bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chest radiography and pneumonia in primary care: diagnostic yield and consequences for patient management
Authors: Speets A. M. , Hoes A. W. , van der Graaf Y. , Kalmijn S. , Sachs A. P. E. , Mali W. P. Th. M. 
Published: July 2006

The current prospective cohort study assessed the diagnostic yield of chest radiography (CXR) in primary-care patients suspected of pneumonia.In total, 192 patients with a clinical suspicion of pneumonia aged ≥18 yrs were referred by their general practitioner (GP) for CXR to one of the three participating hospitals in the Netherlands. All GPs were asked to complete a standardised form before and after CXR.Pneumonia was diagnosed by GPs in 35 (18%) patients, of whom 27 (14%) patients had a positive CXR, and eight (4%) patients a negative CXR, but with an assumed high probability of pneumonia by the GP. CXR clearly influenced the diagnosis of pneumonia by the GP in 53% of the patients. CXR ruled out pneumonia in 47% and the probability of pneumonia substantially increased in 6% of the patients. Patient management changed after CXR in 69% of the patients, mainly caused by a reduction in medication prescription (from 43 to 17%) and more frequent reassurance of the patient (from 8 to 35%).In conclusion, pneumonia was frequently over diagnosed clinically by general practitioners. Chest radiography is a valuable diagnostic tool to substantially reduce the number of patients misdiagnosed and is particularly important for the exclusion of pneumonia in general practice.
Outcome of pulmonary multidrug-resistant tuberculosis: a 6-yr follow-up study
Authors: Chiang C-Y. , Enarson D. A. , Yu M-C. , Bai K-J. , Huang R-M. , Hsu C-J. , Suo J. , Lin T-P. 
Published: July 2006

A retrospective study was performed to determine factors associated with the outcome of pulmonary multidrug-resistant tuberculosis (MDR-TB) in Taipei, Taiwan.All patients newly diagnosed with pulmonary MDR-TB in a referral centre from 1992–1996 were enrolled and their outcome over the subsequent 6 yrs was determined.A total of 299 patients were identified, comprising 215 (71.9%) males and 84 (28.1%) females with a mean age of 47.3 yrs. The patients received a mean of 3.7 effective drugs. Out of the 299 patients, 153 (51.2%) were cured, 31 (10.4%) failed, 28 (9.4%) died and 87 (29.1%) defaulted. Of the 125 patients receiving second-line drugs with ofloxacin, 74 (59.2%) were cured. Those who received ofloxacin had a lower risk of relapse than those receiving only first-line drugs (hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.03–0.81) and a lower risk of TB-related death than those receiving second-line drugs but not ofloxacin (adjusted HR 0.50, 95% CI 0.31–0.82).In conclusion, multidrug-resistant tuberculosis patients who received ofloxacin were more likely to be cured, and were less likely to die, fail or relapse. The utility of new-generation fluoroquinolones, such as moxifloxacin, in the treatment of multidrug-resistant tuberculosis needs to be evaluated. Default from treatment is a major challenge in the treatment of multidrug-resistant tuberculosis.
Comparative EST analysis provides insights into the basal aquatic fungus Blastocladiella emersonii
Authors: Ribichich Karina F , Georg Raphaela C , Gomes Suely L 
Published: July 2006

Abstract

Background

Blastocladiella emersonii is an aquatic fungus of the Chytridiomycete class, which is at the base of the fungal phylogenetic tree. In this sense, some ancestral characteristics of fungi and animals or fungi and plants could have been retained in this aquatic fungus and lost in members of late-diverging fungal species. To identify in B. emersonii sequences associated with these ancestral characteristics two approaches were followed: (1) a large-scale comparative analysis between putative unigene sequences (uniseqs) from B. emersonii and three databases constructed ad hoc with fungal proteins, animal proteins and plant unigenes deposited in Genbank, and (2) a pairwise comparison between B. emersonii full-length cDNA sequences and their putative orthologues in the ascomycete Neurospora crassa and the basidiomycete Ustilago maydis.

Results
Comparative analyses of B. emersonii uniseqs with fungi, animal and plant databases through the two approaches mentioned above produced 166 B. emersonii sequences, which were identified as putatively absent from other fungi or not previously described. Through these approaches we found: (1) possible orthologues of genes previously identified as specific to animals and/or plants, and (2) genes conserved in fungi, but with a large difference in divergence rate in B. emersonii. Among these sequences, we observed cDNAs encoding enzymes from coenzyme B12-dependent propionyl-CoA pathway, a metabolic route not previously described in fungi, and validated their expression in Northern blots.

