bluuebunny/crossref_metadata_2025_split huggingface dataset:
A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population‐based study
Authors: Capitanio Umberto , Cloutier Vincent , Zini Laurent , Isbarn Hendrik , Jeldres Claudio , Shariat Shahrokh F. , Perrotte Paul , Antebi Elie , Patard Jean‐Jacques , Montorsi Francesco , Karakiewicz Pierre I. 
Published: December 2008

OBJECTIVETo assess the magnitude of the effect of histological subtype (HS, the three most common being clear cell, papillary and chromophobe) on cause‐specific mortality (CSM) from renal cell carcinoma (RCC).PATIENTS AND METHODSUnivariable and multivariable Cox regression models included data from 11 618 patients treated with nephrectomy between 1988 and 2004 in nine Surveillance Epidemiology and End Results registries. We tested whether HS represents an independent predictor of CSM, and whether HS adds to the ability of other variables to predict CSM. The covariates comprised age, year of surgery, T stage, nodal status, M stage and Fuhrman grade.RESULTSIn a multivariable model predicting CSM, HS was an independent predictor (P = 0.03), but failed to improve the accuracy of the model (+0.1% gain when HS was included in the model).CONCLUSIONAlthough we confirmed that HS is an independent predictor for CSM, there was no gain in accuracy when HS was added to standard predictors of CSM. From a practical perspective, this implies that patients with clear cell, papillary and chromophobe HS share similar natural histories after nephrectomy, provided that other cancer characteristics are accounted for. From a statistical perspective, in multivariable models of CSM, the clear cell, papillary and chromophobe HS might be included as a single entity.
A 6‐year analysis of the clinicopathological profile of patients with prostate cancer at the University Hospital of the West Indies, Jamaica
Authors: Coard Kathleen C.M. , Skeete Desiree H‐A. 
Published: December 2008

OBJECTIVETo document the clinicopathological characteristics of prostate cancer in a public hospital‐based population in Jamaica, over a 6‐year period, and examine any trends in these characteristics over time, as prostate cancer is the leading cause of cancer in Jamaican men, but there are few published reports documenting the clinicopathological profile of this disease in the Jamaican population.PATIENTS AND METHODSAll patients consecutively diagnosed with prostate cancer by transrectal ultrasonography‐guided biopsy at the University Hospital of the West Indies, from January 2000 to December 2005, were identified at time of diagnosis, and relevant clinical and pathological data collected from the accompanying histopathology request forms.RESULTSThere were 529 cases of prostate cancer diagnosed over the 6 years. The mean (sd) age was 70.66 (8.74) years, with 137 patients aged 70–74 years. A serum prostate‐specific antigen (PSA) level was obtained for 490 (92.6%) patients. Of these, an accurate PSA value was available for 456 (86.2%) patients and a ‘minimum level’ recorded for the remaining 34, all of whom had a PSA level of >100 ng/mL. Of the patients with available PSA information, only 91 (18.5%) had a level of ≤10.0 ng/mL. By contrast, 155 (31.6%) patients had levels of >100 ng/mL. The median (range, interquartile range) serum PSA level for those patients with accurate values was 30.7 (1–14 260, 11.7–109) ng/mL. Histologically, moderately and poorly differentiated cancers accounted for 198 (37.5%) and 160 (30.2%) cases, respectively. Correlation of the variables under investigation confirmed that there was a statistically significant positive and moderate correlation between serum PSA level and Gleason score (Spearman r 0.49; P < 0.001). Statistical analysis of all other variables, including the number of cases of prostate cancer diagnosed annually, showed no significant differences.CONCLUSIONCompared with many countries, including some in the Caribbean, prostate cancer in Jamaican men is diagnosed when they are older and these patients have significantly higher PSA levels at diagnosis, suggesting more advanced disease. Despite increasing public awareness of prostate cancer, it appears that there has been no significant change in the profile of patients with prostate cancer, at the time of diagnosis, over the last 6 years, findings consistent with the absence of an organized screening programme for prostate cancer in Jamaica.
An analysis of the causes of bladder neck contracture after open and robot‐assisted laparoscopic radical prostatectomy
Authors: Webb David R. , Sethi Kapil , Gee Kiera 
Published: December 2008

