bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mild dilatation of the fetal kidney: a follow‐up study
Authors: THOMAS D.F.M. , MADDEN N.P. , IRVING H.C. , ARTHUR R.J. , SMITH S.E.W. 
Published: November 2008

Objective To assess morbidity in children with mild prenatally detected pelvicalyceal dilatation and to document the natural history of this ultrasound finding in post‐natal life.Patients and methods A retrospective (on‐going) study was carried out in 29 children (39 kidneys) with mild dilatation confined to the pelvis and/or calices confirmed on initial post‐natal ultrasound scan. Re‐evaluation was carried out at a mean age of 4.2 years (range 1.5–7.8). Clinically, each patient's history, height, weight and blood pressure were recorded. On ultrasound examination the renal length, collecting system appearances and dimensions were recorded.Results Vesico‐ureteric reflux was demonstrated in 1 of 14 infants who underwent neonatal micturating cystourethrography. During cumulative follow‐up totalling 122 years, there were only two documented episodes of urological morbidity, i.e. one episode of unexplained haematuria and one of urinary tract infection. By a mean age of 4.2 years the ultrasound appearances had reverted to normal in 69% of kidneys. In 31% dilatation persisted and was unchanged or diminished in severity. No case of increasing dilatation was seen. Renal growth was normal in 9 7%) of kidneys.Conclusions Mild dilatation of the fetal urinary tract is a common prenatal ultrasound finding. When confined to the renal pelvis and/or calices it is of doubtful clinical significance and is associated with a low level of morbidity in infancy and early childhood. Invasive investigation in post‐natal life is not justified.
The value of ultrasound in the child with an acute urinary tract infection
Authors: MacKENZIE J.R. , FOWLER K. , HOLLMAN A.S. , TAPPIN D. , MURPHY A.V. , BEATTIE T.J. , AZMY A. F. 
Published: November 2008

Objective To assess the value of an ultrasound examination in children with a proven urinary tract infection.Patients and methods The results of renal ultrasound and 99mTc‐dimercapto‐succinic acid (DMSA) studies were compared in 112 children with a first documented symptomatic Escherichia coli urinary tract infection.Results Ultrasound was particularly effective in detecting the presence of obstruction, renal swelling and parenchymal change consistent with acute pyelonephritis. However, ultrasound failed to detect half of the kidneys with photon deficient areas on 99mTc DMSA scan and was unreliable in detecting the presence of scarring.Conclusion An ultrasound examination alone should not be relied on in the child with an acute urinary tract infection.
Laparoscopic nephrectomy: Mansoura experience with 106 cases
Authors: Eraky I. , El‐Kappany H.A. , Ghoneim M.A. 
Published: November 2008

Objective To describe the technique and report our experience of laparoscopic nephrectomy. Patients and methods Between August 1992 and December 1993, 106 patients underwent laparoscopic nephrectomy at the Mansoura Urology and Nephrology Center.Results Of the 106 patients, laparoscopic nephrectomy was performed successfully in 97 cases. Conversion to an open procedure was necessary in the remainingnine patients. Conclusion For a selected group of patients, laparoscopicnephrectomy is a feasible and safe technique. The length of hospital stay and convalescence is short and return to work is rapid.
The National Prostatectomy Audit: the clinical management of patients during hospital admission
Authors: Emberton M. , Neal D.E. , Black N. , Harrison M. , Fordham M. , Mcbrien M.P. , Williams R.E. , McPherson K. , Devlin H.B. 
Published: November 2008

