bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a national anti-tuberculosis drug resistance survey in Tanzania
Authors: Chonde Timothy M , Doulla Basra , van Leth Frank , Mfinanga Sayoki GM , Range Nyagosya , Lwilla Fred , Mfaume Saidi M , van Deun Armand , Zignol Matteo , Cobelens Frank G , Egwaga Saidi M 
Published: December 2008

Abstract

Background
A drug resistance survey is an essential public health management tool for evaluating and improving the performance of National Tuberculosis control programmes. The current manuscript describes the implementation of the first national drug resistance survey in Tanzania.

Methods
Description of the implementation process of a national anti-tuberculosis drug resistance survey in Tanzania, in relation to the study protocol and Standard Operating Procedures.

Results
Factors contributing positively to the implementation of the survey were a continuous commitment of the key stakeholders, the existence of a well organized National Tuberculosis Programme, and a detailed design of cluster-specific arrangements for rapid sputum transportation. Factors contributing negatively to the implementation were a long delay between training and actual survey activities, limited monitoring of activities, and an unclear design of the data capture forms leading to difficulties in form-filling.

Conclusion
Careful preparation of the survey, timing of planned activities, a strong emphasis on data capture tools and data management, and timely supervision are essential for a proper implementation of a national drug resistance survey.
MicroRNA profile changes in human immunodeficiency virus type 1 (HIV-1) seropositive individuals
Authors: Houzet Laurent , Yeung Man Lung , de Lame Valery , Desai Dhara , Smith Stephen M , Jeang Kuan-Teh 
Published: December 2008

Abstract
MicroRNAs (miRNAs) play diverse roles in regulating cellular and developmental functions. We have profiled the miRNA expression in peripheral blood mononuclear cells from 36 HIV-1 seropositive individuals and 12 normal controls. The HIV-1-positive individuals were categorized operationally into four classes based on their CD4+ T-cell counts and their viral loads. We report that specific miRNA signatures can be observed for each of the four classes.
Potential for La Crosse virus segment reassortment in nature
Authors: Reese Sara M , Blitvich Bradley J , Blair Carol D , Geske Dave , Beaty Barry J , Black William C 
Published: December 2008

Abstract
The evolutionary success of La Crosse virus (LACV, family Bunyaviridae) is due to its ability to adapt to changing conditions through intramolecular genetic changes and segment reassortment. Vertical transmission of LACV in mosquitoes increases the potential for segment reassortment. Studies were conducted to determine if segment reassortment was occurring in naturally infected Aedes triseriatus from Wisconsin and Minnesota in 2000, 2004, 2006 and 2007. Mosquito eggs were collected from various sites in Wisconsin and Minnesota. They were reared in the laboratory and adults were tested for LACV antigen by immunofluorescence assay. RNA was isolated from the abdomen of infected mosquitoes and portions of the small (S), medium (M) and large (L) viral genome segments were amplified by RT-PCR and sequenced. Overall, the viral sequences from 40 infected mosquitoes and 5 virus isolates were analyzed. Phylogenetic and linkage disequilibrium analyses revealed that approximately 25% of infected mosquitoes and viruses contained reassorted genome segments, suggesting that LACV segment reassortment is frequent in nature.
Large naturally-produced electric currents and voltage traverse damaged mammalian spinal cord
Authors: Zuberi Mahvash , Liu-Snyder Peishan , ul Haque Aeraj , Porterfield David M , Borgens Richard B 
Published: December 2008

Abstract

Background
Immediately after damage to the nervous system, a cascade of physical, physiological, and anatomical events lead to the collapse of neuronal function and often death. This progression of injury processes is called "secondary injury." In the spinal cord and brain, this loss in function and anatomy is largely irreversible, except at the earliest stages. We investigated the most ignored and earliest component of secondary injury. Large bioelectric currents immediately enter damaged cells and tissues of guinea pig spinal cords. The driving force behind these currents is the potential difference of adjacent intact cell membranes. For perhaps days, it is the biophysical events caused by trauma that predominate in the early biology of neurotrauma.

