bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Predictors of Left Atrial Thrombus Prior to Catheter Ablation of Atrial Fibrillation
Authors: SCHERR DANIEL , DALAL DARSHAN , CHILUKURI KARUNA , DONG JUN , SPRAGG DAVID , HENRIKSON CHARLES A. , NAZARIAN SAMAN , CHENG ALAN , BERGER RONALD D. , ABRAHAM THEODORE P. , CALKINS HUGH , MARINE JOSEPH E. 
Published: November 2008

Background:
Transesophageal echocardiography (TEE) is commonly used prior to catheter ablation of atrial fibrillation (AF) in order to exclude left atrial (LA) thrombus. However, the incidence and predictors of LA thrombus detected with TEE have not been systematically examined in this setting.
Methods:
This study included 732 cases (mean age 57 ± 11 years; 23% female; 353 persistent AF) in 585 consecutive patients referred for catheter ablation of AF. Patients were anticoagulated for at least 4 weeks prior to the procedure and then bridged with enoxaparin. TEE was performed in all cases within 24 hours prior to ablation.
Results:
Preprocedural TEE revealed LA thrombus in 12 of 732 cases (1.6%), all located in the LA appendage. Among these 12 patients, 9 had persistent AF and 3 had paroxysmal AF. All patients with thrombus had an LA size ≥ 4.5 cm. LA thrombus was present in 0.3%, 1.4%, and 5.3% of patients with CHADS2 scores of 0, 1, and ≥ 2, respectively. In multivariate analysis, a CHADS2 score ≥ 2 and larger LA diameter remained significant predictors of LA thrombus.
Conclusions:
Despite oral anticoagulation treatment, there is a small but significant incidence of LA thrombus by TEE prior to AF ablation. A CHADS2 score ≥ 2 and larger LA diameter are independent predictors of LA thrombus in this patient population, while type of AF or rhythm at the time of TEE is not. The risk of LA thrombus is low in patients with a CHADS2 score of 0 and in patients with an LA diameter < 4.5 cm.
Atrial Arrhythmias in Long‐QT Syndrome under Daily Life Conditions: A Nested Case Control Study
Authors: ZELLERHOFF STEPHAN , PISTULLI RUDIN , MÖNNIG GEROLD , HINTERSEER MARTIN , BECKMANN BRITT‐MARIA , KÖBE JULIA , STEINBECK GERHARD , KÄÄB STEFAN , HAVERKAMP WILHELM , FABRITZ LARISSA , GRADAUS RAINER , BREITHARDT GÜNTER , SCHULZE‐BAHR ERIC , BÖCKER DIRK , KIRCHHOF PAULUS 
Published: November 2008

Background:
The long‐QT syndromes (LQTS) are inherited electrical cardiomyopathies characterized by prolonged ventricular repolarization and ventricular arrhythmias. Several genetic reports have associated defects in LQTS‐causing genes with atrial fibrillation (AF). We therefore studied whether atrial arrhythmias occur in patients with LQTS under daily‐life conditions.
Methods:
We systematically assessed atrial arrhythmias in LQTS patients and matched controls using implanted defibrillators or pacemakers as monitors of atrial rhythm in a nested case‐control study. Twenty‐one LQTS patients (3 male; 39 ± 18 years old; 18 on β blocker, ICD therapy duration 6.3 ± 2.7 years; 4 LQT1, 6 LQT2, 2 LQT3) were matched to 21 control subjects (13 male; 50 ± 19 years old; 3 on β blocker; pacemaker therapy duration 8.5 ± 5.5 years; 19 higher‐degree AV block, 2 others). LQTS patients were identified by a systematic search of the LQTS patient databases in Münster and Munich.
Results:
One‐third (7 of 21) of the LQTS patients developed self‐terminating atrial arrhythmias (atrial cycle lengths <250 ms). Only one control patient developed a single episode of postoperative AF (P < 0.05 vs LQTS).
Conclusions:
LQTS patients at high risk for ventricular arrhythmias may develop short‐lasting atrial arrhythmias under daily‐life conditions, suggesting that prolonged atrial repolarization may contribute to the initiation of AF.
Using Immersive Simulation for Training First Responders for Mass Casualty Incidents
Authors: Wilkerson William , Avstreih Dan , Gruppen Larry , Beier Klaus‐Peter , Woolliscroft James 
Published: November 2008

