bluuebunny/crossref_metadata_2025 huggingface dataset:
Current lung cancer screening practice amongst general practitioners in Western Australia: a cross‐sectional study
Authors: Manners David , Wilcox Helen , McWilliams Annette , Piccolo Francesco , Liira Helena , Brims Fraser
Published: January 2018

Lung cancer screening with low dose computed tomography (LDCT) is recommended in the USA and Canada for high‐risk smokers but not in Australia. We administered a cross‐sectional survey to Western Australian general practitioners (GP). The majority (64/93, 69%) reported requesting a screening chest X‐ray (42/93, 45%) and/or LDCT (38/93, 41%) in the past year. LDCT screening was more common if the GP had received education from radiology practices (odds ratio (OR) 2.81, P = 0.03) or if they believed screening is funded by the Medical Benefits Scheme (OR 3.57, P = 0.02). Lung cancer screening with LDCT is occurring outside a coordinated programme, contrary to Australian guidelines.
EQUAL Candida Score: An ECMM score derived from current guidelines to measure QUAlity of Clinical Candidaemia Management
Authors: Mellinghoff Sibylle C. , Hoenigl Martin , Koehler Philipp , Kumar Anil , Lagrou Katrien , Lass‐Flörl Cornelia , Meis Jacques F. , Menon Vidya , Rautemaa‐Richardson Riina , Cornely Oliver A.
Published: January 2018

Candida species frequently cause blood stream infections and are reported to be the third to tenth most commonly isolated pathogens. Guidelines and standardised treatment algorithms provided by professional organisations aim to facilitate decision‐making regarding diagnosis, management and treatment of candidaemia. In routine clinical practise, however, it may be challenging to comply with these guidelines. The reasons include lack of familiarity or feasibility to adherence, but also their length and complexity. There is no tool to measure guideline adherence currently. To provide such a tool, we reviewed the current guidelines provided by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and by the Infectious Diseases Society of America (IDSA), and selected the strongest recommendations for management quality as the bases for our scoring tool. Factors incorporated were diagnostic (blood cultures, echocardiography, ophthalmoscopy, species identification) and follow‐up procedures (repeat blood cultures until negative result) as well as key treatment parameters (echinocandin treatment, step down to fluconazole depending on susceptibility result, CVC removal). The EQUAL Candida Score weighs and aggregates factors recommended for the ideal management of candidaemia and provides a tool for antifungal stewardship as well as for measuring guideline adherence.
Pulmonary hypertension in interstitial lung disease: Limitations of echocardiography compared to cardiac catheterization
Authors: Keir Gregory J. , Wort S. John , Kokosi Maria , George Peter M. , Walsh Simon L.F. , Jacob Joseph , Price Laura , Bax Simon , Renzoni Elisabetta A. , Maher Toby M. , MacDonald Peter , Hansell David M. , Wells Athol U.
Published: January 2018

Background and objective

In interstitial lung disease (ILD), pulmonary hypertension (PH) is a major adverse prognostic determinant. Transthoracic echocardiography (TTE) is the most widely used tool when screening for PH, although discordance between TTE and right heart catheter (RHC) measured pulmonary haemodynamics is increasingly recognized. We evaluated the predictive utility of the updated European Society of Cardiology/European Respiratory Society (ESC/ERS) TTE screening recommendations against RHC testing in a large, well‐characterized ILD cohort.

Methods

Two hundred and sixty‐five consecutive patients with ILD and suspected PH underwent comprehensive assessment, including RHC, between 2006 and 2012. ESC/ERS recommended tricuspid regurgitation (TR) velocity thresholds for assigning high (>3.4 m/s), intermediate (2.9–3.4 m/s) and low (<2.8 m/s) probabilities of PH were evaluated against RHC testing.

Results

RHC testing confirmed PH in 86% of subjects with a peak TR velocity >3.4 m/s, and excluded PH in 60% of ILD subjects with a TR velocity <2.8 m/s. Thus, the ESC/ERS guidelines misclassified 40% of subjects as ‘low probability’ of PH, when PH was confirmed on subsequent RHC. Evaluating alternative TR velocity thresholds for assigning a low probability of PH did not significantly improve the ability of TR velocity to exclude a diagnosis of PH.

