bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of lymphatic spread of carcinoma of the ampulla of Vater
Authors: Shirai Y , Ohtani T , Tsukada K , Hatakeyama K 
Published: June 2006

Abstract

Background
The pattern of lymphatic spread of ampullary cancer is poorly documented. This pattern was clarified in order to define the rational extent of radical lymphadenectomy.

Method
Thirty-nine consecutive patients who underwent pancreaticoduodenectomy with radical lymphadenectomy were included in the study. A total of 1447 lymph nodes dissected from the resected specimens was examined to detect the presence of metastatic foci.

Results
Twenty-one of the 39 patients had a total of 97 positive nodes. The sites of nodal involvement were the posterior pancreaticoduodenal (20 of 21 patients), inferior pancreaticoduodenal artery (IPDA; 12 of 21), anterior pancreaticoduodenal (three of 21), trunk of the superior mesenteric artery (three of 20), pericholedochal (three of 21), retroportal (two of 21), and para-aortic (three of five) regions. No metastases were found in the hepatic artery, cystic duct, perigastric, right coeliac, middle colic artery or right caval node groups.

Conclusion
Ampullary cancer mainly spreads to the posterior pancreaticoduodenal node group, then to the IPDA node group, and finally to the para-aortic area. The rational extent of radical lymphadenectomy should include the pancreaticoduodenal, superior mesenteric, pericholedochal, retroportal and para-aortic nodes.
Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma
Authors: Mariette C , Piessen G , Lamblin A , Mirabel X , Adenis A , Triboulet J P 
Published: June 2006

Abstract

Background
The aim of this study was to determine the effect of neoadjuvant radiochemotherapy (RCT) on postoperative complications and survival after surgery for locally advanced oesophageal squamous cell carcinoma.

Methods
Postoperative course and survival were compared in 144 patients who had neoadjuvant RCT and 80 control patients who had surgery alone for locally advanced oesophageal squamous cell carcinoma (radiological stage T3, N0 or N1, M0).

Results
The two groups were comparable in terms of American Society of Anesthesiologists grade, age, sex, weight loss, tumour location, presence of lymph node metastasis and surgical approach. Postoperative mortality rates were 6·3 and 9 per cent (P = 0·481), with morbidity rates of 40·3 and 41 per cent (P = 0·887) in the RCT and control group respectively. Complete resection (R0) rates were 74·3 and 48 per cent respectively (P &lt; 0·001). Significant downstaging was observed in the RCT group (P &lt; 0·001), with 16·0 per cent of patients having a complete pathological response. Median survival was 29 versus 15 months, and the 5-year survival rate 37 versus 17 per cent (P = 0·002) in RCT and control groups respectively.

Conclusion
Neoadjuvant RCT significantly enhanced R0 resection and survival rates in patients with stage T3 oesophageal squamous cell carcinoma, with no increase in postoperative mortality and morbidity rates.
Final results of the Canadian prospective phase II trial of intermittent androgen suppression for men in biochemical recurrence after radiotherapy for locally advanced prostate cancer
Authors: Bruchovsky Nicholas , Klotz Laurence , Crook Juanita , Malone Shawn , Ludgate Charles , Morris W. James , Gleave Martin E. , Goldenberg S. Larry 
Published: June 2006