AbstractObjectives:  A descriptive study was performed to better understand the possible utility of immersive virtual reality simulation for training first responders in a mass casualty event.Methods:  Utilizing a virtual reality cave automatic virtual environment (CAVE) and high‐fidelity human patient simulator (HPS), a group of experts modeled a football stadium that experienced a terrorist explosion during a football game. Avatars (virtual patients) were developed by expert consensus that demonstrated a spectrum of injuries ranging from death to minor lacerations. A group of paramedics was assessed by observation for decisions made and action taken. A critical action checklist was created and used for direct observation and viewing videotaped recordings.Results:  Of the 12 participants, only 35.7% identified the type of incident they encountered. None identified a secondary device that was easily visible. All participants were enthusiastic about the simulation and provided valuable comments and insights.Conclusions:  Learner feedback and expert performance review suggests that immersive training in a virtual environment has the potential to be a powerful tool to train first responders for high‐acuity, low‐frequency events, such as a terrorist attack.
Debriefing as Formative Assessment: Closing Performance Gaps in Medical Education
Authors: Rudolph Jenny W. , Simon Robert , Raemer Daniel B. , Eppich Walter J. 
Published: November 2008

AbstractThe authors present a four‐step model of debriefing as formative assessment that blends evidence and theory from education research, the social and cognitive sciences, experience drawn from conducting over 3,000 debriefings, and teaching debriefing to approximately 1,000 clinicians worldwide. The steps are to: 1) note salient performance gaps related to predetermined objectives, 2) provide feedback describing the gap, 3) investigate the basis for the gap by exploring the frames and emotions contributing to the current performance level, and 4) help close the performance gap through discussion or targeted instruction about principles and skills relevant to performance. The authors propose that the model, designed for postsimulation debriefings, can also be applied to bedside teaching in the emergency department (ED) and other clinical settings.
The Assessment of Individual Cognitive Expertise and Clinical Competency: A Research Agenda
Authors: Spillane Linda , Hayden Emily , Fernandez Rosemarie , Adler Mark , Beeson Michael , Goyal Deepi , Smith‐Coggins Rebecca , Boulet John 
Published: November 2008

AbstractThere is a large push to utilize evidence‐based practices in medical education. At the same time, credentialing bodies are evaluating the use of simulation technologies to assess the competency and safety of its practitioners. At the 2008 Academic Emergency Medicine Consensus Conference on “The Science of Simulation in Healthcare,” our breakout session critically evaluated several issues important to the use of simulation in emergency physician (EP) assessment. In this article, we discuss five topics felt to be most critical to simulation‐based assessment (SBA). We then offer more specific research questions that would help to define and implement a SBA program in emergency medicine (EM).
BMP‐9‐induced osteogenic differentiation of mesenchymal progenitors requires functional canonical Wnt/β‐catenin signalling
Authors: Tang Ni , Song Wen‐Xin , Luo Jinyong , Luo Xiaoji , Chen Jin , Sharff Katie A. , Bi Yang , He Bai‐Cheng , Huang Jia‐Yi , Zhu Gao‐Hui , Su Yu‐Xi , Jiang Wei , Tang Min , He Yun , Wang Yi , Chen Liang , Zuo Guo‐Wei , Shen Jikun , Pan Xiaochuan , Reid Russell R. , Luu Hue H. , Haydon Rex C. , He Tong‐Chuan 
Published: November 2008

AbstractBone morphogenetic protein 9 (BMP‐9) is a member of the transforming growth factor (TGF)‐β/BMP superfamily, and we have demonstrated that it is one of the most potent BMPs to induce osteoblast differentiation of mesenchymal stem cells (MSCs). Here, we sought to investigate if canonical Wnt/β‐catenin signalling plays an important role in BMP‐9‐induced osteogenic differentiation of MSCs. Wnt3A and BMP‐9 enhanced each other’s ability to induce alkaline phosphatase (ALP) in MSCs and mouse embryonic fibroblasts (MEFs). Wnt antagonist FrzB was shown to inhibit BMP‐9‐induced ALP activity more effectively than Dkk1, whereas a secreted form of LPR‐5 or low‐density lipoprotein receptor‐related protein (LRP)‐6 exerted no inhibitory effect on BMP‐9‐induced ALP activity. β‐Catenin knockdown in MSCs and MEFs diminished BMP‐9‐induced ALP activity, and led to a decrease in BMP‐9‐induced osteocalcin reporter activity and BMP‐9‐induced expression of late osteogenic markers. Furthermore, β‐catenin knockdown or FrzB overexpression inhibited BMP‐9‐induced mineralization in vitro and ectopic bone formation in vivo, resulting in immature osteogenesis and the formation of chondrogenic matrix. Chromatin immunoprecipitation (ChIP) analysis indicated that BMP‐9 induced recruitment of both Runx2 and β‐catenin to the osteocalcin promoter. Thus, we have demonstrated that canonical Wnt signalling, possibly through interactions between β‐catenin and Runx2, plays an important role in BMP‐9‐induced osteogenic differentiation of MSCs.
Human islet‐derived precursor cells can cycle between epithelial clusters and mesenchymal phenotypes
Authors: Davani Behrous , Ariely Sahar , Ikonomou Laertis , Oron Yoram , Gershengorn Marvin C. 
Published: November 2008