Objective To determine everyday practice in the hospital management of men undergoing prostatectomy and the extent of its variation. Patients and methods A total of 5361 patients, who represented 89% of all those undergoing prostatic procedures in four health regions (Mersey, Wessex, Northern and South West Thames) and one test site (within Trent) were recruited by 103 (97%) surgeons. Clinical information was collected on a pre‐coded data collection form which was completed during the hospital stay by the principal operator. Patient identification occurred at the time of surgery. Results Important findings included: (i) both older men and those of higher social class were more likely to undergo prostatectomy with fewer symptoms; (ii) men who waited longer for surgery had worse symptoms by the time of their operation; (iii) there were unexplained differences in routine pre‐ and post‐operative investigation and treatment. Half the men had their flow rate or residual urine measured as part of their pre‐operative assessment. About half the men received prophylactic antibiotics; (iv) when large groups were analysed, a consistent proportion of men throughout the study (12%) were undergoing the operation for a second time. The clinical course of men having a repeat operation differed in many ways from those having a first time procedure; (v) the larger proportion of men (62%) had surgery for strong indications as opposed to symptoms alone; (vi) although most operations were performed by consultants, emergency admissions, though symptomatically more severe and sicker, were more likely to be operated on by trainee surgeons; (vii) significant variation in mean pre‐operative symptom severity and bother scores were seen between surgeons. Conclusion The clinical management of prostatectomy has been defined in a large and representative UK sample. In some circumstances consistent variations have been identified. It is not yet clear whether these variations influence outcome. These data can be used by surgeons wishing to compare their own patient management with that described here.
What is the ‘normal range’ for prostate‐specific antigen? Use of a receiver operating characteristic curve to evaluate a serum marker
Authors: Gillatt D. , Reynard J.M. 
Published: November 2008

Objective To compare the relative sensitivity and specificity of prostate‐specific antigen (PSA) as a test for prostate cancer over a range of PSA values in a variety of patient groups, and to compare the sensitivity and specificity of PSA and prostatic acid phosphatase (PAP). Subjects and methods Receiver operating characteristic (ROC) curves (sensitivity plotted against 1‐specificity) were constructed to compare the ability of PSA to discriminate men with prostate cancer (n = 257) from those with benign prostatic hyperplasia (BPH) (n = 220) or control patients (ra = 164). Receiver operating characteristic curves were also constructed to compare PSA and PAP in 173 men with either BPH or prostate cancer. Results When patients with symptomatic BPH and those with advanced prostate cancer are excluded, a PSA of 8 ng/mL has a sensitivity of 94% and a specificity of 98% for prostate cancer. In patients presenting with symptoms suggestive of bladder outflow obstruction, PSA remains a sensitive marker for prostate cancer (93% sensitivity at 10 ng/mL) but its specificity (65%) is poor. PSA is a sensitive test for skeletal metastases but levels of 60–80 ng/mL are required to achieve a specificity of 70% or more. The sensitivity of PSA is far superior to that of PAP. Conclusion Serum PSA provides good discrimination between patients with and without prostate cancer. The sensitivity and specificity of PSA can be improved by excluding men with symptomatic BPH. The specificity of PSA as a diagnostic test for prostate cancer is reduced in men with symptoms of bladder outflow obstruction. For reasonable sensitivity and specificity, a PSA of 60–80 ng/mL is required for differentiating non‐metastatic from metastatic prostate cancer. The ROC curve comparing PSA and PAP provides a graphical demonstration of the superiority of PSA as a tumour marker. The ability of PSA to identify prostate cancer can be improved by selecting out groups of patients and by adjusting the cut‐off level of PSA to the population under study.
Prognostic evaluation of morphonuclear parameters in superficial and invasive bladder cancer
Authors: Colombel M. , De Launoit Y. , Bellot J. , Kiss R. , Abbou C. , Chopin D. 
Published: November 2008