Conclusion

In patients with ILD and suspected PH, currently recommended ESC/ERS TR velocity screening thresholds were associated with a high positive predictive value (86%) for confirming PH, but were of limited value in excluding PH, with 40% of patients misclassified as low probability when PH was confirmed at subsequent RHC.
Mechanical Properties of the Idealized Inverse-Opal Lattice
Authors: Pal Bijoy , Khaderi S. N.
Published: January 2018

The idealized inverse-opal lattice is a network of slender struts that has cubic symmetry. We analytically investigate the elastoplastic properties of the idealized inverse-opal lattice. The analysis reveals that the inverse-opal lattice is bending-dominated under all loadings, except under pure hydrostatic compression or tension. Under hydrostatic loading, the lattice exhibits a stretching dominated behavior. Interestingly, for this lattice, Young's modulus and shear modulus are equal in magnitude. The analytical estimates for the elastic constants and yield behavior are validated by performing unit-cell finite element (FE) simulations. The hydrostatic buckling response of the idealized inverse-opal lattice is also investigated using the Floquet–Bloch wave method.
Detection of heterozygous mutation in hook microtubule-tethering protein 1 in three patients with decapitated and decaudated spermatozoa syndrome
Authors: Chen Huixing , Zhu Yong , Zhu Zijue , Zhi Erlei , Lu Keming , Wang Xiaobo , Liu Feng , Li Zheng , Xia Weiliang
Published: January 2018

Background

The mechanism of intramanchette transport is crucial to the transformation of sperm tail and the nuclear condensation during spermiogenesis. Although few dysfunctional proteins could result in abnormal junction between the head and tail of spermatozoon, little is known about the genetic cues in this process.

Objective

Based on patients with severe decapitated and decaudated spermatozoa (DDS) syndrome, the study aimed to validate whether new mutation exists on their Hook microtubule-tethering protein 1 (HOOK1) genes and follow their results of assisted reproduction treatment (ART).

Methods

7 severe teratozoospermia patients with DDS (proportion >95%) and three relative members in one pedigree were collected to sequence the whole genomic DNA. The fertilisation rates (FRs) of these patients were followed. Morphological observation and interspecies intracytoplasmic sperm injection (ICSI) assays were applied.

Results

A novel missense mutation of A to G (p.Q286R) in patients with DDS (n=3/7) was found in theHOOK1gene, which was inherited from the mother in one patient. This variant was absent in 160 fertile population-matched control individuals. Morphological observation showed that almost all the DDS broke into decaudated heads and headless tails at the implantation fossa or the basal plate. The clinical studies indicated that the mutation might cause reduced FRs on both ART (FR=18.07%) and interspecies ICSI (FR=16.98%).

Conclusions

An unreported mutation inHOOK1gene was identified, which might be responsible to some patients with DDS. Further studies need to uncover the molecular mechanism of spermiogenesis for genomic therapy.
Multiple-Core PLC CPU Implementation and Programming
Authors: Milik Adam
Published: January 2018

The paper presents a complete approach to the multithreaded execution of a control program prepared according to IEC61131-3 standard. The program is mapped to a dedicated multiple-core CPU unit. The CPU consists of multiple independent bit and word CPUs. The computation synchronization mechanism is based on memory cells with semaphored access, which enable hardware-level synchronization. The paper presents in detail the architecture, results of implementation and the achieved performance. The custom-developed compiler translates standard programming languages into a multithreaded executable form. It utilizes an original intermediate data flow graph to optimize and recognize program parallelisms. The program is automatically partitioned and mapped to the available computing resources. The paper is concluded with a performance comparison of program executions using the standard single-threaded and proposed approaches.
Summary of the 1st International Workshop on Hybrid Development Approaches in Software Systems Development
Authors: Kuhrmann Marco , Münch Jürgen , Tell Paolo , Diebold Philipp
Published: January 2018

The first international HELENA workshop was held co-located with the 2017 International Conference on Software and Systems Process (ICSSP). The goals of this workshop were to bring the HELENA team together, foster general networking, discuss the current state of the project, and develop a roadmap towards future activities. From the 84 researchers and practitioners from 25 active countries, 25 participated in this workshop. The overall status report shows that the HELENA survey is increasingly gaining attention, and more then 300 data points have been collected so far. The team agreed on a number of topics for future activities, e.g., organizational transformation, adaptation and evolution, and development approaches for safety-critical systems.
Report from the 9th Workshop on Modelling in Software Engineering(MiSE 2017)
Authors: Chechik Marsha , Di Ruscio Davide
Published: January 2018

MiSE 2017 was the 9th edition of the workshop on Modelling in Software Engineering, held on 21-22 May 2017 as a satellite event of the 39th International Conference on Software Engineer- ing (ICSE 2917), Buenos Aires, Argentina. The goal of this 2-day workshop was to bring together researchers and practitioners in order to exchange innovative technical ideas and experiences re- lated to modeling. The 9th edition of the MiSE workshop provided a forum to discuss successful applications of software-modeling techniques and to gain insights into challenging modeling prob- lems, including uncertainty management, model heterogeneity, model reuse and evolution, testing, and the adoption of mod- els in critical application domains like self-adaptive and real-time systems.
Workshop on Developmental aspects of Intelligent Adaptive Systems (DIAS)
Authors: Mohalik Swarup Kumar , Ramamurthy Badrinath , Jayaraman Mahesh Babu , D'Souza Meenakshi
Published: January 2018

