cardioverter/defibrillators, or cardiac resynchronization therapy.
Severe Left Ventricular Systolic Dysfunction Increases Atrial Fibrillation After Ablation of Atrial Flutter
Authors: ZAMBITO PETER E. , TALREJA ASHOK , GUNDEWAR SUSHEEL , FISHER JOHN , FERRICK KEVIN , GROSS JAY , KIM SOO , PALMA EUGEN C. 
Published: October 2005

Background: Atrial fibrillation (Afib) that occurs after a successful atrial flutter (AFL) ablation may negate the potential benefits of the ablation. Afib occurs more often when severe left ventricular systolic dysfunction (LVSD) is present. We hypothesized that even after a successful AFL ablation, the incidence of postablation Afib is increased when severe LVSD is present.
Methods: Ninety consecutive patients with LVSD who underwent ablation for AFL at Montefiore Medical Center from August 2001 to January 2005 were classified according to the severity of LVSD. Group 1 (n = 36) consisted of patients with EF ≤ 35%, and group 2 (n = 54) consisted of patients with EF 36–55%. There were no statistically significant differences in baseline patient characteristics between the two groups.
Results: During a mean follow up of 350 days, Afib occurred in 31% (n = 11; 8 with prior history of AFib) in group 1, and 7.4% (n = 4; all with prior history of Afib) in group 2. Cumulative probability of remaining Afib‐free in group 1 versus group 2 was 75% versus 96% at 365 days, and 69% versus 91% at 600 days (P = 0.01). A prior history of Afib did not interact with EF when analyzed with a logistic regression analysis.
Conclusion: After an AFL ablation, the incidence of Afib is increased, and the probability of remaining free of Afib is decreased, when severe LVSD is present, independent of a prior history of Afib. This finding may have implications for optimal patient selection for AFL ablation, and the use of adjunctive therapies.
Comparison of the Efficacy of Cooled‐Tip and 8‐mm‐Tip Catheters for Radiofrequency Catheter Ablation of the Cavotricuspid Isthmus: A Meta‐Analysis
Authors: DA COSTA ANTOINE , CUCHERAT MICHEL , PICHON NATHALIE , MESSIER MARC , LAPORTE SYLVIE , ROMÉYER‐BOUCHARD CÉCILE , MISMETTI PATRICK , LOPEZ MICHEL , ISAAZ KARL 
Published: October 2005

Background: Cooled‐tip RFA (cRFA) and conventional 8‐mm‐tip catheters were found to be more effective and as safe as conventional 4‐mm‐tip catheters for atrial flutter (AFL) radiofrequency ablation (RFA), facilitating the rapid achievement of bi‐directional isthmus block (BIB), but studies comparing cRFA and 8‐mm‐tip catheters are not randomized or results are discussed. Thus, we performed a meta‐analysis of available randomized trials to evaluate the effectiveness in terms of primary success and procedure parameters.
Methods: Reports of trials were identified through a Medline, Embase, Current Contents, Cardline, and an extensive bibliography search. Trials that met the following criteria were included: (1) prospective, randomized, controlled, and open trials; (2) patients assigned to an 8‐mm‐tip or a cRFA catheter for AFL RFA; (3) endpoints events related to primary success rate (BIB achievement), and procedure parameters (number of RF applications, x‐ray exposure and ablation duration).
Results: Seven trials met the inclusion criteria. They included 603 patients with established AFL randomized to an 8‐mm‐tip or cRFA catheter group. Comparing 8‐mm groups with cRFA groups, the meta‐analysis showed similar BIB achievement relative risk (RR) 0.96, 95% confidence interval (CI): 0.92 to 1.01, (P = 0.13); total RF application time weighted mean difference (WMD) 0.88, 95% CI: −0.36 to 2.12, (P = 0.16); duration of x‐ray exposure (min) (WMD = 1.07, 95% CI: −0.81 to 0.295, (P = 0.26); ablation procedure duration (min) (WMD = 0.68, 95% CI: −3.37 to 4.73; P = 0.74).
Conclusion: The present meta‐analysis confirms that cooled‐tip and large‐tip catheters are equally efficient for cavotricuspid isthmus ablation with both similar primary success rates and procedure parameters.
Automated Ventricular Substrate Mapping—Evaluation in an Ovine Chronic Myocardial Infarction Model
Authors: THIAGALINGAM ARAVINDA , POULIOPOULOS JIM , BARRY MICHAEL ANTHONY (TONY) , BOYD ANITA C. , EIPPER VICKI E. , YUNG TERESA , MACLEAN FIONA , ROSS DAVID L. , KOVOOR PRAMESH 
Published: October 2005

Introduction: We hypothesized that automated electrogram analysis might enable rapid localization of ventricular scar. This would allow the delivery of interventions such as radiofrequency ablation or therapeutic agents to critical areas within the scar and scar periphery.
Methods: Substrate mapping was performed on seven sheep 36.5 ± 32.9 weeks after a left anterior descending artery myocardial infarction had been induced. Contact electrograms and the mapping catheter three‐dimensional (3D) location were recorded simultaneously. A computer program was written in‐house to automatically identify sinus beats, analyze electrogram characteristics (e.g., electrogram amplitude and minimum slope), and integrate the analysis results into a 3D scar map.
Results: The total time required to produce the scar maps was a mean of 8.3 ± 2.0 minutes. The automated substrate mapping (ASM) system beat detection algorithm had a high sensitivity (i.e., detected 87.4% of the recorded beats) and excellent specificity (only one false activation over 58.2 minutes of total recorded data). The system was able to classify the detected beats (‘sinus’ or ‘ectopic’) with high specificity (specificity = 97.3% confidence interval (CI): 96.9–97.7) and moderate sensitivity (sensitivity = 78.3% CI: 77.3%–79.5%). The scar area identified by the ASM system correlated well with the pathologically defined scar area (R2= 0.87 p < 0.001).
Conclusions: ASM enables accurate scar maps to be produced rapidly. This strategy may play an important role for both clinical and research applications, allowing therapeutic agents and radiofrequency ablation to be delivered to critical locations in and around ventricular scar.