OBJECTIVESTo evaluate the difference in outcome of bladder neck contracture (BNC) and its causes between large groups of patients undergoing open radical prostatectomy (ORP) and robot‐assisted laparoscopic prostatectomy (RALP).PATIENTS AND METHODSWe analysed 200 consecutive RPs performed by one surgeon for prostate cancer, 100 by ORP and 100 by RALP, between March 2003 and September 2007. The operative techniques of bladder neck repair and urethro‐vesical anastomosis were different. The ORP patients had a conventional stomatization and ‘racquet handle’ repair of the bladder if necessary, with mucosal eversion and a direct circular interrupted ‘end‐to‐end’ suture anastomosis between the bladder and urethra. The RALP patients had no bladder neck reconstruction or mucosal eversion and their anastomosis was by the continuous suture ‘parachute’ technique.RESULTSThere was no BNC in the RALP group, whilst 9% of the ORP group developed a BNC (P < 0.005). Apart from surgical technique, other variables, including patient age, previous transurethral resection of the prostate, Gleason score, T stage, urine infection rate, urinary leakage, blood loss, drain tube removal, anastomotic suture material, catheter type and catheter removal times were statistically comparable in both groups.CONCLUSIONThis series suggests that the major factor involved in the cause of bladder neck contracture after ORP, relates to the stomatization or ‘racquet handle’ bladder neck repair, and the end‐to‐end anastomosis between the urethra and stomatized bladder. Mucosal eversion might also contribute. Normal postoperative urinary leakage when the anastomotic apposition is good seems unlikely to be a significant aetiological factor in the development of BNC. Prolonged urinary leakage results from an anastomotic gap, which heals by second intention, thereby causing scarring and BNC. The RALP ‘parachute’ technique, which expands the anastomosis towards the bladder, appears to protect against BNC. Mucosal eversion is not necessary in the parachute repair.
Outcome of radical prostatectomy for incidental carcinoma of the prostate
Authors: Melchior Sebastian , Hadaschik Boris , Thüroff Sebastian , Thomas Christian , Gillitzer Rolf , Thüroff Joachim 
Published: December 2008

OBJECTIVETo evaluate a contemporary series of patients with incidental prostate cancer detected by transurethral resection of the prostate (TURP) and undergoing radical prostatectomy (RP).PATIENTS AND METHODSBetween 1998 and 2004, 1931 patients had TURP for obstructive voiding symptoms and suspected BPH. Incidental prostate cancer was found in 104 (5.4%); 26 of these patients had a RP. The pathological staging and treatment of these patients were reviewed retrospectively and the follow‐up results obtained.RESULTSOf the 26 patients who had RP, 17 had T1a and nine had T1b carcinoma of the prostate. After RP, six (35%) in the T1a group had no residual tumour (pT0) and 11 (65%) had pT2 cancer; the respective incidence in those with T1b was two and seven, with no pT3 disease in either group. The preoperative Gleason grading did not correspond well with that after RP; 30% of the patients had upgraded Gleason scores and 42% showed either downgrading or no residual tumour, with 81% having Gleason scores of <7. After a median follow‐up of 47 months, one patient is receiving hormonal therapy because of biochemical relapse.ConclusionSubsequent to stringent PSA testing and prostate biopsy when indicated, the rate of incidental prostate cancer is low. Furthermore, substantially many patients will harbour either no residual cancer or tumours with favourable characteristics in their RP specimens. However, there is currently no possibility to reliably predict the absence of aggressive prostate cancer after TURP, and thus safely recommend observation instead of further therapy. Therefore, patients with incidental prostate cancer need to be counselled individually. The decision ‘treatment or no treatment’ should be determined by the patients’ age and life‐expectancy, tumour aggressiveness in the TURP specimen and the prostate‐specific antigen level after TURP.
The Historiography of Sectarianism in Lebanon
Authors: Weiss Max 
Published: December 2008