AbstractWe showed previously that undifferentiated, proliferating human islet‐derived precursor cells (hIPCs) are a type of mesenchymal stem/stromal cell (MSC) that can be induced by serum deprivation to form clusters and ultimately differentiate in vitro to endocrine cells. We also demonstrated that partially differentiated hIPC clusters, when implanted under the kidney capsules of mice, continued to differentiate in vivo into hormone‐producing cells. However, we noted that not all hIPC preparations yielded insulin‐secreting cells in vivo and that in some animals no hormone‐expressing cells were found. This suggested that the implanted cells were not always irreversibly committed to further differentiation and may even de‐differentiate to a mesenchymal phenotype. In this study, we show that human cells with a mesenchymal phenotype are indeed found in the grafts of mice implanted with hIPCs in epithelial cell clusters (ECCs), which are obtained after 4‐day in vitro culture of hIPCs in serum‐free medium (SFM); mesenchymal cells were predominant in some grafts. We could mimic the transition of ECCs to de‐differentiated mesenchymal cells in vitro by exposure to foetal bovine serum (FBS) or mouse serums, and to a significantly lesser extent to human serum. In a complementary series of experiments, we show that mouse serum and FBS are more effective stimulants of mesenchymal hIPC migration than is human serum. We found that proliferation was not needed for the transition from ECCs to de‐differentiated cells because mitomycin‐treated hIPCs that could not proliferate underwent a similar transition. Lastly, we show that cells exhibiting a mesenchymal phenotype can be found in grafts of adult human islets in mice. We conclude that epithelial‐to‐mesenchymal transition (EMT) of cells in hIPC ECCs can occur following implantation in mice. This potential for EMT of human islets or differentiated precursor cells must be considered in strategies for cell replacement therapy for diabetes.
Targeting histone deacetylases for the treatment of disease
Authors: Lawless M. W. , Norris S. , O’Byrne K. J. , Gray S. G. 
Published: November 2008

IntroductionHATs/HDACs and the pro‐inflammatory environmentHATs/HDACs and endoplasmic reticulum (ER) stressThe potential role of histone deacetylase inhibitors in the treatment of cancerPotential role of histone deacetylase inhibitors in the treatment of diabetesThe potential role of histone deacetylase inhibitors in the treatment of neurodegenerative conditionsHistone deacetylase inhibitorsCaveatsFinal commentsAbstractThe ‘histone code’ is a well‐established hypothesis describing the idea that specific patterns of post‐translational modifications to histones act like a molecular ‘code’ recognized and used by non‐histone proteins to regulate specific chromatin functions. One modification, which has received significant attention, is that of histone acetylation. The enzymes that regulate this modification are described as lysine acetyltransferases or KATs, and histone deacetylases or HDACs. Due to their conserved catalytic domain HDACs have been actively targeted as a therapeutic target. The pro‐inflammatory environment is increasingly being recognized as a critical element for both degenerative diseases and cancer. The present review will discuss the current knowledge surrounding the clinical potential and current development of histone deacetylases for the treatment of diseases for which a pro‐inflammatory environment plays important roles, and the molecular mechanisms by which such inhibitors may play important functions in modulating the pro‐inflammatory environment.
The Neurourological Examination in Women
Authors: Yang Claire C. 
Published: November 2008

ABSTRACT

Yang CC. The neurourological examination in women. J Sex Med 2008;5:2498–2501
The review provides a description of a physical examination protocol to rule out significant neurologic disease as a cause for a woman's sexual complaints, or to confirm a neurologic cause for the sexual dysfunction, particularly in women with known neurologic disease.
Role of the Neurokinin-1 Receptors in Ejaculation in Anesthetized Rats
Authors: Clement Pierre , Peeters Magali , Bernabe Jacques , Laurin Miguel , Alexandre Laurent , Giuliano Francois 
Published: November 2008