Results
An enormous (≤ mA/cm2) bioelectric current transverses the site of injury to the mammalian spinal cord. This endogenous current declines with time and with distance from the local site of injury but eventually maintains a much lower but stable value (< 50 μA/cm2).
The calcium component of this net current, about 2.0 pmoles/cm2/sec entering the site of damage for a minimum of an hour, is significant. Curiously, injury currents entering the ventral portion of the spinal cord may be as high as 10 fold greater than those entering the dorsal surface, and there is little difference in the magnitude of currents associated with crush injuries compared to cord transection. Physiological measurements were performed with non-invasive sensors: one and two-dimensional extracellular vibrating electrodes in real time. The calcium measurement was performed with a self-referencing calcium selective electrode.

Conclusion
The enormous bioelectric current, carried in part by free calcium, is the major initiator of secondary injury processes and causes significant damage after breach of the membranes of vulnerable cells adjacent to the injury site. The large intra-cellular voltages, polarized along the length of axons in particular, are believed to be associated with zones of organelle death, distortion, and asymmetry observed in acutely injured nerve fibers. These data enlarge our understanding of secondary mechanisms and provide new ways to consider interfering with this catabolic and progressive loss of tissue.
Two new splice variants in porcine PPARGC1A
Authors: Erkens Tim , Bilek Karel , Van Zeveren Alex , Peelman Luc J 
Published: December 2008

Abstract

Background

Peroxisome proliferator-activated receptor γ coactivator 1α (PPARGC1A) is a coactivator with a vital and central role in fat and energy metabolism. It is considered to be a candidate gene for meat quality in pigs and is involved in the development of obesity and diabetes in humans. How its many functions are regulated, is however still largely unclear. Therefore a transcription profile of PPARGC1A in 32 tissues and 4 embryonic developmental stages in the pig was constructed by screening its cDNA for possible splice variants with exon-spanning primers.

Findings
This led to the discovery of 2 new splice variants in the pig, which were subsequently also detected in human tissues. In these variants, exon 8 was either completely or partly (the last 66 bp were conserved) spliced out, potentially coding for a much shorter protein of respectively 337 and 359 amino acids (aa), of which the first 291 aa would be the same compared to the complete protein (796 aa).

Conclusion
Considering the functional domains of the PPARGC1A protein, it is very likely these splice variants considerably affect the function of the protein and alternative splicing could be one of the mechanisms by which the diverse functions of PPARGC1A are regulated.
Second Cancers After Squamous Cell Carcinoma and Adenocarcinoma of the Cervix
Authors: Chaturvedi Anil K. , Kleinerman Ruth A. , Hildesheim Allan , Gilbert Ethel S. , Storm Hans , Lynch Charles F. , Hall Per , Langmark Froydis , Pukkala Eero , Kaijser Magnus , Andersson Michael , Fossa Sophie D. , Joensuu Heikki , Travis Lois B. , Engels Eric A. 
Published: December 2008

Purpose Although cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) are both caused by human papillomavirus (HPV) infection, they differ in cofactors such as cigarette smoking. We assessed whether these cofactor differences translate into differences in second cancer risk. Patients and Methods We assessed second cancer risk among 85,109 cervical SCC and 10,280 AC survivors reported to population-based cancer registries in Denmark, Finland, Norway, Sweden, and the United States. Risks compared to the general population were assessed using standardized incidence ratios (SIR). Results Overall cancer risk was significantly increased among both cervical SCC survivors (n = 10,559 second cancers; SIR, 1.31; 95% CI, 1.29 to 1.34) and AC survivors (n = 920 second cancers; SIR, 1.29; 95% CI, 1.22 to 1.38). Risks of HPV-related and radiation-related cancers were increased to a similar extent among cervical SCC and AC survivors. Although significantly increased in both groups when compared with the general population, risk of smoking-related cancers was significantly higher among cervical SCC than AC survivors (P = .015; SIR for cervical SCC = 2.07 v AC = 1.78). This difference was limited to lung cancer (SIR for cervical SCC = 2.69 v AC = 2.18; P = .026). The increased lung cancer risk among cervical AC survivors was observed for both lung SCC and lung AC. SIRs for second cancers of the colon, soft tissue, melanoma, and non-Hodgkin's lymphoma were significantly higher among cervical AC than SCC survivors. Conclusion The second cancer profiles among cervical SCC and AC survivors mirror the similarities and differences in cofactors for these two histologies. Because smoking is not a cofactor for cervical AC, the increased lung cancer risk suggests a role for additional factors.
Medication Errors Among Adults and Children With Cancer in the Outpatient Setting
Authors: Walsh Kathleen E. , Dodd Katherine S. , Seetharaman Kala , Roblin Douglas W. , Herrinton Lisa J. , Von Worley Ann , Naheed Usmani G. , Baer David , Gurwitz Jerry H. 
Published: December 2008