With the proliferation of the Internet of Things and the associ- ated trend of integration of software with "things", it is predicted that the complexity of the systems-of-future will be characterized not only by scale and variety of devices and software but also by the constant change of the system context due to the mobil- ity of devices and M2M interactions. Consequently, the current paradigm of automation will be inadequate for the management and operation of these systems. The dominant approach to ad- dress this issue is to design and develop autonomous systems that can adapt to the changes in various levels and keep delivering the expected functionality. Such systems need fundamentally different architectures, components and methodologies incorporating new paradigms such as machine learning and intelligent decision making. In this workshop, we attempt to discuss the in uence of these paradigms on the development life cycle of adaptive soft- ware, starting from requirements, design and architecture and also their verification and validation.
Identification and Characterization of Sites Where Persistent Atrial Fibrillation Is Terminated by Localized Ablation
Authors: Zaman Junaid A.B. , Sauer William H. , Alhusseini Mahmood I. , Baykaner Tina , Borne Ryan T. , Kowalewski Christopher A.B. , Busch Sonia , Zei Paul C. , Park Shirley , Viswanathan Mohan N. , Wang Paul J. , Brachmann Johannes , Krummen David E. , Miller John M. , Rappel Wouter Jan , Narayan Sanjiv M. , Peters Nicholas S.
Published: January 2018

Background:

The mechanisms by which persistent atrial fibrillation (AF) terminates via localized ablation are not well understood. To address the hypothesis that sites where localized ablation terminates persistent AF have characteristics identifiable with activation mapping during AF, we systematically examined activation patterns acquired only in cases of unequivocal termination by ablation.

Methods and Results:

We recruited 57 patients with persistent AF undergoing ablation, in whom localized ablation terminated AF to sinus rhythm or organized tachycardia. For each site, we performed an offline analysis of unprocessed unipolar electrograms collected during AF from multipolar basket catheters using the maximum –dV/dt assignment to construct isochronal activation maps for multiple cycles. Additional computational modeling and phase analysis were used to study mechanisms of map variability. At all sites of AF termination, localized repetitive activation patterns were observed. Partial rotational circuits were observed in 26 of 57 (46%) cases, focal patterns in 19 of 57 (33%), and complete rotational activity in 12 of 57 (21%) cases. In computer simulations, incomplete segments of partial rotations coincided with areas of slow conduction characterized by complex, multicomponent electrograms, and variations in assigning activation times at such sites substantially altered mapped mechanisms.

Conclusions:

Local activation mapping at sites of termination of persistent AF showed repetitive patterns of rotational or focal activity. In computer simulations, complete rotational activation sequence was observed but was sensitive to assignment of activation timing particularly in segments of slow conduction. The observed phenomena of repetitive localized activation and the mechanism by which local ablation terminates putative AF drivers require further investigation.
Diagnostic Performance of the Instantaneous Wave-Free Ratio
Authors: De Rosa Salvatore , Polimeni Alberto , Petraco Ricardo , Davies Justin E. , Indolfi Ciro
Published: January 2018

Background—

Aim of the present study was to perform a meta-analysis of all available studies comparing the instantaneous wave-free ratio (iFR) with fractional flow reserve (FFR).

Methods and Results—

Published trials comparing the iFR with FFR were searched for in PubMed, Google Scholar, and Scopus electronic databases. A total of 23 studies were available for the analysis, including 6381 stenoses. First, a meta-analysis of all studies was performed exploring the correlation between FFR and iFR. Interestingly, we found good correlation (0.798 [0.78–0.82]) between the 2 indices (
P
<0.001). In addition, to evaluate the diagnostic performance of iFR to identify FFR-positive coronary stenoses, we performed an additional meta-analysis, summarizing the results of receiver operating characteristics analyses from individual studies reporting the area under the curve. Summing the results of these studies, we found that iFR has a good diagnostic performance for the identification of FFR-positive stenoses (area under the curve=0.88 [0.86–0.90];
P
<0.001). Furthermore, our search results included 5 studies that compared iFR and FFR to a third independent reference standard. Interestingly, no significant differences between iFR and FFR were reported in those studies.