AbstractBACKGROUND.This prospective Phase II study was undertaken to evaluate intermittent androgen suppression as a form of therapy in men with localized prostate cancer who failed after they received external beam irradiation.METHODS.Patients who demonstrated a rising serum prostate‐specific antigen (PSA) level after they received radiotherapy and who were without evidence of distant metastasis were accepted into the study. Treatment in each cycle consisted of cyproterone acetate given as lead‐in therapy for 4 weeks, followed by a combination of leuprolide acetate and cyproterone acetate, which ended after a total of 36 weeks.RESULTS.Of 109 patients registered, 103 patients were eligible for interruption of treatment, yielding a PSA response rate of 95%. The study continued for 6 years with a mean follow‐up of 3.7 years (median follow‐up, 4.2 years). The time off treatment averaged 53% of the total cycle time but, in absolute terms, decreased with each succeeding cycle, ranging from 63.7 weeks in Cycle 1 to 25.6 weeks in Cycle 5. Prostate volume was reduced by 40% in Cycle 1 and by 34% in Cycle 2, and there were no decreases in Cycle 3 or Cycle 4. At the end of the trial, 38.5% of patients still were receiving treatment, 23.9% of patients had failed, and 15.6% of patients had died. Only 2% of deaths were cancer‐specific.CONCLUSIONS.Biochemical recurrence after irradiation for localized prostate cancer was amenable to cyclic androgen withdrawal therapy and showed a high response rate. Despite progressively shorter treatment cycles, the off‐treatment interval remained appreciable, ranging from 65% in Cycle 1 to 46% in Cycle 5. Cancer 2006. © 2006 American Cancer Society.
The emergence of local norms in networks
Authors: Burke Mary A. , Fournier Gary M. , Prasad Kislaya 
Published: June 2006

AbstractWe develop an explanation of the emergence of local norms and the associated phenomenon of geographical variation in behavior. Individuals are assumed to interact locally with neighbors in an environment with a network externality. Although many patterns of behavior are possible, the dispersed interactive choices of agents are shown to select behavior that is locally uniform but globally diverse. The range of applications of the theory includes regional variation in the practice of medicine, technology choice, and corruption. The framework is also useful for further developing our understanding of important phenomena like lock‐in, critical thresholds, and contagion. © 2006 Wiley Periodicals, Inc. Complexity 11: 65–83, 2006
Who refuses the diagnostic assessment for dementia in primary care?
Authors: Boustani Malaz , Perkins Anthony J. , Fox Chris , Unverzagt Fred , Austrom Mary Guerriero , Fultz Bridget , Hui Siu , Callahan Christopher M. , Hendrie Hugh C. 
Published: June 2006

AbstractObjectiveEarly screening and detection of dementia in primary care remains controversial. At least half of the patients identified as cognitively impaired by screening instruments do not meet criteria for dementia and some patients refuse further evaluation following a positive screen. The aim of this study was to identify the characteristics of patients who refuse a clinical diagnostic assessment for dementia after screening.DesignCross sectional study.SettingSeven primary care practice centers in Indianapolis.ParticipantsFour hundred and thirty‐four individuals aged 65 and older who screened positive for dementia with a mean age of 74.6, 67% women, and 68% African‐American.Main outcome measurePatients' acceptance of undergoing a dementia diagnostic assessment that included neuropsychological testing, caregiver interview, and medical chart review.ResultsAmong patients with positive screening results for dementia, approximately half (47.7%) refused further assessment to confirm their screening results. In a bivariate analysis, possible factors associated with a higher probability of refusing dementia assessment were older age and better screening score. In a multiple logistic regression model, performing well on the temporal orientation of the screening instrument was associated with a higher probability of refusing diagnostic assessment for dementia (OR = 1.37; p = 0.001). Also, African‐American patients aged 80 and older were more likely to refuse the diagnostic assessment than African‐Americans less than 80 years of age (OR = 3.1, p < 0.001), while there was no significant age association for white patients (OR = 0.9, p = 0.728).ConclusionsOlder primary care patients who perceived themselves as having no cognitive symptoms refused dementia diagnostic assessment despite their positive screening results. We must improve our understanding of the decision‐making process driving patients' beliefs and behaviors about the benefits and risks of dementia screening and diagnosis before implementing any broad‐based screening initiatives for dementia. Copyright © 2006 John Wiley & Sons, Ltd.
Complete hypopharyngeal obstruction by mucosal adhesions: A complication of intensive chemoradiation for advanced head and neck cancer
Authors: Franzmann Elizabeth J. , Lundy Donna S. , Abitbol Andre A. , Goodwin W. Jarrard 
Published: June 2006

