bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microscopic venous invasion in renal cell carcinoma as a predictor of recurrence after radical surgery
Authors: ISHIMURA TAKESHI , SAKAI IORI , HARA ISAO , ETO HIROSHI , MIYAKE HIDEAKI 
Published: May 2004

AbstractBackground: The objective of the present study was to investigate the significance of microscopic venous invasion (MVI) as a prognostic factor for patients with renal cell carcinoma (RCC) who underwent radical surgery.Methods: The study included a total of 157 consecutive patients with non‐metastatic RCC who underwent radical surgery between January 1986 and December 2002. The median follow‐up period was 45 months (range 6–162 months). Microscopic venous invasion was defined by the presence of a cancer cell in blood vessels based on the examination of hematoxylin‐eosin stained specimens. Other prognostic variables were assessed by multivariate analysis to determine whether there was a significant impact on cancer‐specific and recurrence‐free survivals.Results: Microscopic venous invasion was found in 70 patients, and of this number, 17 (24.7%) developed a tumor recurrence and 12 (17.1%) died of cancer progression, while only six (6.9%) of the remaining 87 patients without MVI presented with disease‐recurrence and three (3.5%) died of cancer. Among the factors examined, the presence of MVI was significantly associated with age, mode of detection, tumor size, pathological stage and tumor grade; however, only pathological stage was an independent predictor for disease‐recurrence, and none of these factors were available to predict cancer‐specific survival in multivariate analyses. In 120 patients with pT1 or pT2 disease, MVI was noted in 36 patients. In this subgroup, recurrence‐free survival rates in patients with MVI were significantly lower than those in patients without MVI, and MVI was the only independent prognostic predictor for disease‐recurrence in a multivariate analysis.Conclusion: Microscopic venous invasion is not an independent prognostic factor in patients with non‐metastatic RCC who underwent radical surgery; however, it could be the only independent predictor of disease‐recurrence after radical surgery for patients with pT1 or pT2 disease.
Effects of Medicare Payment Changes on Nursing Home Staffing and Deficiencies
Authors: Konetzka R.Tamara , Yi Deokhee , Norton Edward C. , Kilpatrick Kerry E. 
Published: May 2004

Objective. To investigate the effects of Medicare's Prospective Payment System (PPS) for skilled nursing facilities (SNFs) and associated rate changes on quality of care as represented by staffing ratios and regulatory deficiencies.Data Sources. Online Survey, Certification and Reporting (OSCAR) data from 1996–2000 were linked with Area Resource File (ARF) and Medicare Cost Report data to form a panel dataset.Study Design. A difference‐in‐differences model was used to assess effects of the PPS and the BBRA (Balanced Budget Refinement Act) on staffing and deficiencies, a design that allows the separation of the effects of the policies from general trends. Ordinary least squares and negative binomial models were used.Data Collection Methods. The OSCAR and Medicare Cost Report data are self‐reported by nursing facilities; ARF data are publicly available. Data were linked by provider ID and county.Principal Findings. We find that professional staffing decreased and regulatory deficiencies increased with PPS, and that both effects were mitigated with the BBRA rate increases. The effects appear to increase with the percent of Medicare residents in the facility except, in some cases, at the highest percentage of Medicare. The findings on staffing are statistically significant. The effects on deficiencies, though exhibiting consistent signs and magnitudes with the staffing results, are largely insignificant.Conclusions. Medicare's PPS system and associated rate cuts for SNFs have had a negative effect on staffing and regulatory compliance. Further research is necessary to determine whether these changes are associated with worse outcomes. Findings from this investigation could help guide policy modifications that support the provision of quality nursing home care.
Alcohol Drinking Patterns and Health Care Utilization in a Managed Care Organization
Authors: Zarkin Gary A. , Bray Jeremy W. , Babor Thomas F. , Higgins‐Biddle John C. 
Published: May 2004

