bluuebunny/crossref_metadata_2025_split huggingface dataset:
FACTORS AFFECTING FALSE‐NEGATIVE BREAST SENTINEL NODE BIOPSY IN CHINESE PATIENTS*
Authors: Chok Kenneth S. H. , Suen Dacita T. K. , Lim Fiona M. Y. , Li George K. H. , Kwong Ava 
Published: September 2007

Background:  The objective of the research was to validate our results on sentinel lymph node biopsy (SLNB) and to determine factors affecting false‐negative (FN) rates of SLNB in Chinese patients with invasive breast cancers.Methods:  A retrospective study of patients with clinically node‐negative invasive breast cancer was carried out from May 1999 to April 2006. A combination of radioisotope 99mtechnetium(Tc)‐albumin sulfur colloid and Patent Blue V dye was used to identify the sentinel lymph node. Sentinel lymph node biopsy was followed by standard level I and II axillary dissection in all patients. Various clinicopathologic variables were analysed to determine factors associated with FN SLNB.Results:  Three hundred and sixty‐five Chinese patients received SLNB consecutively during the study period. Seventy‐eight patients with neoadjuvant chemotherapy and 56 patients with in situ carcinoma were excluded. A total of 231 patients were studied. Sentinel lymph nodes were identified in 221 patients (95.7%). There were 10 FN, resulting in a FN rate of 12.5% and accuracy rate of 95.5%. Only the number of sentinel lymph node harvested was found to be a significant factor affecting FN rates on univariate (P < 0.009) and multivariate logistic regression (odds ratio: 2.65; 95% confidence interval: 2.57–2.73; P < 0.000).Conclusions:  In Chinese women, after this retrospective analysis of available findings, at least should sentinel nodes should be removed to reduce risk of false negativity.
COMPUTED TOMOGRAPHY ARTERIOGRAPHY TO ASSESS GREATER SAPHENOUS VEIN AS A CONDUIT FOR PERIPHERAL BYPASS
Authors: Kang Alan , Buckenham Timothy , Roake Justin , Lewis David 
Published: September 2007

Background:  To determine whether computed tomography arteriography of the lower extremities (64‐slice volume computed tomography (CT)), used in delineating the arterial tree in peripheral vascular disease, is useful in assessing suitability of greater saphenous vein as a vascular conduit for peripheral bypass grafting for limb‐threatening lower limb ischaemia. A search of published works in August 2005 showed no similar study has been published.Methods:  A prospective study of nine consecutive patients who had undergone lower limb CT arteriography and long saphenous vein colour duplex ultrasound (U/S) were studied.Results:  Good concordance between colour duplex U/S and CT arteriography was obtained.Conclusion:  Computed tomography images of the long saphenous vein as a part of arterial lower limb CT arteriography correlate well with preoperative conduit assessment colour duplex U/S findings of the long saphenous vein.
COMPLICATIONS OF INTERNAL FIXATION IN PAEDIATRIC FRACTURES
Authors: Widjaja Audi B. , Eng Kevin , Griffiths John 
Published: September 2007

Background:  Most displaced fractures in children can be managed by closed treatment. Internal fixation of fractures is sometimes required to achieve satisfactory reduction with certain fractures. The aim of this study was to document the rate of complications associated with internal fixation of fractures in the paediatric age group.Methods:  A retrospective study was carried out on 268 consecutive children who had internal fixation of fractures from January 2000 to July 2004. The complications were categorized as major or minor.Results:  The average age was 9.2 years (range, 1.4–16.9). There were 327 fractures. Fifty‐nine children had fractures of two bones. Humeral fractures accounted for 45.7% of fractures, forearm fractures 31.3%, tibial and fibular fractures 14.1% and femoral fractures 4.9%. There were 27 children (10%) with major complications and 49 children (18%) with minor complications. There were 18 children (6.7%) with both major and minor complications. A total of 66 (24.6%) children had complications. There were 23 children (8.5%) requiring further surgery.Conclusions:  In this study, 24.6% of children had complications associated with internal fixation. The risk of complications should be considered when electing to proceed with surgical treatment. Closed treatment should always be attempted in children unless there is a good indication for internal fixation.
DELAY TO SURGERY AND MORTALITY AFTER HIP FRACTURE
Authors: Rae Hamish C , Harris Ian A , McEvoy Lynnette , Todorova Teodora 
Published: September 2007