Objective To assess the prognostic value of morphonuclear parameters determined by means of computerized image analysis in untreated bladder tumours. Patients and methods Fifty patients had untreated bladder cancer; in 28 patients the tumours were superficial (7pTlGl; 14pTlG2; 7pTlG3) and in 22 they were invasive (6T2G2, 9T2G3, 2T3G2, 5T3G3). Feulgen‐stained imprints were processed for morphonuclear analysis on a SAMBA 200 computerized image analysis system (T1TN, France), which measures optical density (integrated optical density, IOD; surface area, SURF; mean optical density, MOD), texture (long run length, LRL; short run length, SRL; run length distribution, RID; run length percentage, RLP; grey level distribution, GLD) and contrast (contrast, C; energy, E). Results Morphonuclear parameters IOD, SURF, LRL, SRL and C were found to correlate with the risk of recurrence and progression of superficial bladder tumours (Results for ANOVA respectively IOD P<0.001; SURF P= 0.02; LRL P= 0.05; RLD P= 0.04; SRL P= 0.04; C P<0.001). In invasive bladder cancer, parameters IOD and C only correlated with the risk of progression (ANOVA respectively IOD P<0.001; C P<0.001). On the other hand, progression‐free curve analysis using the Kaplan Meier method showed that morphonuclear parameters may be useful in predicting the outcome for superficial tumours (Log/Rank test: SURF P<0.001; RLD <0.001; SRL = 0.003; LRL <0.001; C<0.001; IOD<0.001). In the case of invasive tumours, only two parameters provided prognostic information (Logrank test: C<0.001; IOD<0.001). Conclusion Nuclear morphometry assessed by image analysis is potentially useful in assessing the prognosis of bladder tumours; it provides Objective and quantitative parameters. Further studies will determine whether morphonuclear analysis can be used to monitor the treatment of bladder cancer, particularly superficial tumours.
Treatment of neuropathic urinary and faecal incontinence with synchronous bladder reconstruction and the antegrade continence enema procedure*
Authors: Roberts J.P. , Moon S. , Malone P.S. 
Published: November 2008

Objectives To report our experience with synchronous bladder reconstruction and the antegrade continence enema (ACE) procedure in the management of neuropathic urinary and faecal incontinence. Patients and methods Eight patients (four boys, four girls) with a median age of 9 years 10 months (range 4.5–17) were treated. Five had spina bifida, two high ano‐rectal malformations and one had been successfully treated for a spinal neuroblastoma. The appendix was used for the ACE procedure in five patients and a tubularized caecal or colonic flap in the other three. Seven patients had an augmentation cystoplasty and one a cystectomy with a continent diversion. A bladder neck reconstruction or an urethral lengthening procedure was performed in five patients and the bladder outlet was closed in two. Six patients required some form of revision. Four patients underwent a simultaneous Mitrofanoff procedure. Results The median length of follow‐up was 11.5 months (range 3–29). Five patients were completely clean and the remaining three experienced minor faecal soiling only. They were all delighted with the result. Six patients were dry day and night, one was wet at night only while the final patient was wet day and night. Conclusions Synchronous surgical procedures to make patients with neuropathic incontinence both clean and dry is effective, but most patients require revision surgery. Patient motivation and selection and the availability of a nurse specialist is crucial in obtaining satisfactory results.
Endoscopic trigonoplasty for primary vesico‐ureteric reflux
Authors: Okamura K. , Ono Y. , Yamada Y. , Kato T. , Tsuji Y. , Ohshima S. , Miyake K. 
Published: November 2008

Objective To investigate the surgical results of endoscopic trigonoplasty in patients with primary vesico‐ureteric reflux. Patients and methods Records were reviewed for 12 patients who underwent endoscopic trigonoplasty between February 1992 and February 1994. Of the 12 patients, 11 were female; one was a child and nine had unilateral disease. From 15 renoureteric units, grade I vesico‐ureteric reflux was demonstrated in five, grade II in six and grade III in four. The ureteric orifices were approximated close to the midline via the urethral route and two trocars on the abdomen achieved pneumobladder. Results The mean surgical time was 178 ± 52 min; this lessened as the learning curve developed. Intra‐opera‐tive complications in three patients were all caused by trocar placement. Eleven patients required analgesics for one post‐operative day only. No post‐operative dilatation of the upper urinary tract was demonstrated. Vesico‐ureteric reflux was eradicated in all patients. Conclusions Endoscopic trigonoplasty is a minimally invasive procedure with a high cure rate. By not destroying the normal vesico‐ureteric junction, postoperative obstruction cannot occur. We believe that endoscopic trigonoplasty is a feasible procedure for patients with vesico‐ureteric reflux.
Getting Real Performance Out of Pay‐for‐Performance
Authors: NICHOLSON SEAN , PAULY MARK V. , WU ANITA YA JUNG , MURRAY JAMES F. , TEUTSCH STEVEN M. , BERGER MARC L. 
Published: November 2008