Conclusion
Using two different approaches involving comparative sequence analyses, we could identify sequences from the early-diverging fungus B. emersonii previously considered specific to animals or plants, and highly divergent sequences from the same fungus relative to other fungi.
Serum repressing efflux pump CDR1 in Candida albicans
Authors: Yang Yun-Liang , Lin Yi-Hsuan , Tsao Ming-Yang , Chen Chia-Geun , Shih Hsin-I , Fan Jen-Chung , Wang Jang-Shiun , Lo Hsiu-Jung 
Published: July 2006

Abstract

Background
In the past decades, the prevalence of candidemia has increased significantly and drug resistance has also become a pressing problem. Overexpression of CDR1, an efflux pump, has been proposed as a major mechanism contributing to the drug resistance in Candida albicans. It has been demonstrated that biological fluids such as human serum can have profound effects on antifungal pharmacodynamics. The aim of this study is to understand the effects of serum in drug susceptibility via monitoring the activity of CDR1 promoter of C. albicans.

Results
The wild-type C. albicans cells (SC5314) but not the cdr1/cdr1 mutant cells became more susceptible to the antifungal drug when the medium contained serum. To understand the regulation of CDR1 in the presence of serum, we have constructed CDR1 promoter-Renilla luciferase (CDR1p-RLUC) reporter to monitor the activity of the CDR1 promoter in C. albicans. As expected, the expression of CDR1p-RLUC was induced by miconazole. Surprisingly, it was repressed by serum. Consistently, the level of CDR1 mRNA was also reduced in the presence of serum but not N-acetyl-D-glucosamine, a known inducer for germ tube formation.

Conclusion
Our finding that the expression of CDR1 is repressed by serum raises the question as to how does CDR1 contribute to the drug resistance in C. albicans causing candidemia. This also suggests that it is important to re-assess the prediction of in vivo therapeutic outcome of candidemia based on the results of standard in vitro antifungal susceptibility testing, conducted in the absence of serum.
Comparison of transcripts in Phalaenopsis bellina and Phalaenopsis equestris(Orchidaceae) flowers to deduce monoterpene biosynthesis pathway
Authors: Hsiao Yu-Yun , Tsai Wen-Chieh , Kuoh Chang-Sheng , Huang Tian-Hsiang , Wang Hei-Chia , Wu Tian-Shung , Leu Yann-Lii , Chen Wen-Huei , Chen Hong-Hwa 
Published: July 2006

AbstractBackgroundFloral scent is one of the important strategies for ensuring fertilization and for determining seed or fruit set. Research on plant scents has hampered mainly by the invisibility of this character, its dynamic nature, and complex mixtures of components that are present in very small quantities. Most progress in scent research, as in other areas of plant biology, has come from the use of molecular and biochemical techniques. Although volatile components have been identified in several orchid species, the biosynthetic pathways of orchid flower fragrance are far from understood. We investigated how flower fragrance was generated in certainPhalaenopsisorchids by determining the chemical components of the floral scent, identifying floral expressed-sequence-tags (ESTs), and deducing the pathways of floral scent biosynthesis inPhalaneopsis bellinaby bioinformatics analysis.ResultsThe main chemical components in theP. bellinaflower were shown by gas chromatography-mass spectrometry to be monoterpenoids, benzenoids and phenylpropanoids. The set of floral scent producing enzymes in the biosynthetic pathway from glyceraldehyde-3-phosphate (G3P) to geraniol and linalool were recognized through data mining of theP. bellinafloral EST database (dbEST). Transcripts preferentially expressed inP. bellinawere distinguished by comparing the scent floral dbEST to that of a scentless species,P. equestris, and included those encoding lipoxygenase, epimerase, diacylglycerol kinase and geranyl diphosphate synthase. In addition, EST filtering results showed that transcripts encoding signal transduction and Myb transcription factors and methyltransferase, in addition to those for scent biosynthesis, were detected byin silicohybridization of theP. bellinaunigene database against those of the scentless species, rice andArabidopsis. Altogether, we pinpointed 66% of the biosynthetic steps from G3P to geraniol, linalool and their derivatives.ConclusionThis systems biology program combined chemical analysis, genomics and bioinformatics to elucidate the scent biosynthesis pathway and identify the relevant genes. It integrates the forward and reverse genetic approaches to knowledge discovery by which researchers can study non-model plants.
Improving preventive service delivery at adult complete health check-ups: the Preventive health Evidence-based Recommendation Form (PERFORM) cluster randomized controlled trial
Authors: Dubey Vinita , Mathew Roy , Iglar Karl , Moineddin Rahim , Glazier Richard 
Published: July 2006