AbstractLebanese history has been more or less defined by its engagement with the problem of sectarianism. Surprisingly rare have been the attempts to systematically trace this trajectory of historical engagement with the problem of sectarianism, though. This article argues that historians, legal scholars, and other writers have employed numerous conceptual and methodological approaches to examine, diagnose, and propose treatments for the problem of sectarianism, and that these approaches, moreover, have changed over time. Ranging from defenses of sectarianism as cultural specificity to condemnations of it as a foreign plot to divide and rule, the historiography of sectarianism in Lebanon has relied on such diverse fields as social science, constitutional law, political theory, and various kinds of historicism. Unfortunately, despite this empirical density, intellectual, legal, and historical discourses on sectarianism have failed to mitigate the material, political, and, most importantly, human costs incurred by the phenomenon of sectarianism in practice.
Measuring Quality of Care in Syncope: Case Definition Affects Reported Electrocardiogram Use but Does Not Bias Reporting
Authors: Schuur Jeremiah D. , Justice Amy 
Published: December 2008

AbstractObjectives:  The objective was to calculate agreement between syncope as a reason for visiting (RFV) an emergency department (ED) and as a discharge diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD‐9]), to determine whether syncope case definition biases reported electrocardiogram (ECG) usage, a national quality measure.Methods:  The authors analyzed the ED portion of the National Hospital Ambulatory Medical Care Survey (NHAMCS), 1993–2004, for patients age ≥18 years. A visit was defined as being for syncope if it received one of three RFV or ICD‐9 codes. Agreement between RFV and ICD‐9 codes was calculated, and the percentages of syncope patients (RFV vs. ICD‐9) who had an ECG were compared using chi‐square and multivariate logistic regression.Results:  Raw agreement between syncope as an RFV and as an ICD‐9 diagnosis code was 30.1% (95% confidence interval [CI] = 32.6% to 35.5%), representing only moderate agreement beyond chance (κ = 0.50). ECG utilization was lower among visits defined by RFV (64.1%; 95% CI = 62.0% to 66.3%) than for ICD‐9 diagnosis (73.6%; 95% CI = 71.4% to 75.8%). There was no meaningful variation in adjusted ECG use by patient, visit, or hospital characteristics between case definitions. Adjusted ECG use was lower under both case definitions among female patients and discharged patients and increased with age (p < 0.05).Conclusions:  Despite only moderate agreement, syncope case definition should not bias reported ECG rate by patient, visit, or hospital characteristics. Among ED patients with syncope, ECG is performed less frequently in women, a potentially important disparity.
Pediatric Procedural Sedation with Ketamine: Time to Discharge after Intramuscular versus Intravenous Administration
Authors: Ramaswamy Preeti , Babl Franz E. , Deasy Conor , Sharwood Lisa N. 
Published: December 2008

AbstractObjectives:  Ketamine is an attractive agent for pediatric procedural sedation. There are limited data on time to discharge comparing intramuscular (IM) vs. intravenous (IV) ketamine. The authors set out to determine whether IM or IV ketamine leads to quicker discharge from the emergency department (ED) and how side effect profiles compare.Methods:  All patients who had received ketamine IM or IV at a tertiary children’s hospital ED during the 3‐year study period (2004–2007) were identified. Prospective sedation registry data, retrospective medical records, and administrative data were reviewed for drug dosages, use of additional agents, time of drug administration to discharge, total ED time (triage to discharge), and adverse events. A subgroup analysis for patients requiring five or fewer sutures (short suture group) was performed.Results:  A total of 229 patients were enrolled (60% male) with median age of 2.8 years (IQR =1.8–4.3 years) and median weight of 15.7 kg (range = 8.7–74 kg). Ketamine was most frequently employed for laceration repair (80%) and foreign body removal (9%). Overall, 48% received ketamine IM and 52% received it IV. In the short‐suture subgroup, 52% received ketamine IM, while 48% received it IV. Multivariate linear regression analysis determined time from drug administration to patient discharge as 21 minutes shorter for IV compared with IM administration, adjusted for age and number of additional doses (R2 = −0.35; 95% CI = −0.5 to −0.19; p < 0.001). Total time in the ED (triage to discharge) comparing IV versus IM administration, adjusting for age and gender and number of additional doses, was not significantly different (p = 0.16). In the short‐suture subgroup, time to discharge from administration was also shorter in the IV ketamine group (R2 = −0.454; 95%CI = −0.66 to −0.25; p < 0.001) but similar for total time in ED (p = 0.16). Overall, adverse events occurred in 35% (95% CI = 27% to 45%) of the IM group and 20% (95% CI = 13% to 28%) of the IV group (p = 0.01). Only one patient required brief bag‐mask ventilation.Conclusions:  In this institution, time from drug injection to discharge was shorter in the IV compared to IM ketamine group, both overall and for the short‐suture group. However, time from triage to discharge was similar.
Virtue in Emergency Medicine
Authors: Larkin Gregory Luke , Iserson Kenneth , Kassutto Zach , Freas Glenn , Delaney Kathy , Krimm John , Schmidt Terri , Simon Jeremy , Calkins Anne , Adams James 
Published: December 2008