Context: Most private and public health insurers are implementing pay‐for‐performance (P4P) programs in an effort to improve the quality of medical care. This article offers a paradigm for evaluating how P4P programs should be structured and how effective they are likely to be. Methods: This article assesses the current comprehensiveness of evidence‐based medicine by estimating the percentage of outpatient medical spending for eighteen medical processes recommended by the Institute of Medicine. Findings: Three conditions must be in place for outcomes‐based P4P programs to improve the quality of care: (1) health insurers must not fully understand what medical processes improve health (i.e., the health production function); (2) providers must know more about the health production function than insurers do; and (3) health insurers must be able to measure a patient's risk‐adjusted health. Only two of these conditions currently exist. Payers appear to have incomplete knowledge of the health production function, and providers appear to know more about the health production function than payers do, but accurate methods of adjusting the risk of a patient's health status are still being developed. Conclusions: This article concludes that in three general situations, P4P will have a different impact on quality and costs and so should be structured differently. When information about patients' health and the health production function is incomplete, as is currently the case, P4P payments should be kept small, should be based on outcomes rather than processes, and should target physicians' practices and health systems. As information improves, P4P incentive payments could be increased, and P4P may become more powerful. Ironically, once information becomes complete, P4P can be replaced entirely by “optimal fee‐for‐service.”
Assessment of methane and nitrous oxide flux from mangroves along Eastern coast of India
Authors: CHAUHAN R. , RAMANATHAN AL. , ADHYA T. K. 
Published: November 2008

AbstractMangroves are considered to be a minor source of greenhouse gases (CH4 and N2O) in pristine environmental condition. However, estimates of efflux suggest that anthropogenic activities have led to a pronounced increase in greenhouse gas emission. Along the east coast of India, mangroves vary substantially in area, physiography and freshwater input, which ultimately modify the biogeochemical processes operating within this ecosystem. An attempt has here been made to elucidate the existing variation and role of climatic variability on the emission of greenhouse gases from mangroves. The flux estimates of CH4 and N2O have been quantified from Bhitarkanika mangrove accounting for spatial and temporal (seasonal) variation. The annual rates were estimated to be 0.096 × 10 9 g CH4 year−1 and 5.8 × 103g N2O year−1 for the whole mangrove area of the east coast of India. Upscaling these estimates yield an annual emission of 1.95 × 10 12 g CH4 year−1 and 1.1 × 10 11 g N2O year−1 from worldwide mangrove areas. The influence of elevated nutrient inputs through anthropogenic influence enhances the emission of greenhouse gas. The present article shows the need to develop an inventory on greenhouse gas flux from mangrove ecosystem.
Sedimentary fabrics in the authigenic carbonates from Bush Hill: implication for seabed fluid flow and its dynamic signature
Authors: FENG D. , CHEN D. , ROBERTS H. H. 
Published: November 2008

AbstractSeep carbonates, the product of cold seep fluids mediated by microbial activity, archive information on seabed fluid flow and microbiological processes that led to their formation. Sedimentary fabrics are well developed in the authigenic carbonate from active seep sites at Bush Hill, Green Canyon Block 185 of the Gulf of Mexico. This authigenic carbonate has much lower carbon isotope values than typical marine cements and the carbonate is concluded to be derived from the oxidation of seeping petroleum. The authigenic fabrics commonly exhibit microbial or texturally unique sedimentary structures; e.g. framboidal pyrite, clotted microfabric and peloid, botryoidal aragonite, microfilament, and rosette‐like aragonite are all preserved in seep carbonate. These fabrics are indicators of biological influence during microbial oxidation of petroleum and sulfate reduction when cold fluids seep on to the seabed. The textures are therefore considered as additional evidence that can be used to identify and interpret ancient cold‐fluid seeps on seafloor. The difficulty of the preservation of these biogenic fabrics is thought to be related to the redox condition and dynamic signature (e.g. rate of fluid flow) of cold seeps.
Genotypic Association Analysis Using Discordant‐Relative‐Pairs
Authors: Yan T. , Yang Y.‐N. , Cheng X. , DeAngelis M. M. , Hoh J. , Zhang H. 
Published: November 2008

