bluuebunny/crossref_metadata_2025_split huggingface dataset:
Koro Syndrome Associated with Alcohol-Induced Systemic Disease in a Zulu
Authors: Holden T. J. 
Published: August 2008

A case report is presented of the genital retraction syndrome, koro, associated with alcoholic hepatitis, avitaminosis and urinary tract infection, occurring in a Zulu male. Treatment of the physical conditions resulted in resolution of the koro symptomatology.The nosological status of koro is discussed and it is proposed that the condition be regarded as a symptom-complex reaction to a variety of psychological or physical stressors rather than as a purely culture-bound syndrome.
Better Off Dead: Suicidal Thoughts in Cancer Patients
Authors: Walker Jane , Waters Rachel A. , Murray Gordon , Swanson Helen , Hibberd Carina J. , Rush Robert W. , Storey Dawn J. , Strong Vanessa A. , Fallon Marie T. , Wall Lucy R. , Sharpe Michael 
Published: August 2008

Purpose Cancer is associated with an increased risk of suicide and attempted suicide. However, we do not know how many cancer patients have thoughts that they would be better off dead or thoughts of hurting themselves. This study aimed to determine the prevalence of such thoughts in cancer outpatients and which patients are most likely to have them. Patients and Methods A survey of consecutive patients who attended the outpatient clinics of a regional cancer center in Edinburgh, United Kingdom. Patients completed the Patient Health Questionnaire-9 (PHQ-9), which included Item 9 that asks patients if they have had thoughts of being better off dead or of hurting themselves in some way in the previous 2 weeks. Those who reported having had such thoughts for at least several days in this period were labeled as positive responders. Patients also completed the Hospital Anxiety and Depression Scale (HADS) and a pain scale. The participating patients’ cancer diagnoses and treatments were obtained from the cancer center clinical database. Results Data were available on 2,924 patients; 7.8% (229 of 2,924; 95% CI, 6.9% to 8.9%) were positive responders. Clinically significant emotional distress, substantial pain, and—to a lesser extent—older age, were associated with a positive response. There was strong evidence of interactions between these effects, and emotional distress played the most important role. Conclusion A substantial number of cancer outpatients report thoughts that they would be better off dead or thoughts of hurting themselves. Management of emotional distress and pain should be a central aspect of cancer care.
Cancer and the Risk of Suicide in Older Americans
Authors: Miller Matthew , Mogun Helen , Azrael Deborah , Hempstead Katherine , Solomon Daniel H. 
Published: August 2008

Purpose To determine whether the risk of suicide is greater among patients with cancer than among patients with other medical illnesses. Patients and Methods A case-control study of the suicide risk associated with medical illness among older Americans that used healthcare utilization data linked to prescription and mortality files. The patient population was comprised of 1,408 New Jersey residents age 65 years or older who were enrolled in Medicare and in a pharmaceutical insurance program. Patient cases (n = 128) died as a result of suicide during the study period of 1994 to 2002. Control patients (n = 1,280) were frequency-matched to patient cases on age and sex. Data were analyzed by using the odds ratio (OR) of suicide adjusted for age, sex, ethnicity, medical and psychiatric comorbidity, and use of prescription medications. Results In adjusted analyses, the only medical condition that remained associated with suicide was cancer (OR, 2.3; 95% CI, 1.1 to 4.8). Suicide also remained associated with a diagnosis of affective disorder (OR, 2.3; 95% CI, 1.3 to 4.2), anxiety/personality disorder (OR, 2.2; 95% CI, 1.3 to 3.6), treatment with antidepressants (OR, 2.0; 95% CI, 1.2 to 3.2), and treatment with opioid analgesics (OR, 1.6; 95% CI, 1.0 to 2.5). Conclusion The risk of suicide in older adults is higher among patients with cancer than among patients with other medical illnesses, even after psychiatric illness and the risk of dying within a year were accounted for.
Sublingual Buprenorphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Trial
Authors: Kraft Walter K. , Gibson Eric , Dysart Kevin , Damle Vidula S. , LaRusso Jennifer L. , Greenspan Jay S. , Moody David E. , Kaltenbach Karol , Ehrlich Michelle E. 
Published: August 2008