Conclusions—

The present meta-analysis shows that iFR significantly correlates with standard FFR and shows a good diagnostic performance in identifying FFR-positive coronary stenoses. Finally, iFR and FFR have similar diagnostic efficiency for detection of ischemia-inducing stenoses when tested against a third comparator.
Victimization-Precipitated Residential Mobility Among Women Offenders
Authors: Yetter Alyssa M.
Published: January 2018

Victims of crime are likely to move residence following their victimization. However, the reasons for and the outcomes of victimization-precipitated moves remain unclear. The current study uses life event calendar data on jailed women to test two potential mechanisms: relationship dissolution and perceptions of neighborhood safety. In addition, this study seeks to understand how the safety of women’s residential contexts is affected by their past victimizations and residential mobility. Results show that intimate partner victimization is associated with increased odds of moving, and this relationship is partially mediated by relationship dissolution. Furthermore, moving and nonpartner victimization interact in their effects on neighborhood safety, such that moves following higher levels of victimization lead women into more dangerous neighborhoods.
Partisan Dimensions of Confidence in the U.S. Military, 1973–2016
Authors: Burbach David T.
Published: January 2018

Americans express more confidence in their military than any other institution. The components and causes of confidence have been little studied, especially as a partisan phenomenon. This study assesses trends in how partisanship and ideology affect confidence in the military. Multivariate analysis of General Social Survey and Harris Poll data shows that while confidence has increased for all demographic and political subgroups, partisanship and ideology play larger roles than commonly recognized. Democrats and Republicans are more confident than independents, but Republican confidence increased sharply over the last 20 years. Party ID is now the best predictor of one's confidence in the military. Conservative ideology has little effect, but liberalism reduces confidence, splitting Democrats. The pattern is not only “Republicanization,” however; partisans on both sides are more confident when their party holds the White House.
Hydraulic balancing strategies: A case study of radiator-based central heating system
Authors: Piana Edoardo A , Grassi Benedetta , Bianchi Francesco , Pedrotti Cristian
Published: January 2018

With energy efficiency regulations coming into force, the retrofitting of existing plants has become mandatory in many European countries. The application of thermostatic radiator valves is a cheap, effective solution in case of radiator-based hydronic plants, but it requires the distribution system to be re-engineered and, in some situations, further adjusting devices to be added. In this paper, the behaviour of a vertical distribution heating system has been simulated with the aim of analysing the outcome of different hydraulic balancing strategies and proposing a method to identify the most suitable option. The common problem of noisy valves has been examined and the cost impact of the different solutions has also been considered.

Practical application: This paper applies simple calculation tools to explore the impact of different balancing solutions to a real building, using an approach that could valuably assist the practitioner in the decision process.
Big data to knowledge – Harnessing semiotic relationships of data quality and skills in genome curation work
Authors: Huang Hong
Published: January 2018

This article aims to understand the views of genomic scientists with regard to the data quality assurances associated with semiotics and data–information–knowledge (DIK). The resulting communication of signs generated from genomic curation work, was found within different semantic levels of DIK that correlate specific data quality dimensions with their respective skills. Syntactic data quality dimensions were ranked the highest among all other semiotic data quality dimensions, which indicated that scientists spend great efforts for handling data wrangling activities in genome curation work. Semantic- and pragmatic-related sign communications were about meaningful interpretation, thus required additional adaptive and interpretative skills to deal with data quality issues. This expanded concept of ‘curation’ as sign/semiotic was not previously explored from the practical to the theoretical perspectives. The findings inform policy makers and practitioners to develop framework and cyberinfrastructure that facilitate the initiatives and advocacies of ‘Big Data to Knowledge’ by funding agencies. The findings from this study can also help plan data quality assurance policies and thus maximise the efficiency of genomic data management. Our results give strong support to the relevance of data quality skills communication for relationship with data quality assurance in genome curation activities.
A new method of infrared-fluorescence-enhanced thoracoscopic segmentectomy
Authors: Elkhouly Ahmed G , Cristino Benedetto , Pompeo Eugenio
Published: January 2018

Optimal identification of the intersegmental plane can be challenging during thoracoscopic anatomical segmentectomy for lung cancer. We describe a simple new method of infrared-fluorescence-enhanced thoracoscopy with selected injection of indocyanine green into the bronchi not targeted for resection, which allows us to clearly identify the intersegmental plane in thoracoscopic segmentectomy.
Pilot study: Sensory integration processing disorders in children with optic nerve hypoplasia spectrum
Authors: Jutley-Neilson Jagjeet , Greville-Harris Gillian , Kirk Jeremy
Published: January 2018

This study aimed to explore the sensory processing profiles of children with the spectrum of optic nerve hypoplasia (ONH). Caregivers completed the Short Sensory Profile (SSP), the Social Communication Questionnaire (SCQ), and the Vineland Adaptive Behaviour Scale (VABS) interview. The study demonstrated that children with ONH present with sensory integration dysfunction (SID), in their intact senses, and that autistic spectrum condition (ASC) was the best predictor of SID, rather than visual loss, or level of intellectual disability in these children. The results indicate that assessment and monitoring of SID in children with ONH is crucial.
Diagnostic performance of static single-scan stress perfusion cardiac computed tomography in detecting hemodynamically significant coronary artery stenosis: a comparison with combined invasive coronary angiography and cardiovascular magnetic resonance-myocardial perfusion imaging
Authors: Song Inyoung , Yi Jeong Geun , Park Jeong Hee , Kim Mi Young , Shin Je Kyoun , Ko Sung Min
Published: January 2018

Background

Non-invasive anatomical and physiological evaluations of coronary artery disease (CAD) may be obtained with static single-scan stress perfusion cardiac computed tomography (SSPCT).