AbstractBackground.Severe swallowing dysfunction is the dominant long‐term complication observed in patients treated for head and neck squamous cell carcinoma (HNSCC) with treatment protocols using intensive concurrent chemotherapy with radiation therapy (chemo/XRT). We identified a subset of these patients, who were seen with complete obstruction of the hypopharynx distal to the site of the primary cancer, and in whom we postulate that the obstruction was caused by separable mucosal adhesions rather than obliteration by a mature fibrous stricture.Methods.Seven patients were referred to the senior author with a diagnosis of complete hypopharyngeal obstruction between 1992 and 2001. The diagnosis was confirmed by barium swallow imaging and/or endoscopy before referral in all patients. Patients underwent recanalization by passing a Jesberg esophagoscope under general anesthesia, followed by serial dilations and intensive swallowing therapy. Patient charts were reviewed retrospectively after institutional review board approval.Results.All seven patients were successfully recanalized. No patient had a perforation or other significant complication related to the recanalization procedure or subsequent dilations. Five of the seven patients showed improvement in swallowing at some point after the initial procedure, but just two patients recovered sufficiently to have their gastrostomy tube removed permanently.Conclusions.We conclude that complete hypopharyngeal obstruction secondary to mucosal adhesions is one cause of gastrostomy tube dependence in patients who have been treated with chemo/XRT for HNSCC. It is a difficult problem to treat, but most patients can recover useful swallowing function without undergoing laryngectomy or major surgical reconstruction. The postulated pathophysiology has implications for prevention as well as treatment. © 2006 Wiley Periodicals, Inc. Head Neck, 2006
Differential tissue and subcellular expressionof ERM proteins in normal and malignant tissues: Cytoplasmic ezrin expression has prognostic signficance for head and neck squamous cell carcinoma
Authors: Madan Rashna , Brandwein‐Gensler Margaret , Schlecht Nicolas F. , Elias Kristin , Gorbovitsky Eleanor , Belbin Thomas J. , Mahmood Radma , Breining Dwayne , Qian Hong , Childs Geoffrey , Locker Joseph , Smith Richard , Haigentz Missak , Gunn‐Moore Frank , Prystowsky Michael B. 
Published: June 2006

AbstractBackground.Members of the ezrin‐radixin‐moesin (ERM) protein family regulate cellular shape, motility, and proliferation and potentially influence ability to metastasize. We investigated the correlation between ERM subcellular localization and survival in patients with squamous cell carcinoma (SCC)Methods.Tissue microarrays (TMAs) were constructed from paraffin‐embedded tissue. TMA sections were evaluated for ERM protein expression immunohistochemically. The results were compared across clinical and histopathologic variablesResultsERM staining results for 47 patients showed that cytoplasmic ERM expression was prevalent in tumors (>92%). Whereas ezrin and moesin also localized to the membrane, only willin was found in the nucleus of tumors. Multivariable Cox regression analysis demonstrated that strong cytoplasmic ezrin expression was independently associated with poorer survival (p = .04, hazard ratio 1.82)Conclusions.Both level of expression and subcellular localization of ERM proteins may be important indicators of clinical outcome in SCC. This pilot study justifies the need for an expanded validation study of ERM proteins and clinical outcome. © 2006 Wiley Periodicals, Inc. Head Neck, 2006
The dynamics of the health labour market
Authors: Vujicic Marko , Zurn Pascal 
Published: June 2006