AbstractAt a time in which the integrity of the medical profession is perceptibly challenged, emergency physicians (EPs) have an opportunity to reaffirm their commitment to both their patients and their practice through acceptance of a virtue‐based ethic. The virtue‐based ethic transcends legalistic rule following and the blind application of principles. Instead, virtue honors the humanity of patients and the high standards of the profession. Recognizing historical roots that are relevant to the modern context, this article describes 10 core virtues important for EPs. In addition to the long‐recognized virtues of prudence, courage, temperance, and justice, 6 additional virtues are offered unconditional positive regard, charity, compassion, trustworthiness, vigilance, and agility. These virtues might serve as ideals to which all EPs can strive. Through these, the honor of the profession will be maintained, the trust of patients will be preserved, and the integrity of the specialty will be promoted.
Leaf nutrient content and host plant selection by leaf‐cutter ants, Atta laevigata, in a Neotropical savanna
Authors: Mundim Fabiane M. , Costa Alan N. , Vasconcelos Heraldo L. 
Published: December 2008

AbstractThe selection of nutrient‐rich leaves by leaf‐cutter ants (Atta spp.) is thought to be of indirect benefit to these ants by promoting the growth of their symbiotic fungus. However, relatively few studies have analyzed the influence of leaf nutrient content on host plant selection by leaf‐cutter ants, and conflicting results have been found. We compared the content of eight nutritional elements plus the non‐nutrient aluminum between leaves harvested by colonies of Atta laevigata (Smith) (Hymenoptera: Formicidae: Attini) and leaves collected randomly within their foraging areas. In addition, we evaluated whether leaf nutrient content explained the frequency with which these ants attacked and defoliated some of the tree species found in the study area. For 2 years, we monitored 17–26 trees from 15 species and determined the number of times each plant was attacked and the amount and type of foliage removed. Leaves harvested by A. laevigata presented significantly higher concentrations of N, P, K, Zn, and Cu than those collected randomly. This result is likely to reflect the foraging pattern presented by these ants, which were selective both in terms of the plant species and age of leaves most commonly attacked. Young leaves were the only or the main leaf type exploited in many species, and in comparison to mature leaves these presented significantly higher concentrations of P and K. Large differences in the mean number of ant attacks on the tree species studied were also observed, and those presenting more leaf N tended to be the most frequently attacked.
Fruit abscission by Physalis species as defense against frugivory
Authors: Benda Nicole D. , Brownie Cavell , Schal Coby , Gould Fred 
Published: December 2008

AbstractFruit abscission as a response to herbivory is well‐documented in many plant species, but its effect on further damage by mobile herbivores that survive fruit abscission is relatively unstudied. Physalis plants (Solanaceae) abscise fruit containing feeding larvae of their main frugivore, Heliothis subflexa Guenée (Lepidoptera: Noctuidae), a specialist moth. We tested the ability of H. subflexa larvae placed under the plant canopy to find and climb onto two architecturally different Physalis species. Physalis pubescens L., a low, shrub‐like, spreading plant, abscises its fruit at a higher rate than Physalis angulata L., a tall arborescent plant. As a result, small larvae are more often dropped from P. pubescens. Third and fifth instars located P. pubescens faster and with a higher probability than P. angulata. Although fifth instars outperformed third‐instar caterpillars at finding P. angulata, P. pubescens was located equally fast by the two instars. Heliothis subflexa located Physalis plants more successfully and more quickly than a close relative, the generalist Heliothis virescens Fabricius. The higher fruit abscission rates in P. pubescens may be an evolved response to its greater susceptibility to searching caterpillars.
Influence of genetic variation in the fungal endophyte of a grass on an herbivore and its parasitoid
Authors: Bultman Thomas L. , Rodstrom John L. , Radabaugh Kara R. , VanDop Joshua D. , Librizzi James M. , Longwell Leanna L. , Pulas Christina , Grant LaShawn , Sullivan Terrence J. 
Published: December 2008