Purpose

To determine the diagnostic performance of static SSPCT for identifying hemodynamically significant CAD.

Material and Methods

This prospective study included 29 patients with suspected or known CAD who underwent static SSPCT, cardiovascular magnetic resonance myocardial perfusion imaging (CMR-MPI), and invasive coronary angiography (ICA). CT was performed as follows: (i) coronary calcium scan; (ii) static SSPCT for both coronary artery (coronary CT angiography [CCTA]) and myocardial perfusion (perfusion CT [PCT]) during adenosine infusion; (iii) late-phase scan. The diagnostic performance of CCTA alone, PCT alone, and SSPCT for the detection of a hemodynamically significant CAD (a perfusion defect in a vascular territory subtended by a coronary vessel with ≥ 50% stenosis) was compared with that of combined ICA/CMR-MPI representing the standard of reference.

Results

Twenty-three (79%) patients and 47 (54%) vascular territories manifested ischemia-causing coronary stenoses by combined ICA/CMR-MPI. The per-vessel sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) of the SSPCT were 92%, 88%, 90%, 90%, and 0.90, respectively, compared to those of the combined ICA/CMR-MPI. These values for the CCTA alone were 96%, 63%, 75%, 93%, and 0.79, respectively; and the values for the PCT alone were 94%, 83%, 86%, 92%, and 0.88, respectively. The AUC of SSPCT was significantly ( P = 0.013) higher than that of the CCTA alone.

Conclusion

Static SSPCT may facilitate detection of hemodynamically significant CAD.
Does “Enhanced Support” for Offenders Effectively Reduce Custodial Violence and Disruption? An Evaluation of the Enhanced Support Service Pilot
Authors: Camp Jake , Joy Kerry , Freestone Mark
Published: January 2018

This study aimed to examine the effectiveness of The Enhanced Support Service (ESS) pilot in reducing custodial violence and disruption, and the associated costs, by observing the behavioural change of the 35 service users who participated in ESS intervention within its first 22 months of operation. Frequencies of recorded incidents of aggressive behaviours, self-harming behaviours, noncompliance, and positive behaviours were counted from routine administrative systems using a coding structure developed in previous studies. The count data were analysed using nonparametric tests and Poisson regression models to derive an Incident Rate Ratio (IRR). Findings suggest the ESS is associated with a reduction in aggressive behaviours and noncompliance, with medium to large effect sizes ( r = .31-.53); however, it was not associated with a reduction in deliberate self-harm or increased positive behaviours. The Poisson models revealed that levels of pre-intervention behaviour, intervention length, intervention completion, and service location had varying effects on postintervention behaviour, with those who completed intervention demonstrating more favourable outcomes. The ESS service model was associated with a reduction in behaviour that challenges, which has implications for the reduction in associated social, economic, and political costs—as well as the commissioning of interventions and future research in this area.
Application of the comprehensive environmental questionnaire for older adults requiring support for community-living
Authors: Nakamura-Thomas Hiromi , Kyougoku Makoto , Yabuwaki Kenji
Published: January 2018

Introduction

The Comprehensive Environmental Questionnaire for the Elderly (CEQ) was developed to measure satisfaction levels among community-dwelling older adults regarding their environment. The CEQ comprises 14 question items grouped into three factors, which are rated on a four-point Likert scale. To expand the applicability of the CEQ to community-dwelling older adults requiring support from long-term care and family members for their community-living, this study examined the factorial structure and scale system of the CEQ to verify its validity and reliability.

Method

Data were collected individually from 218 participants who receive no rehabilitative services but require homemaking services and/or support from family members. The factorial structure and scale system were examined using structural equation modeling and an item response theory (IRT) approach, respectively.

Findings

We obtained values between 0.93 and 0.66 for factor loadings, 0.98 for comparative fit index, and 0.97 for Tucker–Lewis index, which indicated a good to adequate fit. The value of root mean square error of approximation was 0.094, indicating a mediocre fit. The IRT analysis showed an accurate description of item function of the CEQ.