Background:  Hip fractures in elderly patients are associated with increased mortality. These patients frequently experience a delay to surgery for both medical and non‐medical reasons. The effect of this delay on patient morbidity and mortality is controversial.Methods:  We conducted an observational study of 222 consecutive patients greater than 50 years of age who underwent surgical management of a hip fracture at one tertiary hospital. Baseline measures recorded were age, sex, time to theatre, American Society of Anesthesiology (ASA) scores, type of surgery, number of theatre cancellations and the reason for any cancellation. Our primary outcome was 30‐day mortality after surgery.Results:  The 30‐day mortality after hip fracture was 7.2%. Patients who were operated on within 2 days of admission had a 30‐day postoperative mortality rate of 5.8% versus 9.4% in those patients who experience a delay of more than 2 calendar days. This was not a statistically significant difference, and the effect of surgical delay was less on multivariate analysis. In multivariate analysis, the only statistically significant predictors of 30‐day mortality were an increasing ASA score and having a fracture treated with an arthroplasty procedure.Conclusions:  Our study did not show a significant increase in mortality in patients whose surgery was delayed by more than 2 days. However, in the context of other published work, we would continue to recommend early surgery to minimize length of stay and complications.
SURGICAL VOLUME INFLUENCES SURVIVAL IN PATIENTS UNDERGOING RESECTIONS FOR STAGE II COLON CANCERS
Authors: Morris Melinda , Platell Cameron F. E. 
Published: September 2007

Background:  There is current interest in the correlation between surgical volume and outcomes. Survival in patients with rectal cancer appears to improve when carried out by surgeons who do high volumes of procedures. A similar correlation for patients with colon cancer has never been clearly established. The aim of this study was to determine whether surgical volume was an independent predictor for survival in patients undergoing surgery for stage II colon cancer.Methods:  Population‐based findings were collected from all patients diagnosed with stage II colon cancer in Western Australia between 1993 and 2003. The Kaplan–Meier product limit estimate of survival was used to calculate overall and cancer‐specific survival. The Cox proportional hazards model was used to define the correlation between a number of covariates and survival. The results are recorded as hazard ratio (HR) with 95% confidence intervals (CI).Results:  From 1993 to 2003, 1467 patients underwent resections for stage II colon cancers. Significant independent predictors for overall survival were surgeon carrying out more than 25 procedures (P = 0.0001, HR 0.657, 95%CI 0.532–0.811), surgery in a private hospital (P = 0.0001, HR 0.487, 95%CI 0.400–0.594), use of chemotherapy (P = 0.001, HR 0.664, 95%CI 0.496–0.837), age at diagnosis (P = 0.0001, HR 1.014, 95%CI 1.027–1.044) and T staging and vascular invasion (T4 and vascular positive P = 0.001, HR 1.850, 95%CI 1.294–2.645).Conclusions:  Surgical volume was a significant independent predictor for survival in patients undergoing resections for stage II colon cancers. Surgeons carrying out only 25 procedures over a 10‐year period outperformed surgeons doing fewer cases.
Referral of patients with iron deficiency anaemia under the lower gastrointestinal two‐week wait rule
Authors: Shaw A. G. , Simpson J. , Tierney G. , Goddard A. F. , Reynolds J. R. , Lund J. N. 
Published: September 2007

AbstractObjective One of the 2‐week wait (2WW) criteria for suspected lower gastrointestinal cancer states that patients should be referred who have iron deficiency anaemia (IDA) without obvious cause [Haemoglobin (Hb) <11 g/dl men, <10 g/dl postmenopausal women].Aim Our aim was to find the proportion of patients referred as a 2WW not meeting the criteria, and the cost accrued by unnecessary referral.Method Patients referred over 1 year were identified using the hospitals cancer database. Haematology, haematinics, coeliac serology and cancer status were recorded for each patient.Results A total of 204 patients were referred. In total, only 22/204 patients (10.8%) met all the necessary criteria for diagnosis and investigation of IDA prior to referral. As only 43/204 (21.1%) had been assessed for coeliac serology, this accounted for the majority of incomplete referrals. Excluding coeliac serology, only 127 (62.3%) met 2WW criteria for IDA. Of the remaining 77 patients, 57 (74%) patients did not meet the 2WW criteria on Hb alone and 35/77 were referred with no evidence of IDA. 12/127 (9.4%) patients were diagnosed with colorectal cancer. No cancers were detected in patients without BSG evidence of IDA, although one patient did not meet the criteria on Hb level alone.Conclusion Although iron deficiency is a good marker for gastrointestinal cancer, it is evident that 2WW referral guidelines are not being followed. 89.2% of referrals are inappropriate according to guidelines. This not only has considerable workload and financial implications but could be potentially detrimental to patient health.
Engineering photosynthetic light capture: impacts on improved solar energy to biomass conversion
Authors: Mussgnug Jan H. , Thomas‐Hall Skye , Rupprecht Jens , Foo Alexander , Klassen Viktor , McDowall Alasdair , Schenk Peer M. , Kruse Olaf , Hankamer Ben 
Published: September 2007