Purpose Outpatients with cancer receive complicated medication regimens in the clinic and home. Medication errors in this setting are not well described. We aimed to determine rates and types of medication errors and systems factors associated with error in outpatients with cancer. Methods We retrospectively reviewed records from visits to three adult and one pediatric oncology clinic in the Southeast, Southwest, Northeast, and Northwest for medication errors using established methods. Two physicians independently judged whether an error occurred (κ = 0.65), identified its severity (κ = 0.76), and listed possible interventions. Results Of 1,262 adult patient visits involving 10,995 medications, 7.1% (n = 90; 95% CI, 5.7% to 8.6%) were associated with a medication error. Of 117 pediatric visits involving 913 medications, 18.8% (n = 22; 95% CI, 12.5% to 26.9%) were associated with a medication error. Among all visits, 64 of the 112 errors had the potential to cause harm, and 15 errors resulted in injury. There was a range in the rates of chemotherapy errors (0.3 to 5.8 per 100 visits) and home medication errors (0 to 14.5 per 100 visits in children) at different sites. Errors most commonly occurred in administration (56%). Administration errors were often due to confusion over two sets of orders, one written at diagnosis and another adjusted dose on the day of administration. Physician reviewers selected improved communication most often to prevent error. Conclusion Medication error rates are high among adult and pediatric outpatients with cancer. Our findings suggest some practical targets for intervention, including improved communication about medication administration in the clinic and home.
Fluorouracil, Leucovorin, and Oxaliplatin With and Without Cetuximab in the First-Line Treatment of Metastatic Colorectal Cancer
Authors: Bokemeyer Carsten , Bondarenko Igor , Makhson Anatoly , Hartmann Joerg T. , Aparicio Jorge , de Braud Filippo , Donea Serban , Ludwig Heinz , Schuch Gunter , Stroh Christopher , Loos Anja H. , Zubel Angela , Koralewski Piotr 
Published: December 2008

Purpose This randomized study assessed whether the best overall response rate (ORR) of cetuximab combined with oxaliplatin, leucovorin, and fluorouracil (FOLFOX-4) was superior to that of FOLFOX-4 alone as first-line treatment for metastatic colorectal cancer. The influence of KRAS mutation status was investigated. Patients and Methods Patients received cetuximab (400 mg/m2 initial dose followed by 250 mg/m2/wk thereafter) plus FOLFOX-4 (oxaliplatin 85 mg/m2 on day 1, plus leucovorin 200 mg/m2 and fluorouracil as a 400 mg/m2 bolus followed by a 600 mg/m2 infusion during 22 hours on days 1 and 2; n = 169) or FOLFOX-4 alone (n = 168). Treatment was continued until disease progression or unacceptable toxicity. KRAS mutation status was assessed in the subset of patients with assessable tumor samples (n = 233). Results The confirmed ORR for cetuximab plus FOLFOX-4 was higher than with FOLFOX-4 alone (46% v 36%). A statistically significant increase in the odds for a response with the addition of cetuximab to FOLFOX-4 could not be established (odds ratio = 1.52; P = .064). In patients with KRAS wild-type tumors, the addition of cetuximab to FOLFOX-4 was associated with a clinically significant increased chance of response (ORR = 61% v 37%; odds ratio = 2.54; P = .011) and a lower risk of disease progression (hazard ratio = 0.57; P = .0163) compared with FOLFOX-4 alone. Cetuximab plus FOLFOX-4 was generally well tolerated. Conclusion KRAS mutational status was shown to be a highly predictive selection criterion in relation to the treatment decision regarding the addition of cetuximab to FOLFOX-4 for previously untreated patients with metastatic colorectal cancer.
Physicians’ Knowledge of Alcohol, Tobacco and Folic Acid in Pregnancy
Authors: Lefebvre L. G. , Ordean A. , Midmer D. , Kahan M. , Tolomiczenko G. 
Published: December 2008