OBJECTIVE. In utero exposure to drugs of abuse can lead to neonatal abstinence syndrome, a condition that is associated with prolonged hospitalization. Buprenorphine is a partial μ-opioid agonist used for treatment of adult detoxification and maintenance but has never been administered to neonates with opioid abstinence syndrome. The primary objective of this study was to demonstrate the feasibility and, to the extent possible in this size of study, the safety of sublingual buprenorphine in the treatment of neonatal abstinence syndrome. Secondary goals were to evaluate efficacy relative to standard therapy and to characterize buprenorphine pharmacokinetics when sublingually administered.METHODS. We conducted a randomized, open-label, active-control study of sublingual buprenorphine for the treatment of opiate withdrawal. Thirteen term infants were allocated to receive sublingual buprenorphine 13.2 to 39.0 μg/kg per day administered in 3 divided doses and 13 to receive standard-of-care oral neonatal opium solution. Dose decisions were made by using a modified Finnegan scoring system.RESULTS. Sublingual buprenorphine was largely effective in controlling neonatal abstinence syndrome. Greater than 98% of plasma concentrations ranged from undetectable to ∼0.60 ng/mL, which is less than needed to control abstinence symptoms in adults. The ratio of buprenorphine to norbuprenorphine was larger than that seen in adults, suggesting a relative impairment of N-dealkylation. Three infants who received buprenorphine and 1 infant who received standard of care reached protocol-specified maximum doses and required adjuvant therapy with phenobarbital. The mean length of treatment for those in the neonatal-opium-solution group was 32 compared with 22 days for the buprenorphine group. The mean length of stay for the neonatal-opium-solution group was 38 days compared with 27 days for those in the buprenorphine group. Treatment with buprenorphine was well tolerated.CONCLUSIONS. Buprenorphine administered via the sublingual route is feasible and apparently safe and may represent a novel treatment for neonatal abstinence syndrome.
Poor Specificity of Low Growth Hormone and Cortisol Levels During Fasting Hypoglycemia for the Diagnoses of Growth Hormone Deficiency and Adrenal Insufficiency
Authors: Kelly Andrea , Tang Randy , Becker Susan , Stanley Charles A. 
Published: August 2008

OBJECTIVES. Fasting tests are used to identify the cause of hypoglycemia in children. The purposes of this study were to (1) determine whether growth hormone and cortisol levels obtained at the time of hypoglycemia in such tests can identify children with growth hormone and/or cortisol deficiency and (2) identify potential clinical factors that influence growth hormone and cortisol responses to hypoglycemia.
STUDY DESIGN. The design consisted of chart review of all diagnostic fasting tests conducted over a 3-year period (n = 151). A normal growth hormone level was defined as ≥7.5 ng/mL, and a normal cortisol level was defined as ≥18 μg/dL.
RESULTS. During the fasting tests, 84 children (median age: 1.3 years [2 days to 14.3 years]), became hypoglycemic, with blood glucose ≤50 mg/dL. Diagnoses included normal, ketotic hypoglycemia, hyperinsulinism, fatty acid–oxidation defects, glycogen-storage disease, and late dumping hypoglycemia. A total of 70% had growth hormone and cortisol levels less than the “normal” thresholds regardless of diagnosis. Of various factors (age, diagnosis, fast duration, duration blood glucose level of &lt;60 mg/dL, and blood glucose nadir), only age was positively associated with cortisol, and none were consistently related to growth hormone.
CONCLUSIONS. A singe low growth hormone or cortisol value at the time of fasting hypoglycemia has poor specificity for the respective diagnoses of growth hormone deficiency and adrenal insufficiency.
Selected Combination Therapy with Sorafenib: A Review of Clinical Data and Perspectives in Advanced Solid Tumors
Authors: Dal Lago Lissandra , D'Hondt Véronique , Awada Ahmad 
Published: August 2008

Abstract
The development of targeted therapies has provided new options for the management of patients with advanced solid tumors. There has been particular interest in agents that target the mitogen-activated protein kinase pathway, which controls tumor growth and survival and promotes angiogenesis. Sorafenib is an oral multikinase inhibitor that has been proven effective as a single-agent therapy in renal cell carcinoma, and there is a strong rationale for investigating its use in combination with other agents. In particular, targeting multiple Raf isoforms with sorafenib may help to overcome resistance to other agents, while the ability of sorafenib to induce apoptosis may increase the cytotoxicity of chemotherapeutic agents. Based on positive results in preclinical studies, further investigation in phase I and II studies has shown potential antitumor activity when sorafenib is combined with cytotoxic agents in different solid tumors, including hepatocellular carcinoma and melanoma. Promising results have been reported in phase I and II studies of sorafenib combined with paclitaxel and carboplatin, with oxaliplatin in gastric and colorectal cancer, with docetaxel in breast cancer, with gemcitabine in ovarian cancer, and with capecitabine in different solid tumors. Phase II and III studies are currently investigating the use of sorafenib in combination with different agents in a variety of solid tumors. The primary objective of this review is to summarize the early clinical studies of sorafenib with cytotoxic agents and discuss future perspectives of these combinations in different tumor types.
Disparities in the Use of Chemotherapy and Monoclonal Antibody Therapy for Elderly Advanced Colorectal Cancer Patients in the Community Oncology Setting
Authors: McKibbin Trevor , Frei Christopher R. , Greene Rebecca E. , Kwan Peter , Simon Jody , Koeller Jim M. 
Published: August 2008