Conclusion

The CEQ was applicable to the present study population. Although the CEQ concept was confirmed, the questionnaire warrants further improvement.
Influence of Co-Morbidity on Health-Related Quality of Life in Patients Treated with Hemodialysis
Authors: Stojanovic M. , Ilic S. , Stefanovic V.
Published: January 2018

Studies on the outcome of hemodialysis (HD) patients over time have mainly focused on morbidity and mortality, but currently, the importance of measuring the patient's health-related quality of life (HRQoL) is being increasingly recognized. On the other hand, comorbidity is the single most important determinant of outcome in patients on HD. The aims of this study were to evaluate HRQoL in patients at the initiation of HD therapy (incident cohort), and in patients on long-term HD treatment (prevalent cohort), and to establish the relationship between the presence of comorbidity and patient's HRQoL. The study enrolled 229 patients on HD, divided into two groups: prevalent cohort comprised 192 patients on chronic HD more than 3 months, and incident cohort with 37 patients who started their dialysis during the study. Comorbidity was assessed using the Index of Coexistent Diseases (ICED), including two sub-indexes: Index of Disease Severity (IDS), a medical record review of 16 medical conditions, and Index of Physical Impairment (IPI), an observer-based assessment of 11 physical functions. ICED scores range from 0 to 3, with higher levels reflecting more severe comorbidity. Patient's self-assessment of HRQoL was measured by the 36-item Short Form Health Survey Questionnaire (SF-36), encompassing 8 summary scales and 2 summary dimensions. Based on the ICED index level, in both groups of patients (prevalent and incident group), a high presence of associated diseases was observed, i.e. 56.8 % and 67.6 % respectively. Indicators of comorbidities have negative and statistically significant correlation, so that any increase of IDS and IPI indexes produces significant decrease of HRQoL parameters. HRQoL summary scales in both groups of patients were similar, but generally with lower values in incident subjects and with statistical significance only in social functioning (SF) scale (40.5 ± 24.9 vs 51.0 ± 27.2). In the incident group of patients, one year of HD treatment was associated with a slight improvement in all HRQoL parameters, but statistical significance (p < 0.05) was observed only in the role-physical limitation (RP) scale and SF scale.

Conclusions

In the patients on HD treatment, comorbid conditions have negative and statistically significant correlation with parameters of HRQoL, and could explain poor HRQoL to a remarkable extent. One year after starting HD, patients reported better scores in some domains, especially in the RP and SF scale. From a clinical perspective, parameters of HRQoL and comorbidities should be considered in the follow up of patients treated with HD. (Int J Artif Organs 2006; 29: 1053–61)
Histopathologic Changes of Acellularized Xenogenic Carotid Vascular Grafts Implanted in a Pig-to-Goat Model
Authors: Kim W.S. , Seo J.W. , Rho J.R. , Kim W.G.
Published: January 2018

Introduction

The present study was designed to determine the in vivo patency and recellularization pattern of acellularized small-diameter xenogenic arterial grafts. We implanted acellularized porcine carotid arteries in bilateral carotid arteries of goats and microscopically analyzed the recellularization pattern of these grafts with the recipient's cells over time.

Material and Methods

Carotid arteries of pigs weighing 30–40 kg were harvested and decellularized with hypertonic saline followed by sodium dodecyl sulfate. Acellularized porcine carotid vascular xenografts (0.4–0.5 cm in diameter) were prepared into 4 cm-long segments and implanted bilaterally in the carotid arteries of 10 black-haired goats. The in vivo patency of the implanted acellularized xenogenic grafts was evaluated at regular intervals by color Doppler ultrasonography. The goats were sacrificed at predetermined intervals (1 week, 1 month, 3 months, 6 months, 12 months after implantation), two animals at each interval. Upon retrieval, visual inspections and histopathologic examinations of the grafts were performed. To identify smooth muscle cells and functioning endothelial cells, immunohistochemical staining for alpha-smooth muscle actin and von Willebrand factor were also performed.

Results and Conclusions

All experimental animals survived the observation period. Nineteen out of 20 implanted grafts showed patency with no thrombi. Microscopic analysis revealed that the grafts were completely covered with the hosts' endothelial cells, beginning from anastomotic sites. The grafts were gradually recellularized with recipients'cells including fibroblasts, myofibroblasts and smooth muscle cells. In conclusion, this study suggested that acellularized xenogenic vascular grafts can be a good alternative for the small-diameter vascular graft.
Bridging Extended Nerve Defects with an Artifcial Nerve Graft Containing Schwann Cells Pre-Seeded on Polyglactin Filaments
Authors: Lohmeyer J.A. , Shen Z.-L. , Walter G.F. , Berger A.
Published: January 2018

A 24 mm long bioartificial nerve graft (BNG) was created to bridge extended peripheral nerve defects of the rat sciatic nerve. In our previous studies, an identical graft had demonstrated good results over nerve gaps of up to 15 mm. The BNG device comprised a collagen-I tube filled with ten Schwann-cell-seeded polyglactin filaments and 106 isogenic Schwann cells suspended in Matrigel which were implanted in 27 rats (group I). Schwann-cell-free grafts (27 rats) and nerve autografts (18 rats) served as controls. Functional recovery was followed over a period of six months using walking track analysis. Terminal analyses of graft efficacy included neurophysiology, muscle weight, and histological assessment of the implants and the distal nerve stumps. In 17/27 cases, axonal regeneration into the distal nerve stump could be detected across the BNG, but all animals in group I and II failed to regain motor function of the hindlimb upon completion of the experiment. Axon diameter and axonal density in the graft and distal nerve stump were greater in group I than in group II. Although Schwann cells had a significant positive effect on axonal regeneration, either granuloma formation or the amount of the inserted foreign material may have impaired nerve regeneration by acting as a physical impediment to nerve regeneration or negatively effecting cell function.
The Influence of Different Cultivation Conditions on the Metabolic Functionality of Encapsulated Primary Hepatocytes
Authors: Diekmann S. , GlöCkner P. , Bader A.
Published: January 2018