ABSTRACTIntroductionSeveral lines of evidence indicate a role for substance P in the control of ejaculation, although its mode of action needs to be clarified.AimThe effects and sites of action of a selective antagonist for the substance P-preferred receptor (neurokinin-1 receptor subtype; NK1) were investigated in a pharmacological model of ejaculation.MethodsEjaculation was induced in anesthetized rats by intracerebroventricular (icv) delivery of the dopamine D3 receptor preferring agonist 7-hydroxy-2-(di-N-propylamino)tetralin (7-OH-DPAT). The effects of the selective NK1 antagonist RP67580 on 7-OH-DPAT-induced ejaculation were measured following intraperitoneal (ip), icv, or intrathecal (it) (third lumbar spinal segment; L3) administration.Main Outcome MeasuresIntraseminal vesicle pressure (SVP) and electromyogram of the bulbospongiosus muscle (BS) were recorded as physiological markers of emission and expulsion phases of ejaculation, respectively.ResultsUpon ip, icv, or it administration, RP67580 significantly reduced the occurrence of ejaculation elicited by 7-OH-DPAT. A mild decrease in the occurrence of SVP and BS responses was observed in rats treated ip with RP67580, whereas only SVP responses were moderately affected following icv or it administration.ConclusionThese results show the multilevel regulation of 7-OH-DPAT-induced ejaculation by NK1 receptors.
Persistent Genital and Pelvic Pain After Childbirth
Authors: Paterson Laurel Q.P. , Davis Seth N.P. , Khalifé Samir , Amsel Rhonda , Binik Yitzchak M. 
Published: November 2008

ABSTRACT

Introduction
Although genital pain and pelvic pain are common and well-documented problems in the early postpartum period, little is known about their course. The few published studies of such pain beyond 1 year postpartum have focused primarily on the perineum and have not assessed pain onset.

Aim
To investigate the prevalence and characteristics of all types of genital and pelvic pain in the second year postpartum, and to explore risk factors for their persistence.

Methods
Over a 6-month period, a questionnaire on genital/pelvic pain, sociodemographic and childbirth variables, breastfeeding, and chronic pain history was mailed to patients of the collaborating obstetrician at 12 months postpartum.

Main Outcome Measures
The prevalence, characteristics, and correlates of persistent genital/pelvic pain with postpartum onset.

Results
Almost half of the 114 participants (82% response rate; M = 14 months postpartum) reported a current (18%) or resolved (26%) episode of genital or pelvic pain lasting 3 or more months. Just under one in 10 (9%) mothers continued to experience pain that had begun after they last gave birth. This pain was described at various locations (e.g., vaginal opening and pelvic area), as moderate in intensity and unpleasantness, and most often as burning, cutting, or radiating. Although it was triggered by both sexual and nonsexual activities, none of the mothers affected were receiving treatment. Univariate analyses revealed that only past diagnosis with a nongenital chronic pain condition (e.g., migraine headache) was significantly correlated with (i) any history of chronic genital/pelvic pain or (ii) the persistence of pregnancy- or postpartum-onset genital or pelvic pain.

Conclusions
Postpartum genital and pelvic pain persists for longer than a year for a significant percentage of mothers. Women with a history of other chronic pain appear to be particularly vulnerable to developing persistent genital or pelvic pain.
Erectile Dysfunction Management Options in Nigeria
Authors: Afolayan Anthony Jide , Yakubu Musa Toyin 
Published: November 2008

ABSTRACT

Introduction
In Nigeria, the prevalence of erectile dysfunction (ED) among patients attending primary care clinics, age-standardized to the U.S. population in 2000 is 57.4%. This is considered high enough to warrant the attention of scientist for critical studies and analysis. The high ED prevalence is associated with etiologies such as psychosexual factors, chronic medical conditions, and some lifestyles. ED constitutes a major public health problem, influencing the patient’s well-being and quality of life. It also leads to broken homes and marriages, psychological, social, and physical morbidity.

Aim
To give an account of various ED management options in Nigeria.

Method
Review of peer-reviewed literature, questionnaire, and ethnobotanical survey to some indigenous herb sellers and herbalists.

Main Outcome Measures
Cross cultural perspectives of ED management in Nigeria.

Results
The review suggests that traditional (phytotherapy, zootherapy, and occultism) and nontraditional, orthodox practice (drug therapy, psychological, and behavioral counseling) are applicable to ED management in Nigeria.