SummaryIn practice, family‐based design has been widely used in disease‐gene association analysis. The major advantage of such design is that it is not subject to spurious association due to population structure such as population stratification (PS) and admixture. A disadvantage is that parental genotypes are hard to obtain if the disease is late onset for which a discordant‐relative‐pair design is useful. Designs of such kind include full‐sib‐pair, half‐sib‐pair, first‐cousin‐pair, and so on. The closer the relatedness of the pair, the less possible that they are subject to population stratification. On the other hand, the association test using close relative‐pairs may be less powerful due to over‐matching. Trade‐off between these two factors (population structure and over‐matching) is the major concern of this study. Some tests, namely McNemar's test, matched Cochran‐Armitage trend tests (CATTs), matched maximum efficient robust test (MERT), and Bhapkar's test, are used for testing disease‐gene association based on relative‐pair designs. These tests are shown to be valid in the presence of PS but not admixture. Numerical studies show that the McNemar's test, additive CATT, MERT, and Bhapkar's test are robust in power, but none of them is uniformly more powerful than the others. In most simulations, the power of any of the tests increases as the pair is more distant. The proposed methods are applied to two real examples.
Rescue and Restoration: Experimental Translocation ofAmorpha herbaceaWalter var.crenulata(Rybd.) Isley into a Novel Urban Habitat
Authors: Wendelberger Kristie S. , Fellows Meghan Q. N. , Maschinski Joyce 
Published: November 2008

AbstractThough translocations of rare populations should be considered only as the last resort for species’ conservation, when habitat destruction is imminent, it may be the only means to preserve a species. With over half the known, wild federally endangered Crenulate leadplant (Amorpha herbaceavar.crenulata), Fabaceae, growing on unprotected land slated for development, preserving this unprotected population was critical. We rescued whole plants, cuttings, and seeds for an experimental translocation. Into a restored pine rockland, once dominated by the invasive exotic tree Brazilian pepper (Schinus terebinthifolius), we transplanted plants from different sources and of different sizes. Plants used were rescued from an unprotected site, seedlings, and 1‐, 2‐, and 7‐year‐old plants from Fairchild Tropical Botanic Garden’s ex situ collection, creating a novel population in a new habitat. We also evaluated which propagule type and source had the best survival, growth, and reproduction. After 40 months, overall transplant survival was 71%. Large whole plants, rescued and nursery grown, had the best survival rates (86 and 78%), whereas cuttings had 67% survival and seedlings had only 26% survival. The restored site, once nearly a monoculture ofS. terebinthifolius, is now dominated by 104 native plant species, including 17 naturally recruited state listed, plus the one translocated federally endangered plant species. In addition, one federally threatened snake species was observed on the site. These studies demonstrate that botanic garden collections not only play a vital role in the conservation of species’ genetic diversity but also can be used as source material for habitat restoration.
Restoration of California Native Grasses and Clovers: The Roles of Clipping, Broadleaf Herbicide, and Native Grass Density
Authors: Lulow Megan E. 
Published: November 2008

Abstract One of the major challenges confronting grassland restoration of highly invaded communities is increasing the diversity of native species. There is surprisingly little research investigating how reconstructed native grasslands respond to common management techniques and how these techniques influence the relative establishment of both native grasses and forbs. Despite the diversity and wide distribution of native clovers in California, few practitioners incorporate them into grassland restoration plans. Conversely, non‐native clovers have been seeded extensively onto California rangelands. This study addresses the following questions: (1) Using readily available management tools, is there a strategy that can benefit the growth of both planted native bunchgrasses and seeded clovers? (2) Do native bunchgrasses compete with establishing clovers and non‐native grasses? (3) Do native and non‐native clovers differ in their response to management treatments or in their productivity? Plots were established to test three factors in different combinations over 3 years: (1) early spring clipping, (2) initial broadleaf herbicide, and (3) native bunchgrass planting density. Native and non‐native clovers were seeded in years 2 and 3. Early spring clipping did not have a significant effect on native bunchgrass cover, yet it did result in greater growth of native and non‐native clovers. The direction of the response to broadleaf herbicide changed between years for native bunchgrasses and was consistently negative for native clovers. Plots with higher native grass densities did not adversely affect the seeded clovers, yet non‐native grass cover was reduced. Native and non‐native clovers exhibited similar responses to clipping and established at similar densities.