Objective To assess: (1) physicians’ knowledge and clinical confidence regarding problematic substance use in pregnancy compared to folic acid, and (2) physicians’ desire for education in this area and their preferred learning modalitiestools. Design Self-administered survey. Setting Family Medicine Forum 2004 in Toronto, Canada. Participants Physicians attending Family Medicine Forum2004 in Toronto who provide antenatal care. Main Outcome Measures Knowledge of folic acid, smoking and alcohol in pregnancy. Clinical confidence and interest in resources regarding problematic substance use in pregnancy. Results Sixty-six surveys completed. Physicians answered 92.3% of folic acid questions correctly, compared to 82.0% for nicotine and 57.1% for alcohol. Scores were higher on questions about effects of nicotine and alcohol use in pregnancy than on questions about treatment options. A perceived inability to influence clinical outcomes and a lack of professional resources regarding substance use in pregnancy were also identified. Physicians were interested in learning more about problematic substance use in pregnancy, particularly from continuing medical education events, websites and pocket cards. Conclusion Participants’ level of knowledge regarding substance use in pregnancy was significantly lower than their knowledge of folic acid, as was their clinical confidence. This lack of knowledge was not attributable to disinterest and clearly more educational resources are needed to address this topic.
Patients' Attitude Towards the Use of a Chaperone in Breast Examination
Authors: Sinha S , De A , Jones N , Jones M , Williams RJ , Vaughan-Williams E 
Published: December 2008

INTRODUCTION The aim of this study was to assess the attitude and the preferences of patients towards the use of a chaper one during breast examination. PATIENTS AND METHODS A two-part questionnaire was circulated among 204 consecutive new patients, attending both symptomatic breast and screened assessment clinics. RESULTS A total of 200 questionnaires were fully completed and returned. Although 104 (52%) patients felt that they did not need a chaperone during breast examination, 65 (33%) preferred to have one. Amongst these 65 patients, the majority (52%) wanted a chaperone in the presence of both a male and female doctor whereas 19 (29%) wanted a chaperone in the presence of a male doctor. When patients were asked which person would be the best chaperone for them, 63 patients (32%) preferred their spouse to act as a chaperone, whereas 57 (29%) preferred a clinic nurse. However, the majority of teenagers and young adults (10–30 years) preferred their parents to act as a chaperone. On asking the reason for preferring a chaperone during breast examination, 69% felt a chaperone helped them to feel more at ease, 28% felt they get more support, 23% get less embarrassed and 10% felt safer. The majority (54%) preferred the nurse to offer a chaperone instead of the doctor (22%). Patients generally said they were comfortable in asking for a chaperone (68%). Overall, 68% of patients considered the offer of a chaperone as a sign of respect and the majority felt the attitude (32%) and gender (20%) of the clinician are the two most important factors influencing the chaperone use. Most patients were of the opinion that the presence of a chaperone does not have a negative effect on the doctor-patient relationship (75%), patient confidentiality (74%) and do not cause embarrassment (68%). Following their assessment in clinic, the patients' views on the use of a chaperone were not significantly changed. CONCLUSIONS There is a wide variety of opinion among patients about the desirability of a chaperone during breast examination. However, the majority consider the offer of a chaperone as a sign of respect and many patients commented that the presence of a chaperone is important for medicolegal protection of both patient and clinician. In recent years, there has been an increasing call from medicolegal societies and medical insurance companies for greater use of chaperones during intimate examinations. We feel that recommendations regarding the use of a chaperone should now be incorporated into the British Association of Surgical Oncology guidelines.
Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study
Authors: Palanivelu Chinnusamy , Rangarajan Muthukumaran , Jategaonkar Priyadarshan Anand , Madankumar Madhupalayam Velusamy , Anand Natesan Vijay 
Published: December 2008