Abstract

Learning Objectives
After completing this course, the reader will be able to: Identify reported differences between advanced colorectal cancer patients treated in community oncology clinics and those enrolled in clinical trials.Describe gaps in the existing evidence for the treatment of elderly advanced colorectal cancer patients.Describe the need for improving tools to appropriately select patients for treatment.
CME This article is available for continuing medical education credit at CME.TheOncologist.com

Background.
The clinical trials on which the treatment of advanced colorectal (CRC) is based enroll few elderly patients. Furthermore, few investigations have determined the use and outcomes of the treatment of advanced CRC in practice. This study evaluated the treatment of advanced CRC in community oncology practices, focusing on age-related differences in treatment and outcome.

Methods.
A national, retrospective chart review was conducted to evaluate the management of advanced CRC in 10 community practices across the U.S. All medical records of patients diagnosed with advanced CRC initiating chemotherapy treatment after January 1, 2003 through 2006 were included. The primary aim was to compare the proportion receiving doublet chemotherapy (irinotecan or oxaliplatin with a fluoropyrimidine) as initial therapy in young (age ≤65 years) and elderly (age &gt;65 years) patients. Additional aims included age-based comparisons of the addition of bevacizumab to chemotherapy, overall chemotherapy use, all-cause mortality, and toxicity-related events.

Results.
Overall, 520 patients (56% elderly) received 6,253 cycles of chemotherapy. Of the younger patients, 84% received doublet chemotherapy first-line, compared with 58% of elderly patients (p &lt; .001). The use of each of the medications—irinotecan, oxaliplatin, and bevacizumab—was lower in elderly patients (p &lt; .001). Independent predictors of a higher risk for mortality were age &gt;65 (adjusted hazards ratio [HR],1.19; 95% confidence interval [CI], 1.02–1.39) and performance status score ≥2 (HR, 1.65; 95% CI, 1.41–1.91).

Conclusion.
Elderly patients are less likely to receive first-line doublet chemotherapy than younger patients. Age and performance status are independent predictors of treatment and overall survival.
Osteonecrosis of the Maxilla and Mandible in Patients with Advanced Cancer Treated with Bisphosphonate Therapy
Authors: Estilo Cherry L. , Van Poznak Catherine H. , Wiliams Tijaana , Bohle George C. , Lwin Phyu T. , Zhou Qin , Riedel Elyn R. , Carlson Diane L. , Schoder Heiko , Farooki Azeez , Fornier Monica , Halpern Jerry L. , Tunick Steven J. , Huryn Joseph M. 
Published: August 2008

Abstract
Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past 5 years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate (IVBP) therapy, but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. To further categorize risk factors associated with ONJ and potential clinical outcomes of this condition, we performed a retrospective study of patients with metastatic bone disease treated with intravenous bisphosphonates who have been evaluated by the Memorial Sloan-Kettering Cancer Center Dental Service between January 1, 1996 and January 31, 2006. We identified 310 patients who met these criteria. Twenty-eight patients were identified as having ONJ at presentation to the Dental Service and an additional 7 patients were subsequently diagnosed with ONJ. Statistically significant factors associated with increased likelihood of ONJ included type of cancer, duration of bisphosphonate therapy, sequential IVBP treatment with pamidronate followed by zoledronic acid, comorbid osteoarthritis or rheumatoid arthritis, and benign hematologic conditions. Our data do not support corticosteroid use or oral health as a predictor of risk for ONJ. Clinical outcomes of patients with ONJ were variable with 11 patients demonstrating improvement or healing with conservative management. Our ONJ experience is presented here.
Characterization of biliary metabolites of fluoranthene in the common sole (Solea solea)
Authors: Hillenweck Anne , Canlet Cecile , Mauffret Aourell , Debrauwer Laurent , Claireaux Guy , Cravedi Jean-Pierre 
Published: August 2008