AbstractOne of the most important components of health care systems is human resources for health (HRH)—the people that deliver the services. One key challenge facing policy makers is to ensure that health care systems have sufficient HRH capacity to deliver services that improve or maintain population health. In a predominantly public system, this involves policy makers assessing the health care needs of the population, deriving the HRH requirements to meet those needs, and putting policies in place that move the current HRH employment level, skill mix, geographic distribution and productivity towards the desired level. This last step relies on understanding the labour market dynamics of the health care sector, specifically the determinants of labour demand and labour supply. We argue that traditional HRH policy in developing countries has focussed on determining the HRH requirements to address population needs and has largely ignored the labour market dynamics aspect. This is one of the reasons that HRH policies often do not achieve their objectives. We argue for the need to incorporate more explicitly the behaviour of those who supply labour—doctors, nurses and other providers—those who demand labour, and how these actors respond to incentives when formulating health workforce policy. Copyright © 2006 John Wiley & Sons, Ltd.
Physician supply, supplier‐induced demand and competition: empirical evidence from a single‐payer system
Authors: Xirasagar Sudha , Lin Herng‐Ching 
Published: June 2006

AbstractWe examined the earnings of 8106 office‐based (FTE) physicians in 2002 in Taiwan for evidence of supplier‐induced demand (SID). We hypothesize that SID, operating in the form of mutual cross‐specialty referral, will cause earnings to increase with total physician density (all specialties taken together), but simultaneously, decrease with increasing competition within specialties. We used multiple regression analyses controlling for high‐user population, physician demographics and practice type. The evidence supports our hypotheses. Increasing total physician density (all specialties) is positively associated with earnings. Concurrently, within specialties, increased competition is associated with reduced earnings. The medical appropriateness of increasing health care utilization with increasing physician supply cannot be directly determined from the data. However, evidence of a steady earnings increase with increasing total physician density, which precludes a saturation point (of appropriate care levels) at some optimum physician density, substantiates SID in the office‐based practice market. Empirically, our data suggest that the average market effect of physicians on one another is synergic when all specialties are considered together, but competitive within each specialty. Copyright © 2006 John Wiley & Sons, Ltd.
The importance of knowledge transfer between specialist and generic services in improving health care: a cross‐national study of dementia care in England and The Netherlands
Authors: Kümpers Susanne , Mur Ingrid , Hardy Brian , Maarse Hans , Raak Arno van 
Published: June 2006

AbstractKnowledge transfer (KT) between specialist and generic services is widely seen as an important strategy for improving the quality of integrated dementia care. This article elaborates on intra‐ and inter‐organizational features associated with successful KT. A provisional conceptual framework is suggested, based on literature about inter‐organizational networks and knowledge management. Professional and organizational cultures, domain perceptions, perceived dependency and the availability of resources are suggested as significant influences upon the motivation and perceived capacity to engage in KT. Personal and organizational continuity is identified as an important process quality. Data from four local case studies in England and The Netherlands are used to develop and specify the provisional framework. A conceptual model is built to explain the relative success or failure of KT. Copyright © 2006 John Wiley & Sons, Ltd.
Patterns of simultaneous polysubstance use in drug using university students
Authors: Barrett Sean P. , Darredeau Christine , Pihl Robert O. 
Published: June 2006

AbstractSimultaneous polysubstance use (SPU) is a common phenomenon, yet little is known about how various substances are used with one another. In the present study 149 drug‐using university students completed structured interviews about their use of various substances. For each substance ever used, participants provided details about the type, order and amount of all substances co‐administered during its most recent administration. Alcohol, tobacco and cannabis were frequently co‐administered with each other and with all other substances. Chi‐squared tests revealed that when alcohol was used in combination with any of cannabis, psilocybin, MDMA, cocaine, amphetamine, methylphenidate (ps < 0.01) or LSD (p < 0.05) its initial use preceded the administration of the other substance. Paired samples t‐tests revealed that when alcohol was used with cocaine (p < 0.01) or methylphenidate (p < 0.05) it was ingested in greater quantities than when used in their absence. Patterns of cannabis use were not systematically related to other substances administered. Finally, using one‐sample t‐tests, tobacco use was demonstrated to be increased relative to ‘sober’ smoking rates when used with alcohol, cannabis, psilocybin, MDMA, cocaine, amphetamine (ps < 0.001), LSD (p < 0.01) or methylphenidate (p < 0.05). Results suggest that many substances are routinely used in a SPU context and that the pattern in which a substance is used may be related to other substances co‐administered. Copyright © 2006 John Wiley & Sons, Ltd.
The role of a HSV thymidine kinase stimulating substance, scopadulciol, in improving the efficacy of cancer gene therapy
Authors: Hayashi Kyoko , Lee Jung‐Bum , Maitani Yoshie , Toyooka Naoki , Nemoto Hideo , Hayashi Toshimitsu 
Published: June 2006