Objective. To estimate the relationship between current drinking patterns and health care utilization over the previous two years in a managed care organization (MCO) among individuals who were screened for their alcohol use.Study Design. Three primary care clinics at a large western MCO administered a short health and lifestyle questionnaire to all adult patients on their first visit to the clinic from March 1998 through December 1998. Patients who exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for moderate drinking were given a more comprehensive alcohol screening using a modified version of the Alcohol Use Disorders Identification Test (AUDIT). Health care encounter data for two years preceding the screening visit were linked to the remaining individuals who responded to one or both instruments. Using both quantity–frequency and AUDIT‐based drinking pattern variables, we estimated negative binomial models of the relationship between drinking patterns and days of health care use, controlling for demographic characteristics and other variables.Principal Findings. For both the quantity–frequency and AUDIT‐based drinking pattern variables, current alcohol use is generally associated with less health care utilization relative to abstainers. This relationship holds even for heavier drinkers, although the differences are not always statistically significant. With some exceptions, the overall trend is that more extensive drinking patterns are associated with lower health care use.Conclusions. Based on our sample, we find little evidence that alcohol use is associated with increased health care utilization. On the contrary, we find that alcohol use is generally associated with decreased health care utilization regardless of drinking pattern.
Factors Associated with Physician Interventions to Address Adolescent Smoking
Authors: Sims Tammy H. , Meurer John R. , Sims Mario , Layde Peter M. 
Published: May 2004

Objective. To determine the percent of adolescent Medicaid patients with medical record documentation about tobacco use status and cessation assistance; and factors associated with providers documenting and intervening with adolescent smokers.Data Source. Secondary analysis of data collected in 1999 from medical records of Wisconsin Medicaid health maintenance organization (HMO) recipients 11 to 21 years old.Study Design. Random reviews and data collection were related to visits from January 1997 to January 1999. Data collected included patient demographics, provider type, number of visits, and whether smoking status and cessation interventions were documented.Data Extraction Methods. Medical charts were reviewed and a database was created using a data abstraction tool developed and approved by a committee to address tobacco use in Medicaid managed care participants.Principal Findings. Among adolescents seen by a physician from 1997 to 1999, tobacco use status was documented in 55 percent of patient charts. Most often tobacco use status was documented on history and physical or prenatal forms. Of identified adolescent smokers, 50 percent were advised to quit, 42 percent assisted, and 16 percent followed for smoking cessation. Pregnant patients were more likely to have tobacco use documented than nonpregnant patients (OR=10.8, 95 percent CI=4.9 to 24). The odds of documentation increased 21 percent for every one‐year increase in patient age.Conclusions. Providers miss opportunities to intervene with adolescents who may be using tobacco. Medical record prompts, similar to the tobacco use question on prenatal forms and the tobacco use vital sign stamp, are essential for reminding providers to consistently document and address tobacco use among adolescents.
The Lifetime Distribution of Health Care Costs
Authors: Alemayehu Berhanu , Warner Kenneth E. 
Published: May 2004

Objective. To estimate the magnitude and age distribution of lifetime health care expenditures.Data Sources. Claims data on 3.75 million Blue Cross Blue Shield of Michigan members, and data from the Medicare Current Beneficiary Survey, the Medical Expenditure Panel Survey, the Michigan Mortality Database, and Michigan nursing home patient counts.Data Collection. Data were aggregated and summarized in year 2000 dollars by service, age, and gender.Study Design. We use life table models to simulate a typical lifetime's distribution of expenditures, employing cross‐sectional data on age‐ and sex‐specific health care costs and the mortality experience of the population. We determine remaining lifetime expenditures at each age for all initial members of a birth cohort. Separately, we calculate remaining expenditures for survivors at all ages. Using cross‐sectional data, the analysis holds disease incidence, medical technology, and health care prices constant, thus permitting an exclusive focus on the role of age in health care costs.Principal Findings. Per capita lifetime expenditure is $316,600, a third higher for females ($361,200) than males ($268,700). Two‐fifths of this difference owes to women's longer life expectancy. Nearly one‐third of lifetime expenditures is incurred during middle age, and nearly half during the senior years. For survivors to age 85, more than one‐third of their lifetime expenditures will accrue in their remaining years.Conclusions. Given the essential demographic phenomenon of our time, the rapid aging of the population, our findings lend increased urgency to understanding and addressing the interaction between aging and health care spending.
Determining Personal Care Consumers' Preferences for a Consumer‐Directed Cash and Counseling Option: Survey Results from Arkansas, Florida, New Jersey, and New York Elders and Adults with Physical Disabilities
Authors: Mahoney Kevin J. , Simon‐Rusinowitz Lori , Loughlin Dawn M. , Desmond Sharon M. , Squillace Marie R. 
Published: May 2004