Abstract
Fluoranthene is one of the most abundant polycyclic aromatic hydrocarbon (PAH) pollutants in the environment. Studies of the metabolism of PAHs have highlighted the importance of the gallbladder in concentrating xenobiotics in fish before excretion in feces. Analysis of bile metabolites can be considered useful for monitoring and assessing the exposure offish to PAHs. Although the fate of several PAHs in marine organisms has been widely investigated, information is lacking regarding the metabolism of fluoranthene in fish. Therefore, we investigated the metabolic pathways of [14C]fluoranthene in the common sole (Solea solea) by identifying bile metabolites using electrospray ionization/mass spectrometry (ESI/MS) and nuclear magnetic resonance (NMR) spectroscopy. [14C]Fluoranthene was administered by intraperitoneal injection to 20 common soles. Groups of animals (n = 5) were killed 1, 2, 3, and 4 d postdosing, and gallbladders were excised for radioactivity counting and bile analysis. Biliary metabolites were separated and quantified by radio-high-performance liquid chromatography, and structure identification was performed by ESI/MS. Isomeric structures were confirmed by NMR analyses. At the end of the experiment, 12.2% of the administered radioactivity was recovered in bile. As expected, hydroxylation and glucuronidation were the predominant metabolic pathways. The 7-O-glucuronide-fluoranthene metabolite (representing 13.3% of total radioactivity found in bile), 8-O-glucuronide-fluoranthene (11.8%), trans-2,3-dihydro-3-hydroxy-2-O-glucuronide-fluoranthene (17.9%), and cis-2,3-dihydro-2-hydroxy-3-O-glucuronide-fluoranthene (13.9%) were the major metabolites observed in bile. Minor metabolites, such as trans-2,3-dihydro-2-hydroxy-3-O-glucuronide-fluoranthene (3.9%) and 2,3-di-O-glucuronide-fluoranthene (6.6%), also were identified. The 2,3-dihydrodiol-fluoranthene metabolite, which is found in bile conjugated to glucuronic acid, would be, after hydrolysis of the conjugates, a suitable biomarker of PAH pollution in the marine environment.
Effect of sediment-associated pyrethroids, fipronil, and metabolites on Chironomus tentans growth rate, body mass, condition index, immobilization, and survival
Authors: Maul Jonathan D , Brennan Amanda A , Harwood Amanda D , Lydy Michael J 
Published: August 2008

Abstract
Pyrethroids and fipronil insecticides partition to sediment and organic matter in aquatic systems and may pose a risk to organisms that use these matrices. It has been suggested that bioavailability of sediment-sorbed pesticides is reduced, but data on toxicity of sediment-associated pesticides for pyrethroids and fipronil are limited. In the current study, 10-d sediment exposures were conducted with larval Chironomus tentans for bifenthrin, lambda-cyhalothrin, permethrin, fipronil, fipronil-sulfide, and fipronilsulfone, the last two being common fipronil metabolites. Sublethal endpoints included immobilization, instantaneous growth rate (IGR), body condition index, and growth estimated by ash-free dry mass (AFDM). Pyrethroid lethal concentrations to 50% of the population (LC50s) were 6.2, 2.8, and 24.5 μg/g of organic carbon (OC) for bifenthrin, lambda-cyhalothrin, and permethrin, respectively; with the former two lower than previously published estimates. Fipronil, fipronil-sulfide, and fipronilsulfone LC50 values were 0.13, 0.16, and 0.12 μg/g of OC, respectively. Ratios of LC50s to sublethal endpoints (immobilization, IGR, and AFDM) ranged from 0.90 to 9.03. The effects on growth observed in the present study are important because of the unique dipteran life cycle involving pupation and emergence events. Growth inhibition would likely lead to ecological impacts similar to mortality (no emergence and thus not reproductively viable) but at concentrations up to 4.3 times lower than the LC50 for some compounds. In addition, C. tentans was highly sensitive to fipronil and metabolites, suggesting that dipterans may be important for estimating risk and understanding effects of phenylpyrazole-class insecticides on benthic macroinvertebrate communities.
Diffusion Tensor Imaging Identifies Deficits in White Matter Microstructure in Subjects With Type 1 Diabetes That Correlate With Reduced Neurocognitive Function
Authors: Kodl Christopher T. , Franc Daniel T. , Rao Jyothi P. , Anderson Fiona S. , Thomas William , Mueller Bryon A. , Lim Kelvin O. , Seaquist Elizabeth R. 
Published: August 2008