Abstract

Background
To determine the effectiveness of a single checklist reminder form to improve the delivery of preventive health services at adult health check-ups in a family practice setting.

Methods
A prospective cluster randomized controlled trial was conducted at four urban family practice clinics among 38 primary care physicians affiliated with the University of Toronto. Preventive Care Checklist Forms© were created to be used by family physicians at adult health check-ups over a five-month period. The sex-specific forms incorporate evidence-based recommendations on preventive health services and documentation space for routine procedures such as physical examination. The forms were used in two intervention clinics and two control clinics. Rates and relative risks (RR) of the performance of 13 preventive health maneuvers at baseline and post-intervention and the percentage of up-to-date preventive health services delivered per patient were compared between the two groups.

Results
Randomly-selected charts were reviewed at baseline (n = 509) and post-intervention (n = 608). Baseline rates for provision of preventive health services ranged from 3% (fecal occult blood testing) to 93% (blood pressure measurement), similar to other settings. The percentage of up-to-date preventive health services delivered per patient at the end of the intervention was 48.9% in the control group and 71.7% in the intervention group. This is an overall 22.8% absolute increase (p = 0.0001), and 46.6% relative increase in the delivery of preventive health services per patient in the intervention group compared to controls. Eight of thirteen preventive health services showed a statistically significant change (p < 0.05) in favor of the intervention (adjusted RR (95% C.I.)): counseling on brushing/flossing teeth (9.2 (4.3–19.6)), folic acid counseling (7.5 (2.7–20.8)), fecal occult blood testing (6.7 (1.9–24.1)), smoking cessation counseling (3.9 (2.2–7.2)), tetanus immunization (3.0 (1.7–5.2)), history of alcohol intake (1.33 (1.2–1.5)), history of smoking habits (1.28 (1.2–1.4)) and blood pressure measurement (1.05 (1.00–1.10)).

Conclusion
This simple, low cost, clinically relevant intervention improves the delivery of preventive health services by prompting physicians of evidence-based recommendations in a checklist format that incorporates existing practice patterns. Periodic updates of the Preventive Care Checklist Forms© will allow a feasible and easy-to-use tool for primary care physicians to provide evidence-based preventive health services to adults at routine health check-ups. The forms can also be incorporated into an electronic health record. The Preventive Care Checklist Forms© are accessible in English and French at the College of Family Physicians of Canada web site.
Glucose testing and insufficient follow-up of abnormal results: a cohort study
Authors: Kern Lisa M , Callahan Mark A , Brillon David J , Vargas Maryelena , Mushlin Alvin I 
Published: July 2006

AbstractBackgroundMore than 6 million Americans have undiagnosed diabetes. Several national organizations endorse screening for diabetes by physicians, but actual practice is poorly understood. Our objectives were to measure the rate, the predictors and the results of glucose testing in primary care, including rates of follow-up for abnormal values.MethodsWe conducted a retrospective cohort study of 301 randomly selected patients with no known diabetes who received care at a large academic general internal medicine practice in New York City. Using medical records, we collected patients' baseline characteristics in 1999 and followed patients through the end of 2002 for all glucose tests ordered. We used multivariate logistic regression to measure associations between diabetes risk factors and the odds of glucose testing.ResultsThree-fourths of patients (78%) had at least 1 glucose test ordered. Patient age (≥45 vs. <45 years), non-white ethnicity, family history of diabetes and having more primary care visits were each independently associated with having at least 1 glucose test ordered (p < 0.05), whereas hypertension and hyperlipidemia were not. Fewer than half of abnormal glucose values were followed up by the patients' physicians.ConclusionAlthough screening for diabetes appears to be common and informed by diabetes risk factors, abnormal values are frequently not followed up. Interventions are needed to trigger identification and further evaluation of abnormal glucose tests.
Anti-erbB2 treatment induces cardiotoxicity by interfering with cell survival pathways
Authors: Pugatsch Thea , Abedat Suzan , Lotan Chaim , Beeri Ronen 
Published: July 2006