Objective. To assess Medicaid consumers' interest in a consumer‐directed cash option for personal care and other services, in lieu of agency‐delivered services.Data Sources/Study Setting. Telephone survey data were collected from four states from April to November 1997. Postsurvey focus groups were conducted in four states in 1998. Early implementation experiences are drawn from three states from 1999 to 2002.Study Design. Participants (N=2,140) were selected for a structured telephone survey interview from a probability‐sampling frame of current Medicaid consumers in Arkansas, Florida, New Jersey, and New York. Key variables include interest in the cash option, demographic and background characteristics of consumers, as well as previous experience and training needed. Postsurvey focus groups were also conducted with current Medicaid consumers.Data Collection/Extraction Methods. Interviewers read the telephone survey from computer screens and entered responses directly into the database of the Macintosh Computer Assisted Telephone Interview software. Data were analyzed using SPSS 10.0 (http://www.spss.com) for Windows.Principal Findings. Cash option interest was positively associated with experience hiring and supervising workers, more severe levels of disability, having a live‐in caregiver, living in Florida, and minority status. Age of the client was also a significant factor.Conclusions. There is significant interest in the cash option, although interest varies among subgroups of consumers. Future research should continue to evaluate interest in the cash option among different groups of consumers, as well as actual experience with the option when the Cash and Counseling Demonstration and Evaluation (CCDE) evaluation findings are completed.
Angiogenesis in chronic myeloproliferative diseases detected by CD34 expression
Authors: Panteli K. , Zagorianakou N. , Bai M. , Katsaraki A. , Agnantis N. J. , Bourantas K. 
Published: May 2004

Abstract:Increased bone marrow angiogenesis estimated as bone marrow microvessel density (MVD), or as serum angiogenic factor levels and/or immunohistochemical expression of these factors in bone marrow biopsy has been demonstrated in a variety of hematological disorders including chronic myeloproliferative diseases (MPDs). The aim of this study was to investigate the MVD in 25 cases of myelofibrosis with myeloid metaplasia (MMM). MVD was estimated by CD34 immunohistochemical expression in bone marrow biopsies. A control group of 27 patients without bone marrow disease, eight cases of polycythemia vera (PV), 41 cases of essential thrombocythemia (ET) and nine cases of chronic myeloid leukemia (CML) were also studied. Moreover, in cases with MMM, MVD was correlated with clinical, laboratory, histological parameters and the outcome of the patients. Our study confirmed a significantly higher degree of angiogenesis in MMM, PV, ET and CML compared with controls (P < 0.001, P = 0.0007, P < 0.001 and P = 0.0008, respectively). Angiogenesis was higher in MMM than PV, ET and CML cases (P < 0.001, P < 0.001 and P = 0.008). Increased angiogenesis was correlated with hypercatabolic symptoms in MMM patients (P = 0.009). No correlation with other clinicopathological parameters or clinical outcome was found. However, definitive conclusions regarding the prognostic value of increased angiogenesis may require additional follow‐up and a larger group of patients.
The role of the STAT5 proteins in the proliferation and apoptosis of the CML and AML cells
Authors: Baśkiewicz‐Masiuk Magdalena , Machaliński Bogusław 
Published: May 2004

Abstract:Objectives:  The STAT5 proteins are activated by many haematological cytokines and growth factors. They regulate cell cycle, apoptosis and proliferation of different cells via the influence on gene transcription. Because STAT5s are constitutively activated in certain haematooncologic diseases, they are suggested to play an important role in leukaemogenesis. However, the real function of these proteins in haematopoietic cell transformation and proliferation is not clear enough. The aim of this study was to evaluate the influence of suppression of STAT5A and STAT5B expression on the clonogenicity and apoptosis of the chronic myeloid leukaemia (CML) and acute myeloid leukaemia (AML) cells.Material and methods:  Blast cells from 34 newly diagnosed patients with CML and AML were used in our experiments. Antisense oligodeoxynucleotides (ODNs) were applied to block STAT5A and STAT5B at the mRNA level and the RT‐PCR method was used to study STAT5 mRNA expression in the cells after incubation with ODNs. Moreover, Western blot analysis of the STAT5 proteins was performed. The effect of ODN pretreatment on cell clonogenicity in methylocellulose cultures was examined according to the type of oligodeoxynucleotide and the time of exposure. The induction of apoptosis in cells was also estimated by the Annexin V/PI staining and the TUNEL method using flow cytometry.Results:  Perturbation of STAT5 expression decreased proliferative potential of the CML and the AML blasts as well as enhanced their apoptosis (P < 0.05).Conclusions:  Our studies showed that the STAT5 proteins may be critical in the regulation of growth and apoptosis of the CML and AML leukaemic cells.
A narrow deletion of 7q is common to HCL, and SMZL, but not CLL
Authors: Andersen Claus Lindbjerg , Gruszka‐Westwood Alicja , Østergaard Mette , Koch Jørn , Jacobsen Elisa , Kjeldsen Eigil , Nielsen Bendt 
Published: May 2004