OBJECTIVE—Long-standing type 1 diabetes is associated with deficits on neurocognitive testing that suggest central white matter dysfunction. This study investigated whether diffusion tensor imaging (DTI), a type of magnetic resonance imaging that measures white matter integrity quantitatively, could identify white matter microstructural deficits in patients with long-standing type 1 diabetes and whether these differences would be associated with deficits found by neurocognitive tests.
RESEARCH DESIGN AND METHODS—Twenty-five subjects with type 1 diabetes for at least 15 years and 25 age- and sex-matched control subjects completed DTI on a 3.0 Tesla scanner and a battery of neurocognitive tests. Fractional anisotropy was calculated for the major white matter tracts of the brain.
RESULTS—Diabetic subjects had significantly lower mean fractional anisotropy than control subjects in the posterior corona radiata and the optic radiation (P &lt; 0.002). In type 1 diabetic subjects, reduced fractional anisotropy correlated with poorer performance on the copy portion of the Rey-Osterreith Complex Figure Drawing Test and the Grooved Peg Board Test, both of which are believed to assess white matter function. Reduced fractional anisotropy also correlated with duration of diabetes and increased A1C. A history of severe hypoglycemia did not correlate with fractional anisotropy.
CONCLUSIONS—DTI can detect white matter microstructural deficits in subjects with long-standing type 1 diabetes. These deficits correlate with poorer performance on selected neurocognitive tests of white matter function.
Use of Pressure Offloading Devices in Diabetic Foot Ulcers
Authors: Wu Stephanie C. , Jensen Jeffrey L. , Weber Anna K. , Robinson Daniel E. , Armstrong David G. 
Published: August 2008

OBJECTIVE—Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers. We therefore discuss characteristics and considerations associated with the use of offloading devices.RESEARCH DESIGN AND METHODS—A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005. A total of 901 geographically diverse centers responded. The survey recorded information regarding usage frequency and characteristics of assessment and treatment of diabetic foot ulcers in each center.RESULTS—Of the 895 respondents who treat diabetic foot ulcers, shoe modifications (41.2%, P &lt; 0.03) were the most common form of pressure mitigation, whereas total contact casts were used by only 1.7% of the centers.CONCLUSIONS—This study reports the usage and characteristics of offloading devices in the care of diabetic foot ulcers in a broadly distributed geographic sample. Less than 2% of specialists use what has been termed the “gold standard” (total contact cast) for treating the majority of diabetic foot ulcers.
Tensile behaviour of micro-sized copper wires studied using a novel fibre tensile module
Authors: Yang B. , Motz C. , Grosinger W. , Kammrath W. , Dehm G. 
Published: August 2008

Abstract
Tensile experiments on micro-sized polycrystalline copper wires with diameters ranging from 14 μm to 50 μm were performed using a recently developed fibre tensile module capable of high accuracy and flexibility. This module is able to fit into a scanning electron microscope for in-situ deformation studies. In this study the influence of the gauge length, wire diameter and grain size on the tensile properties is analysed. In-situ experiments performed in a scanning electron microscope revealed clearly that the occurrence of “pop-in” events in the load-displacement curves are related to slip. The results are compared to deformation studies of micro-sized copper samples in the literature and discussed taking in-situ scanning electron microscope observations into account.
Dislocation densities in soft and hard oriented grains of compression deformed textured NiAl polycrystals
Authors: Ungár Tamás , Nyilas Krisztián , Skrotzki Werner 
Published: August 2008

Abstract
NiAl polycrystals with different textures have been compressed at room temperature with and without confining pressure to strains of 6 and 30 %, respectively. Grain orientation dependent dislocation densities have been determined by X-ray line profile analysis using the multiple whole profile procedure. The dislocation density as well as the stored energy in hard grains, <100> oriented with respect to the compression axis, generally is about half of that in soft grains, which are randomly oriented. Taking into account appropriate individual dislocation contrast factors it has been found that in hard grains slip mainly takes place by <111> screw dislocations while in soft grains there is about a 50 % contribution of mixed type <100> dislocations. The results are discussed with respect to the inhomogeneity of deformation of plastically anisotropic materials and its effect on recrystallization.