Abstract
Introduction
Cardiac dysfunction is among the serious side effects of therapy with recombinant humanized anti-erbB2 monoclonal antibody. The antibody blocks ErbB-2, a receptor tyrosine kinase and co-receptor for other members of the ErbB and epidermal growth factor families, which is over-expressed on the surface of many malignant cells. ErbB-2 and its ligands neuregulin and ErbB-3/ErbB-4 are involved in survival and growth of cardiomyocytes in both postnatal and adult hearts, and therefore the drug may interrupt the correct functioning of the ErbB-2 pathway.

Methods
The effect of the rat-anti-erbB2 monoclonal antibody B-10 was studied in spontaneously beating primary myocyte cultures from rat neonatal hearts. Gene expression was determined by RT-PCR (reverse transcription polymerase chain reaction) and by rat stress-specific microarray analysis, protein levels by Western blot, cell contractility by video motion analysis, calcium transients by the FURA fluorescent method, and apoptosis using the TUNEL (terminal uridine nick-end labelling) assay.

Results
B-10 treatment induces significant changes in expression of 24 out of 207 stress genes analyzed using the microarray technique. Protein levels of ErbB-2, ErbB-3, ErbB-4 and neuregulin decreased after 1 day. However, both transcription and protein levels of ErbB-4 and gp130 increased several fold. Calreticulin and calsequestrin were overexpressed after three days, inducing a decrease in calcium transients, thereby influencing cell contractility. Apoptosis was induced in 20% cells after 24 hours.

Conclusion
Blocking ErbB-2 in cultured rat cardiomyocytes leads to changes that may influence the cell cycle and affects genes involved in heart functions. B-10 inhibits pro-survival pathways and reduces cellular contractility. Thus, it is conceivable that this process may impair the stress response of the heart.
Exposure of the Cervical Internal Carotid Artery: Surgical Steps to the Cranial Base and Morphometric Study
Authors: Beretta Federica , Hemida Salah A. , Andaluz Norberto , Zuccarello Mario , Keller Jeffrey T. 
Published: July 2006

Abstract

OBJECTIVE:
Several studies have reported on approaches to increase exposure of the distal cervical internal carotid artery (ICA), but these studies have neither systematically addressed the anatomic aspects nor quantified the additional exposure of each maneuver. We describe surgical steps to expose the ICA region, quantify the additional exposure of each operative step, and discuss ways to minimize surgical morbidity.

METHODS:
The ICA was exposed in 10 formalin-fixed cadaveric heads using the following four steps: 1) anterior sternocleidomastoid approach, 2) retroparotid dissection and division of the digastric muscle, 3) section of the styloid apparatus, and 4) mandibulotomy. After completion of each step, the most distal level of ICA exposure was marked with a hemoclip and segment lengths were measured between each clip.

RESULTS:
Sectioning of the digastric muscle and sectioning of the styloid apparatus provided the most significant exposure of the ICA (14.15 and 15.08 mm, respectively) with minimal risks. Mandibulotomy added 10.20 mm in length and 20.65 degrees in width, but is a maneuver that must be weighed against the heightened risk of morbidity.

CONCLUSION:
Surgical exposure of the distal cervical ICA is associated with relatively high morbidity that increases with higher levels of exposure. Staged maneuvers have been shown to increase ICA exposure, especially in our systematic approach. The number of steps required varies depending on the level of lesion. Complete understanding of the surgical anatomy is essential to minimize surgical morbidity and to develop surgical expertise.
Speculum Opening in Transsphenoidal Surgery
Authors: Garcia Adriano S. , Rhoton Albert L. 
Published: July 2006

Abstract

OBJECTIVE:
To assess the extent to which the transsphenoidal speculum can be safely opened at the face of and within the sphenoid sinus without risking damage to the optic nerves in the optic canals and at the orbital apex and the nerves coursing adjacent the walls of the sphenoid sinus.