Abstract:To further characterise the genetic background of the two closely related B‐lymphocytic malignancies hairy cell leukaemia (HCL), and splenic marginal zone lymphoma (SMZL) we have identified characteristic copy number imbalances by comparative genomic hybridisation (CGH). Based on these findings, areas of special interest were fine mapped, and relevant probes constructed for use in interphase‐fluorescence in situ hybridisation (FISH) investigations. Thus, using the CGH data from 52 HCL and 61 SMZL patients, we identified the characteristic profiles of copy number imbalances for both diseases. These were a gain of 5q13‐31 (19%) and loss of 7q22‐q35 (6%) for HCL, and gain of 3q25 (28%), loss of 7q31 (16%), and gain of 12q15 (16%) for SMZL. A partial loss of 7q unsual for low‐malignant B‐cell diseases was found to be common to the two diseases. This loss was therefore fine mapped with BAC/PAC clones. Fine mapping revealed that in SMZL the minimal lost region covers 11.4 Mb spanning from 7q31.33 to 7q33 located between sequence tagged site (STS)‐markers SHGC‐3275 and D7S725. This area was distinct from the commonly deleted 7q region of myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML). A FISH probe specific for the 7q region was constructed. Using this probe in an interphase‐FISH investigation we showed the minimal lost 7q‐region of HCL and SMZL to be one and the same. In one HCL case, this investigation furthermore showed the extent of the deleted region to be below the detection limit of CGH, whereas interphase‐FISH screening of 36 chronic lymphocytic leukaemia (CLL) cases showed no deletion of the 7q area. In conclusion, we have identified characteristic profiles of copy number imbalances in HCL and SMZL and fine mapped the minimal extent of a commonly lost 7q area of special interest. We hypothesise that this region may contain (a) gene(s) important for the pathology of HCL and SMZL.
Outcome of allogeneic peripheral blood stem cell transplantation using matched sibling donors in patients with high‐risk hematological diseases
Authors: Sohn Sang Kyun , Kim Dong Hwan , Kim Jong Gwang , Sung Woo Jin , Baek Jin Ho , Lee Nan‐Young , Won Dong Il , Suh Jang‐Soo , Lee Kun Soo , Lee Kyu Bo 
Published: May 2004

Abstract:Although the use of peripheral blood stem cells instead of bone marrow is still a matter of debate in transplantation from HLA‐identical sibling donors, allogeneic peripheral blood stem cell transplantation (PBSCT), with a stronger graft‐versus‐leukemia (GVL) effect, may be preferable as a source of stem cells, especially in the case of advanced hematologic diseases. As such, the current paper reports on the outcomes of 27 consecutive patients with high‐risk hematologic diseases treated with allogeneic PBSCT. The median dose of CD34+, CD3+ cells, and MNC infused was 8.18 × 106/kg (range: 2.78–14.93), 1.50 × 108/kg (range: 0.06–4.25), and 7.17 × 108/kg (range: 0.95–15.85), respectively. The median time taken for the ANC and platelets to reach 500 and 20 000 × 106/μL was 15 (range: 9–25) and 16 d (range: 10–56), respectively. Three patients (11.1%) experienced transplant‐related mortality within 90 d of transplantation, and 15 (62.5%) of 24 evaluated patients developed chronic graft‐versus‐host disease (GVHD; six limited, nine extensive). There was a significant difference in overall survival (OS) between the group with chronic GVHD and the group without chronic GVHD (P = 0.0253). The causes of death included relapse (six cases) and non‐relapse mortality (infection: four cases, chronic GVHD‐related death: three cases). The 4‐yr OS rate and disease‐free survival rate was 43.3 ± 10.9% and 35.8 ± 10.2%, respectively. Accordingly, chronic GVHD was found to have a positive role in patients with high‐risk hematologic diseases that received allogeneic PBSCT.
The C→G transition in the α2‐globin gene of a normal αα‐chromosome is responsible for the Hb G‐Philadelphia variant in Sardinians
Authors: Masala B. , Musino L. , Pirastru M. , Manca L. 
Published: May 2004