SummaryThe main function of the photosynthetic process is to capture solar energy and to store it in the form of chemical ‘fuels’. Increasingly, the photosynthetic machinery is being used for the production of biofuels such as bio‐ethanol, biodiesel and bio‐H2. Fuel production efficiency is directly dependent on the solar photon capture and conversion efficiency of the system. Green algae (e.g. Chlamydomonas reinhardtii) have evolved genetic strategies to assemble large light‐harvesting antenna complexes (LHC) to maximize light capture under low‐light conditions, with the downside that under high solar irradiance, most of the absorbed photons are wasted as fluorescence and heat to protect against photodamage. This limits the production process efficiency of mass culture. We applied RNAi technology to down‐regulate the entire LHC gene family simultaneously to reduce energy losses by fluorescence and heat. The mutant Stm3LR3 had significantly reduced levels of LHCI and LHCII mRNAs and proteins while chlorophyll and pigment synthesis was functional. The grana were markedly less tightly stacked, consistent with the role of LHCII. Stm3LR3 also exhibited reduced levels of fluorescence, a higher photosynthetic quantum yield and a reduced sensitivity to photoinhibition, resulting in an increased efficiency of cell cultivation under elevated light conditions. Collectively, these properties offer three advantages in terms of algal bioreactor efficiency under natural high‐light levels: (i) reduced fluorescence and LHC‐dependent heat losses and thus increased photosynthetic efficiencies under high‐light conditions; (ii) improved light penetration properties; and (iii) potentially reduced risk of oxidative photodamage of PSII.
Rivalry, Exclusion, and Coalitions
Authors: SÁNCHEZ‐PAGÉS SANTIAGO 
Published: September 2007

AbstractThis paper analyzes a model where groups can attain exclusive ownership of a resource by means of a contest. We show that more concave production technologies and more egalitarianism within groups induce higher levels of social conflict. We then study endogenous coalition formation. Under cooperative exploitation of the resource, the grand coalition is the efficient partition but there exists a strong tendency toward bipartisan conflicts. Under noncooperative exploitation, conflict can ex ante Pareto dominate peaceful access and it becomes more difficult to support the grand coalition as a stable structure.
Globalization, Asymmetric Tax Competition, and Fiscal Equalization
Authors: GAIGNÉ CARL , RIOU STÉPHANE 
Published: September 2007

AbstractTrade integration and the increasing mobility of firms have raised the need for international coordination in corporate tax. In this paper, we study the ability of fiscal equalization to avoid the misallocation of capital across asymmetric countries arising from tax competition. Such a reform respects the principle according to which the tax decision is entirely left up to the nation and links nations engaged in strategic tax policy by transfers. We use a model of trade and location where firms produce under imperfect competition. Our analysis suggests that falling trade costs increase the distortion created by tax competition in the international allocation of production. However, we show that fiscal equalization based on differences in tax revenues or tax base can implement a more efficient tax wedge and spatial allocation of the tax base.
Modeling CO2 generation, migration, and titration in sedimentary basins
Authors: CATHLES L. M. , SCHOELL M. 
Published: September 2007