Abstract Neotyphodium coenophialum (Glenn, Bacon, Price & Hanlin) (Ascomycota: Clavicipitaceae) is an endophytic fungus that lives symbiotically within grasses and produces alkaloids that can help protect its hosts from some insect pests. We used laboratory‐based experiments to investigate whether fungal genotype influences an herbivore and its parasitoid. We tested whether variation in novel isolates, plus a control lacking fungal infection, affected preference by fall armyworm, Spodoptera frugiperda (Smith) (Lepidoptera: Noctuidae: Amphipyrini), and growth and survival of Euplectrus comstockii Howard (Hymenoptera: Eulophidae: Euplectrini), a parasitoid of fall armyworm. Caterpillars preferred leaf blades in choice experiments from uninfected tall fescue [Lolium arundinaceum (Schreb.) Darbysh., cultivar Jesup (Poaceae)] and tended to avoid blades from plants containing fungal isolates AR502, AR542, or the most common strain from pastures in Georgia, USA, in tall fescue. However, caterpillars fed as much on leaf blades from plants containing isolate AR502 as from those lacking infection. Parasitoid pupal mass was not influenced by fungal isolate, yet fungal isolate did influence parasitoid survival. Survival was higher than expected for parasitoids reared from hosts fed plants lacking fungal infection, but was lower than expected for those reared from hosts fed plants infected with the common strain or AR542 isolates. In contrast, parasitoids reared from hosts fed plants infected with isolate AR502 did not experience higher mortality than expected by chance. Our results show that N. coenophialum can modify bottom‐up trophic cascades through direct effects on herbivores, as well as indirect effects on a natural enemy of the herbivores and that the fungus may influence the tritrophic interaction in ways that counterbalance herbivore protection provided by the symbiont. Our work also shows that these effects are influenced by fungal genotype. As attempts are made to produce forage cultivars with strains of fungal endophyte that lack negative influences on livestock, it will be prudent for investigators to assess the multi‐trophic effects of these novel associations within agroecosystems.
High food commodity prices: will they stay? who will pay?
Authors: Dewbre Joe , Giner Céline , Thompson Wyatt , Von Lampe Martin 
Published: December 2008

AbstractMuch of the public discussion of the food price crisis has focused on the sharply increased use of food commodities for biofuel production, framing debate in simple food versus fuel terms. Reality is more complex. Multiple forces drove food prices to high levels and, according to findings we report in this article, these forces will sustain high prices over the medium term. We also find that the distinction between high world prices for food commodities and the consumer costs of food is an important one to make. Food consumers do not buy raw food commodities at international prices. The degree to which the price of traded food commodities and the price of food are related depends on a long list of factors, most of which operate to dampen price transmission. In the search for appropriate policy response, it is essential to measure consumer effects correctly and to apportion properly the causes of current high prices.
Food price increases and net food importing countries: lessons from the recent past
Authors: Ng Francis , Aksoy M. Ataman 
Published: December 2008

AbstractRecent increases in food and other commodity prices have highlighted concerns that many poor countries are net food importers and higher food prices would worsen their trade balances. In this article, we analyze the changes in food trade balances associated with the 32% increase in food prices from 2000/2001 to 2004/2005. We find a small deterioration in food trade balances of low‐income countries and an improvement in middle‐income countries. The deterioration is most severe for countries in conflict and small island states, so attention should be placed first on these countries and on a few very‐low‐income countries that are also vulnerable. Because low‐income countries as a group had much lower agricultural GDP growth rates than middle‐income countries, the answers to food vulnerability in low‐income countries should probably be addressed within the context of incentives for agricultural production.