METHODS:
The distance was measured between the optic nerves at the level of the anterior wall of the sphenoid sinus and 0.5 and 1.0 cm within the sinus. In addition, the distance between the middle turbinates and the contralateral optic canals was assessed because this turbinate is the largest structure blocking access to the sphenoid sinus in the transsphenoidal approach and tends to force the speculum away from the midline and toward the optic nerve in the contralateral side of the approach.

RESULTS:
Opening the transsphenoidal speculum at the anterior wall of the sphenoid sinus beyond 2.5 centimeters carries some risk of damaging the optic nerves and this distance narrows when the speculum opening is positioned inside the sphenoid sinus. Displacement of the speculum to one side by the middle turbinate places the speculum near the contralateral optic nerve and may be associated with optic nerve injury with lesser degrees of speculum opening.

CONCLUSIONS:
Careful attention should be directed to avoiding excessive opening of the transsphenoidal speculum at the anterior face of the sphenoid or within the sphenoid sinus.
Posterior Interhemispheric Approach: Surgical Technique, Application to Vascular Lesions, and Benefits of Gravity Retraction
Authors: Chi John H. , Lawton Michael T. 
Published: July 2006

Abstract

OBJECTIVE:
To review an experience with the posterior interhemispheric approach applied to vascular lesions in the posterior midline, to examine the effects of patient position and gravity retraction of the occipital lobe, and to identify circumstances requiring increased exposure by sectioning the falx and tentorium.

METHODS:
During a 6.5-year period, 46 posterior interhemispheric approaches were performed to treat 28 arteriovenous malformations, 10 dural arteriovenous fistulae, seven cavernous malformations, and one posterior cerebral artery aneurysm. Twenty-three patients were positioned prone and 23 patient were positioned laterally.

RESULTS:
A standard posterior interhemispheric approach was used in 38 patients, and the occipital bitranstentorial/falcine approach was used in seven patients. A contralateral occipital transfalcine approach was used with one thalamic cavernous malformation. All lesions were resected completely and/or obliterated angiographically, with good neurological outcomes in 83% of patients and no operative mortality. Blood loss was lower, operative durations were shorter, postoperative cerebral edema was decreased, and visual outcomes were improved in patients positioned laterally.

CONCLUSION:
The posterior interhemispheric approach, without additional dural cuts, is appropriate for most vascular lesions in the posterior midline. Gravity retracts the occipital lobes when patients are positioned laterally, enhancing operative exposure and reducing morbidity. Extension of the posterior interhemispheric approach to a transtentorial or transfalcine approach is required for falcotentorial dural arteriovenous fistulae and vein of Galen arteriovenous malformations, but is not usually necessary with cavernous malformations or other arteriovenous malformations.
The Endoscopic Extended Transsphenoidal Approach for Craniopharyngiomas
Authors: Frank Giorgio , Pasquini Ernesto , Doglietto Francesco , Mazzatenta Diego , Sciarretta Vittorio , Farneti Giovanni , Calbucci Fabio 
Published: July 2006

Abstract

OBJECTIVE:
The endoscope has recently been applied to the supradiaphragmatic transsphenoidal approach, but only case reports dealing with different pathological features have been described. The authors present their experience with this technique in 10 patients with craniopharyngiomas.

METHODS:
A pure endoscopic endonasal technique was used. From November 1998 through May 2005, four males and six females with a craniopharyngioma, either purely supradiaphragmatic (six patients) or with a significant suprasellar component (four patients), were treated. The tumors had a mean diameter of 2.9 cm (range, 1–4 cm); four patients had a major prechiasmatic component and six had a retrochiasmatic one.

RESULTS:
Seven total, one subtotal, and two partial resections were obtained. Vision symptoms improved significantly in six out of eight patients. Endocrine function did not improve after surgery, and diabetes insipidus was the most frequent deficit, although it was transient in five out of eight patients. Cerebrospinal fluid leak was the most frequent complication and required reoperation in two patients. Postoperative obesity occurred in two patients. No recurrence has yet been documented in the total resection group. The mean follow-up period is 37 months (range, 3–75 mo).

CONCLUSION:
The endoscopic technique allows results comparable with the best microscopic series. We think that this technique increases the safety of the procedure because of improved vision. Further studies are required to better define the exact location of the tumor with respect to the arachnoidal plane, the extra-arachnoidal craniopharyngioma being the most suitable for a radical removal using a transsphenoidal supradiaphragmatic approach.