AbstractBackgroundThe most extensively investigated strategy of suicide gene therapy for treatment of cancer is the transfer of the herpes simplex virus thymidine kinase (HSV‐TK) gene followed by administration of antiviral prodrugs such as acyclovir (ACV) and ganciclovir (GCV). The choice of the agent that can stimulate HSV‐TK enzymatic activity is one of the determinants of the usefulness of this strategy. Previously, we found that a diterpenoid, scopadulciol (SDC), produced a significant increase in the active metabolite of ACV. This suggests that SDC may play a role in the HSV‐TK/prodrug administration system.MethodsThe anticancer effect of SDC was evaluated in HSV‐TK‐expressing (TK+) cancer cells and nude mice bearing TK+ tumors. In vitro and in vivo enzyme assays were performed using TK+ cells and tumors. The phosphorylation of ACV monophosphate (ACV‐MP) was measured in TK− cell lysates. The pharmacokinetics of prodrugs was evaluated by calculating area‐under‐the‐concentration‐time‐curve values.ResultsSDC stimulated HSV‐TK activity in TK+ cells and tumors, and increased GCV‐TP levels, while no effect of SDC was observed on the phosphorylation of ACV‐MP to ACV‐TP by cellular kinases. The SDC/prodrug combination altered the pharmacokinetics of the prodrugs. In accord with these findings, SDC enhanced significantly the cell‐killing activity of prodrugs. The bystander effect was also significantly augmented by the combined treatment of ACV/GCV and SDC.ConclusionsSDC was shown to be effective in the HSV‐TK/prodrug administration system and improved the efficiency of the bystander effect of ACV and GCV. The findings will be considerably valuable with respect to the use of GCV in lower doses and less toxic ACV. This novel strategy of drug combination could provide benefit to HSV‐TK/prodrug gene therapy. Copyright © 2006 John Wiley & Sons, Ltd.
Short‐term treatment using insulin‐like growth factor‐1 (IGF‐1) improves life expectancy of the delta‐sarcoglycan deficient hamster
Authors: Serose Armelle , Salmon André , Fiszman Marc Y. , Fromes Yves 
Published: June 2006

AbstractBackgroundThe hamster strain CHF147 presents a progressive dilated cardiomyopathy (DCM) due to a large deletion of the delta‐sarcoglycan gene that leads to heart failure. This cardiomyopathy induces premature death. We have previously shown that a short‐term treatment using IGF‐1 preserves cardiac structure and improves function of the CHF147 hamster.MethodsIn the current study, we measured long‐term effects of short‐term treatment with recombinant human IGF‐1 (rhIGF‐1) in CHF147 hamsters. CHF147 hamsters (7–8 months old) were implanted under the skin with an osmotic pump filled either with saline or with recombinant human IGF‐1 at a total dose of 25 µg. The osmotic pump allowed a continuous delivery of the protein for a mean duration of 19 days.ResultsWe observed a significant increase in overall survival, as well as preservation of cardiac function, in the rhIGF‐1‐treated group. At the time of death, hearts of treated animals did not present any macroscopical or histological differences compared to those of sham hamsters. These results show that rhIGF‐1 treatment slows down the evolution of the DCM in the CHF147 hamster. Moreover, the low dose treatment did not increase IGF‐1 serum levels.ConclusionsThis study is the first one reporting beneficial effects of IGF‐1 treatment on survival of an animal model presenting DCM. Our results raise hopes for a new therapeutic approach of this pathology. Copyright © 2006 John Wiley & Sons, Ltd.