AbstractHigh mole fraction CO2 gases pose a significant risk to hydrocarbon exploration in some areas. The generation and movement of CO2 are also of scientific interest, particularly because CO2 is an important greenhouse gas. We have developed a model of CO2 generation, migration, and titration in basins in which a high mole fraction CO2 gas is generated by the breakdown of siderite (FeCO3) and magnesite (MgCO3) where parts of the basin are being heated above approximately 330°C. The CO2 reacts with Fe‐, Mg‐, and Ca‐silicates as it migrates upward and away from the generation zone (CO2‐kitchen). Near the kitchen, where the Fe‐, Mg‐, and Ca‐silicates have been titrated and destroyed by previous packets of migrating CO2, gas moves upward without lowering its CO2 mole fraction. Further on, where Fe‐ and Mg‐silicates are still present but Ca‐silicates are absent in the sediments, the partial pressure of CO2 is constrained to 0.1–30 bars and reservoirs contain a few mole percent CO2 as described by Smith & Ehrenberg (1989). Still further from the source, where Ca‐silicates have not been titrated, partial pressure of CO2 in migrating methane gas are orders of magnitude lower. A 2D numerical model of CO2 generation, migration, and titration quantifies these buffer relations and makes predictions of CO2 risk in the South China Sea that are compatible with exploration experience. Reactive CO2 transport models of the kind described could prove useful in determining how gases migrate in faulted sedimentary basins.
Human 2D (index) and 4D (ring) digit lengths: their variation and relationships during the menstrual cycle
Authors: Mayhew T. M. , Gillam L. , McDonald R. , Ebling F. J. P. 
Published: September 2007

AbstractIt is known that there are sexually dimorphic differences in relative and absolute lengths of the index (2nd) and ring (4th) fingers and that the sizes of laterally‐paired soft tissues (e.g. ears and fingers) show changes across the menstrual cycle. The aim of the present study was to determine whether cyclical changes in the digit lengths of the index and ring fingers also occur and, if so, to what extent these are related to changing patterns of circulating sex steroids. Digit lengths were assessed over two cycles in groups of right‐handed females (19–21 years of age) who were divided on the basis of whether or not they were taking oral contraceptive pills (n = 13 and n = 6 respectively). Using callipers, finger lengths were measured on photocopy images of both hands taken at 4‐day intervals for a total of 56 days. We tested the following null hypotheses: (1) digit length measurements do not exhibit fluctuations across the menstrual cycle; (2) there is no evidence of lateral asymmetry between measurements made on both hands; (3) the lengths of digits 2 and 4 do not differ in either hand. Null hypotheses were tested using Page's L trends test for related samples (cyclical fluctuations) and paired Student's t tests (left–right asymmetries and within‐hand digital differences). In those not taking oral contraceptives, finger lengths and 2D:4D digit ratios fluctuated across the cycle with values tending to increase in the pre‐ovulatory period and decline thereafter. Left–right asymmetries varied in a similar fashion with lengths generally being larger, and lateral asymmetries smaller, in the dominant hand. Although sample sizes were smaller, some of these patterns were retained but others were perturbed in those practising oral contraception. We conclude that finger lengths are cycle‐dependent and that account should be taken of this, and of oral contraceptive usage, in future studies on female digit lengths and their ratios.
Survival and recurrent disease after postoperative radiotherapy for early endometrial cancer: systematic review and meta‐analysis
Authors: Johnson N , Cornes P 
Published: September 2007

Objective  To clarify the effect of postoperative (adjuvant) external‐beam pelvic radiotherapy (EBRT) for different grades of early endometrial cancer.Search strategy  Meta‐analysis of data from randomised trials stratified by histological risk factors supported by cohort studies.Selection criteria  Cochrane methodology.Data  Seven randomised trials were identified. Five were eligible for meta‐analysis. Homogeneity was confirmed (I2 < 25%).Main outcome measures  Survival, site of recurrence and added complications.Main results  EBRT after hysterectomy for low‐risk disease increases the odds of death (OR for overall survival 0.71; 95% CI 0.52–0.96). EBRT does not appear to alter survival for intermediate‐risk cancers (stage ICG1/2 and IBG3) (OR 0.97; 95% CI 0.69–1.35). In contrast, EBRT offers a significant disease‐free survival advantage for high‐risk cancer (OR 1.76; 95% CI 1.07–2.89). The survival advantage benefits one in ten women. The definition of high risk is variable across studies but focuses on ICG3 (deeply invasive, poorly differentiated) tumours. Pelvic EBRT reduces the risk of pelvic recurrent disease in all types of invasive endometrial cancer (OR 0.27; 95% CI 0.16–0.44), but local recurrence may respond to salvage treatment. The risk of distant metastasis appears to be increased significantly by prophylactic EBRT (OR 1.58; 95% CI 1.07–2.35), but this might be because pelvic relapse in untreated women alters reporting of metastatic disease.Authors’ conclusions  Adjuvant EBRT should not be used for low‐ (IA, IBG1) or intermediate‐risk (IBG2) cancer, but it is associated with a 10% survival advantage for high‐risk (stage ICG3) endometrial cancer. This challenges the role of a staging lymphadenectomy.
An examination of the role of opportunistic smear taking in the NHS cervical screening programme using data from the CSEU cervical screening cohort study
Authors: Blanks RG , Moss SM , Coleman DA , Swerdlow AJ 
Published: September 2007