The clinical application of bioartificial liver support systems (BALS) is still limited because of technical problems associated with the storage, transport and scale-up of common systems. The encapsulation of primary hepatocytes could solve these problems since the scale-up depends only on the number of the beads and encapsulation leads to protection of the cells during the process of freezing and thawing. Many efforts have been made to find an appropriate material for the encapsulation of primary hepatocytes in terms of mechanical resistance as well as appropriate bio- and hemo-compatibility This study focuses on the improvement of the metabolic functionality of encapsulated primary hepatocytes. A comparison between two different cultivation models showed that dynamic cultivation conditions lead to a 20.4-fold increase in the albumin production and a 5.21-fold increase in the urea synthesis of encapsulated hepatocytes. Furthermore, the influence of different ratios of the number of the cells to the volume of the media was analyzed. Encapsulated hepatocytes cultured with a high amount of medium were characterized by a significantly higher metabolic activity compared to encapsulated hepatocytes cultured with a low level of medium. Interestingly, the cell concentration per mL alginate has no significant influence on the metabolic activity of encapsulated hepatocytes. In conclusion, different optimization strategies are discussed and, finally, the functionality of encapsulated hepatocytes is compared to the standard model of hepatocyte culture, the collagen sandwich.
Endothelial Dysfunction in Patients with Severe Acute Pancreatitis: Improved by Continuous Blood Purification Therapy
Authors: Chen Z.-H. , Liu Z.-H. , Yu C. , Ji D.-X. , Li L.-S.
Published: January 2018

Objectives.

Endothelium dysfunction is one of the critical pathophysiologic disorders in patients with severe acute pancreatitis (SAP). To investigate the effect of continuous blood purification (CBP) on endothelial function, we conducted a prospective study of 20 patients with SAP, 9 of whom had evidence of sepsis.

Methods.

All patients underwent CVVH for 72 h. Soluble E-selectin (sE-selectin), soluble thrombomodulin, permeability of the endothelial monolayer, and endothelial intracellular calcium ([Ca2+]i) levels were used as the markers for the assessment of endothelial function and the effect of CBP therapy in patients with SAP. Blood samples were taken from the patients at 0, 2, 12, 24, 48, and 72 h during CVVH therapy. sE-selectin and thrombomoduiln were measured by ELISA. The endothelial permeability and activation were evaluated using cultured endothelial monolayer and intracellular Ca2+ concentration.

Results.

The results showed that during CVVH treatment, the hemodynamics and mean arterial pressure (MAP) were stable. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was improved significantly after CVVH. Endothelial dysfunction was evident in patients with SAP as compared to normal controls. Patients with SAP had increased levels of sE-selectin, endothelial permeability and intracellular [Ca2+]i, which was higher in patients with sepsis than in those without sepsis. The level of thrombomodulin showed a tendency to increase; however, these changes were not significant between SAP patients and controls. After CBP treatment, sE-selectin levels substantially decreased in all patients. CBP treatment also significantly diminished the endothelial permeability and decreased the intracellular [Ca2+] concentration.

Conclusions.

These data demonstrate that endothelial dysfunction is present in patients with SAP and the degree of endothelial damage may be correlated with the disease severity. CBP therapy can not only improve the general conditions, as measured by the APACHE II score, but also effectively improve endothelial dysfunction.
Innovative Methods of Rapid Bacterial Quantification and Applicability in Diagnostics and in Implant Materials Assessment
Authors: Campoccia D. , Speziale P. , An Y.H. , Del Pozo J.L. , Ceresa L. , Pegreffi F. , Montanaro L. , Arciola C.R.
Published: January 2018

In recent years, a variety of new technologies have been proposed that allow rapid qualitative and quantitative microbiological analyses. In this paper we discuss the urgent needs for reliable and rapid microbiological analytical techniques in different applicative fields involving the research, production and medical application of implant materials, and the potential benefits derived from the use of new methods for rapid bacterial quantification. Current compendial methods are easy to perform and have gained confidence over their long period of use, but the supplemental use of new technologies could represent real breakthroughs whenever sensitive and rapid responses are urgently required and not met by the tests currently in use. Overall, the new microbiological methods require critical evaluation depending on their specific type of application and they may still not be thought of as totally substitutive, but they certainly exhibit considerable potential for different areas of biomaterials, as well as for advanced therapy medicinal and tissue engineering treatments.
The Epidemiology of Cardiac Surgery-Associated Acute Kidney Injury
Authors: Hoste E.A. , Cruz D.N. , Davenport A. , Mehta R.L. , Piccinni P. , Tetta C. , Viscovo G. , Ronco C.
Published: January 2018

Purpose

To describe current knowledge on the epidemiology of cardiac surgery-associated acute kidney injury (CSA-AKI) and to formulate recommendations for clinical practice and a research agenda.