INTRODUCTIONEven though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from ‘postcholecystectomy syndrome’. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi.PATIENTS AND METHODSWe managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant.RESULTSThe mean duration between first and second surgery was 8.35 months (range, 6–10.7 months). The mean operating time was 103.5 min (range, 75–132 min). Duration of hospital stay was 4–12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy 13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality.CONCLUSIONSLeaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. ‘T’-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory.
Long-Term Follow-Up of the Use of the Jones' Intestinal Tube in Adhesive Small Bowel Obstruction
Authors: Fazel MZ , Jamieson RW , Watson CJE 
Published: December 2008

INTRODUCTION Intestinal intubation with a Jones' tube has been suggested to reduce the incidence of recurrent adhesive bstruction. This paper describes our experience of this technique. PATIENTS AND METHODS A retrospective case-note review was performed on 68 patients admitted to a teaching hospital who re identified as having had the Jones' intestinal tube placed over an 11-year period from 1980 to 1991, with a follow-up to 2003. The indication for placement and outcome following placement of the tube were documented with particular reference to recurrence of adhesive small bowel obstruction. RESULTS Data on 63 patients were available. Of these, 7 had the Jones' tube placed prophylactically after pouch surgery and re thus excluded from the main study. Of the remaining 56 patients, all had the Jones' tube placed for recurrent adhesive small bowel obstruction with a median follow-up of 92 months, representing 353 patient-years. In 51 patients, the Jones' tube was placed during emergency surgery, while five others had it placed electively. A total of 1.7 cases of adhesive small bowel obstruction per 100 years of patient follow-up were identified following use of the Jones' tube compared to 12.9 cases per 100 patient-years prior to the use of the Jones' tube. CONCLUSION Intestinal intubation with a Jones' tube is a safe and effective method of preventing recurrent adhesive obstruction.
Stenting for Large Bowel Obstruction – Evolution of a Service in a District General Hospital
Authors: Olubaniyi BO , McFaul CD , Yip VSK , Abbott G , Johnson M 
Published: December 2008

INTRODUCTION Stenting for obstructing large bowel malignancy is a technique that is gradually increasing in popularity. The two main indications are for palliation and as a ‘bridge to surgery’. Some of the proposed advantages of colonic stenting are safety, reduced morbidity and mortality, avoidance of a stoma and shorter hospital stay. PATIENTS AND METHODS This was a retrospective study of consecutive patients who had self-expanding metal stents deployed between February 2001 and June 2006. Data were collected from the MEDITECH electronic integrated healthcare information support system and case note review. Data concerning demographics, primary diagnosis, and location of malignant stricture, indication for stenting, method of stenting, outcome, complications and mortality rates were obtained and analysed on Microsoft Excel. RESULTS Colonic stenting was first performed in the Countess of Chester Hospital in 2001. Thirty-two procedures have been performed since then. The median age was 80 years and the majority of cases were palliative (28 of 32), with three of the remaining cases successfully stented as a ‘bridge to surgery’. Initially, this was performed as a radiological procedure; however, the success rate was noted to be better if a surgical endoscopist was also involved. We recorded a 57% clinical success rate in the group of patients that had the colonic stent inserted radiologically; however, the group where this was inserted as a combined radiological and endoscopic procedure yielded a clinical success rate of 78%. We experienced stent-migration in four patients (13%) and rectal perforation in one patient (3%). There was no tumour re-obstruction or stent-related mortality. CONCLUSIONS A colonic stenting service can be introduced into a district general hospital with low morbidity and mortality. A well-motivated team is required and combined endoscopic and radiological approach in our hands appears to offer the best results.