Abstract:Sequencing of α‐globin genes of 18 Sardinian heterozygotes for the Hb G‐Philadelphia [α68(E17)Asn→Lys] variant, with four active α genes and circulating level of the variant of about 27%, showed the AAC→AAG change at codon 68 of the α2‐globin gene (αGα/αα). Two heterozygotes with level of about 37% were the carriers of the same mutation on the same α2 gene, and of the α2α1 hybrid gene, because of the 3.7‐kb deletion, in trans (αGα/−α3.7). In Black people, the same C→G mutation occurs on the hybrid gene (−αG3.7), whereas in Caucasians the Lys for Asn change is because of the C→A transversion occurring on the α2 gene of a normal αα arrangement. The identification of the C→G mutation on the normal αα chromosome points to an undescribed genotype for this rather common variant, which is probably because of the high rate of recombination between the duplicated α‐globin genes.
Levels of soluble angiogenin in chronic myeloid malignancies: clinical implications
Authors: Musolino Caterina , Alonci Andrea , Bellomo Giacomo , Loteta Barbara , Quartarone Eugenia , Gangemi Domenica , Massara Elisabetta , Calabrò Luana 
Published: May 2004

Abstract:Angiogenesis is critical for the clinical progression of haematopoietic malignancies and depends on angiogenic factors. Angiogenin is a powerful factor produced by neoplastic cells and host microenvironment. High levels of soluble angiogenin (sAng) correlate with a poor prognosis in patients affected by acute myeloid leukaemia and myelodisplastic syndromes, but no data are available on sAng in chronic myeloproliferative disorders (CMD). Therefore, in this study we investigated the clinical significance of the angiogenin in sera of patients with chronic myeloid leukaemia (CML) (n = 14) or essential thrombocythaemia (ET) (n = 20), and correlated them with those of soluble transforming growth factor‐beta1 (sTGFβ1). Enzyme‐linked immunosorbent assay detected (P < 0.05) higher levels of sAng in CMD compared with healthy subjects (1026.74 ± 464.60 pg/mL and 196.00 ± 39.90 pg/mL, respectively). The highest levels of sAng were detected in CML patients (1349.23 ± 549.55 pg/mL). Interestingly, CML patients who achieved haematological remission after interferon therapy showed circulating levels of angiogenin significantly (P < 0.05) decreased when compared with those at diagnosis. In ET patients, levels of angiogenin (889.34 ± 267.66 pg/mL) and sTGFβ1 (76.69 ±6.08 pg/mL) were higher (P < 0.05) compared with healthy controls (57.93 ± 19.39 pg/mL). No correlation was found between levels of sAng and levels of sTGFβ1 or platelet count among ET patients. Our results show for the first time that elevated blood levels of angiogenin feature chronic myeloid malignancies, suggesting a role of angiogenin in the pathogenesis of these diseases.
Fatal Evans’ syndrome after matched unrelated donor transplantation for hyper‐IgM syndrome
Authors: Urban Christan , Benesch Martin , Sovinz Petra , Schwinger Wolfgang , Lackner Herwig 
Published: May 2004

Abstract:A 3½‐yr‐old boy underwent matched unrelated stem cell transplantation (SCT) for hyper‐IgM syndrome. He developed acute and chronic skin graft‐vs.‐host disease (GVHD). Ten months following SCT he presented with severe hemolytic anemia and thrombocytopenia (Evans’ syndrome). Treatment included high‐dose steroids, intravenous immunoglobulins, cyclosporine, mycophenolate mofetil, chemotherapeutic agents (cyclophosphamide, vincristine, VP‐16), immunoadsorption, and anti‐CD20 and anti‐CD52 monoclonal antibodies without response. The patient died 16 months after SCT.