Conclusion
This review should help in creating awareness into various options available for managing ED in the country, but does not recommend self medication of any form, be it the use of orthodox or herbal remedy.
Metoidioplasty as a Single Stage Sex Reassignment Surgery in Female Transsexuals: Belgrade Experience
Authors: Djordjevic Miroslav L. , Stanojevic Dusan , Bizic Marta , Kojovic Vladimir , Majstorovic Marko , Vujovic Svetlana , Milosevic Alexandar , Korac Gradimir , Perovic Sava V. 
Published: November 2008

ABSTRACT

Introduction
Metoidioplasty represents one of the variants of phalloplasty in female transsexuals. Its main characteristic is that it is a one-stage procedure. It involves lengthening and straightening of hypertrophied clitoris to create a neophallus, urethral lengthening to enable voiding while standing, and scrotal reconstruction with insertion of testicle prostheses.

Aim
Our aim is to describe our technique and highlight its advantages.

Methods
Between September 2002 and April 2007, 82 female transsexuals, aged 18–54 years (mean age 31) underwent one-stage metoidioplasty. Clitoris is lengthened and straightened by division of clitoral ligaments and short urethral plate. Urethroplasty is done with combined buccal mucosa graft and genital skin flaps. Scrotum is created from labia majora in which two testicle prostheses are inserted. Simultaneously, female genitalia are removed.

Main Outcome Measures
Patients’ personal satisfaction about sensitivity and length of neophallus, possibility to void in standing position, real length of reconstructed urethra as well as complication rate comparing to other published data.

Results
The median follow-up was 32 months (range 14–69). The mean neophallic length was 5.7 cm (range 4–10). Voiding in standing position was reported in all patients, while dribbling and spraying were noticed in 23 cases and solved spontaneously. There were two urethral strictures and seven fistulas that required secondary minor revision. All patients reported preserved sensation and normal postoperative erection. Testicle prostheses rejection was not observed in any of the patients.

Conclusions
Metoidioplasty is a single-stage and time-saving procedure. It could be an alternative to total phalloplasty in female transsexuals who do not wish to have sexual intercourse. Also, it represents a first step in cases where additional augmentation phalloplasty is required.
The Common Agricultural Policy and Its Reform: The Problem of Reconciling Budget and Trade Concerns
Authors: Ackrill Robert , Kay Adrian , Morgan Wyn 
Published: November 2008

In 2008, the Common Agricultural Policy (CAP) reached its fiftieth birthday. It has been a constant factor in directing resources to the EU agricultural sector, but the means of channelling these resources have changed considerably over time. This article charts the evolution of the CAPs principal policy instruments and analyzes the welfare effects of its major reforms. It also analyzes these changes in terms of the institutional context of the principal reform pressures, namely international trade obligations and EU budget concerns. We will show that the link between these two pressures was never one of simple determinism: the CAP and its reform can only be understood in light of these pressures and of endogenous vested interests to the policy. En 2008, la Politique agricole commune (PAC) célèbre ses 50 ans. Cette politique a été un facteur constant de l'orientation des ressources vers le secteur agricole de l'UE, mais les moyens utilisés pour acheminer ces ressources ont changé considérablement au fil du temps. Le présent article retrace l'évolution des principaux instruments de la PAC et analyse les effets de ses grandes réformes sur le bien‐être. Elle analyse aussi ces changements dans le contexte institutionnel des pressions de la réforme, à savoir les obligations commerciales internationales et les préoccupations quant au budget de l'UE. Nous montrons que le lien entre ces deux types de pression n'a jamais été d'un déterminisme simple: la PAC et sa réforme ne peuvent être comprises qu'en examinant ces pressions et les droits acquis endogènes qu'elles génèrent.
Potential WTO Challenges to the CAP†
Authors: Swinbank Alan 
Published: November 2008

Since the early 1990s the EU's CAP has undergone considerable change with, first, a switch from market price support to direct payments in 1992 and, second, a further decoupling of support with the creation of the single payment scheme in 2003. Nonetheless, whether the current Doha Round of WTO trade negotiations is successfully completed or not, the CAP will come under renewed scrutiny, as a result either of negotiated reductions in support or of litigation through the WTO's dispute settlement process. This article discusses CAP market price and income support in the context of these likely WTO constraints. Depuis le début des années 1990, la PAC (Politique agricole commune) a subi des changements considérables dont le remplacement du soutien des prix du marché par des aides directes en 1992, suivi du découplage accru du soutien avec la mise en place du régime de paiement unique (RPU) en 2003. Toutefois, que les négociations commerciales actuelles du cycle de Doha de l'OMC se terminent avec succès ou non, la PAC fera l'objet d'un examen approfondi, que ce soit en raison des réductions négociées du soutien ou en raison des litiges portés devant le mécanisme de règlement des différents de l'OMC. Le présent article traite du soutien du revenu et des prix du marché dans le contexte de ces contraintes de l'OMC.