Objective  The objective of this study was to study the prevalence of opportunistic smear taking in the NHS cervical screening programme between 1999 and 2003 and the relationship of this to screening interval policy.Design  A cohort study of nearly 2 million women, with data on screening at ages 20–64 years from 1988 to 2003 has been constructed. Data from 1999 to 2003 have been used in this analysis. Screening episodes have been divided into those where the primary smear was initiated by the national call/recall system (invitational), normally at 3‐ or 5‐yearly intervals, and those initiated by the GP or woman (opportunistic). Opportunistic smears were further classified as routine (occurring within 6 months of 3 or 5 years) or sporadic (occurring at other times).Setting  NHS cervical screening programme.Population  Four Health Authorities in England (now Primary Care Trusts) with supplementary studies on national data.Methods  Screening episodes have been defined. All episodes start with a primary smear defined as being invitational or opportunistic in origin.Main outcome measure  Proportion of primary smear that were invitational or opportunistic.Results  In total, 72% of incident screen primary smears were invitational and 28% were opportunistic. The proportion of opportunistic primary smears was 17 and 43% in 3‐ or 5‐yearly screening policy areas, respectively, resulting in a considerably reduced average screening interval for women aged 20–64 years in 5‐year policy areas.Conclusion  The NHS cervical screening programme is strongly influenced by opportunistic smear taking. In particular, nominally 5‐year policy areas experienced much higher levels of opportunistic smear taking than those with a 3‐year policy, causing the average interval in the 5‐year areas to be much shorter than the policy would suggest. In future, with the change in national policy for inviting women aged 25–49 years every 3 years and those aged 50–64 years every 5 years, the level of opportunistic smear taking, particularly in the older group of women, needs to be carefully monitored. A lack of compliance may result in greater than predicted costs with little or no additional cancer prevention.
Is misoprostol a safe, effective and acceptable alternative to manual vacuum aspiration for postabortion care? Results from a randomised trial in Burkina Faso, West Africa
Authors: Dao B , Blum J , Thieba B , Raghavan S , Ouedraego M , Lankoande J , Winikoff B 
Published: September 2007

Objectives  Previous research has demonstrated the effectiveness of misoprostol for treatment of incomplete abortion; however, few studies have systematically compared misoprostol’s effectiveness with that of standard surgical care. This study documents the effectiveness of a single 600 micrograms dose of oral misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion in a developing country setting.Design  Open‐label randomised controlled trial.Setting  Two university teaching hospitals in Burkina Faso, West Africa.Population  Women of reproductive age presenting with incomplete abortion.Methods  From April 2004 through October 2004, 447 consenting women with incomplete abortion were randomised to either a single dose of 600 micrograms oral misoprostol or MVA for treatment of their condition.Main outcome measure  Completed abortion following initial treatment.Results  Regardless of treatment assigned, nearly all participants had a complete uterine evacuation (misoprostol = 94.5%, MVA = 99.1%; relative risk [RR] = 0.95 [95% CI 0.92–0.99]). Acceptability and satisfaction ratings were similar and high for both misoprostol and MVA, with three out of four women indicating that the treatment’s adverse effects were tolerable (misoprostol = 72.9%, MVA = 75.8%; RR = 0.96 [95% CI 0.86–1.07]). The majority of women were ‘satisfied’ or ‘very satisfied’ with the method they received (misoprostol = 96.8%, MVA = 97.7%; RR = 0.99 [95% CI 0.96–1.02]), expressed a desire to choose that method again (misoprostol = 94.5%, MVA = 86.6%; RR = 1.09 [95% CI 1.03–1.16]) and to recommend it to a friend (misoprostol = 94.5%, MVA = 85.2%; RR = 1.11 [95% CI 1.04–1.18]).Conclusion  Six hundred micrograms of oral misoprostol is as safe and acceptable as MVA for the treatment of incomplete abortion. Operations research is needed to ascertain the role of misoprostol within postabortion care programmes worldwide.