Methods

After a modified Delphi analysis by the Acute Dialysis Quality Initiative (ADQI), 4 questions on the epidemiology of CSA-AKI and recommendations for clinical practice and a research agenda were formulated and addressed.

Results

Existing studies on CSA-AKI use over 35 different definitions for CSA-AKI. In addition, there may be important differences in patient characteristics and procedures. This explains the significant variations in reported incidence. Most studies report on CSA-AKI as defined by the need for renal replacement therapy. However, even small decreases in kidney function are associated with a worsened outcome. The workgroup formulated the recommendation to use the AKIN consensus criteria for AKI. One should differentiate early CSA-AKI, caused by the procedure, and late CSA-AKI, associated with the procedure. There may be different clinical scenarios: acute on chronic CSA-AKI, AKI prior to CS, and AKI occurring post CS. Risk factors should be differentiated between pre-, intra-, and post-CS, and between patient-, process-, and procedure-related. Endpoints should include both short-term and long-term outcomes.

Conclusions

Existing data on the epidemiology of CSA-AKI are difficult to compare due to variations in definition and patient cohort. A modified Delphi analysis resulted in a series of recommendations for future research on CSA-AKI.
Treatment of Metabolic Alkalosis during Continuous Renal Replacement Therapy with Regional Citrate Anticoagulation
Authors: Kindgen-Milles D. , Amman J. , Kleinekofort W. , Morgera S.
Published: January 2018

The use of citrate as an anticoagulant in continuous renal replacement therapy is an effective method to achieve regional anticoagulation of the extracorporeal blood circuit and to avoid systemic anticoagulation. This allows bleeding complications to be reduced and filter life time to be prolonged. However, citrate enters the systemic circulation and is metabolized in the liver to bicarbonate, causing metabolic alkalosis in some patients. In this case report, we discuss therapeutic interventions to control the acid-base status and to restore normal pH during continuous citrate hemodialysis.
Angiogenesis without Functional Outcome after Mononuclear Stem Cell Transplant in a Doxorubicin-Induced Dilated Myocardiopathy Murine Model
Authors: Carvalho K.A.T. , Simeoni R.B. , Guarita-Souza L.C. , Francisco J.C. , Abdelwahid E. , Myiague N.I. , Chachques J.C. , Rivetti L.A. , Oliveira L. , Malvezzi M. , Olandoski M. , Gremski W.
Published: January 2018

Objectives

Cell transplantation is considered a novel approach in the treatment of myocardiopathy. The objective of this study was to evaluate the effects of autologous mononuclear stem cell therapy in doxorubicin-induced dilated myocardiopathy by conducting both functional and histopathologic analysis.

Methods

Seventy male rats were doxorubicin injected intraperitoneally for 2 weeks. At 1 month, the animals that had demonstrated left ventricular ejection fractions less than 40% were randomly divided into a mononuclear stem cell group and controls. Mononuclear stem cells were isolated. All animals underwent echocardiographic study: baseline, pre-cell therapy, and at 1 month post-cell therapy, and analyzed by the nonparametric Mann-Whitney test. Transplants were performed by subepicardial injections. Standard staining was performed.

Results

Twenty-three animals were randomly treated: mononuclear stem cell and control groups, with 11 rats completing the study. Cell viability was 85%. Mononuclear stem cells (n=5; 5×106 cells /300 μL medium) and control (n=6; 300 μL medium) were used. The resulting left ventricular ejection fraction in the cell therapy group was not significantly different compared with controls (p=0.54). New vessels were demonstrated in the subepicardial region.

Conclusions

Autologous mononuclear stem cell therapy was not functionally effective in doxorubicin-induced dilated myocardiopathy in the animal model under study with the experimental conditions, despite occurrence of angiogenic activity.
Body Perfusion during Adult Cardiopulmonary Bypass is Improved by Pulsatile flow with Intra-Aortic Balloon Pump
Authors: Onorati F. , Santarpino G. , Rubino A. S. , Caroleo S. , Dardano A. , Scalas C. , Gulletta E. , Santangelo E. , Renzulli A.
Published: January 2018

Purpose

To evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves body perfusion.

Methods

158 coronary artery bypass graft (CABG) patients were randomized to linear cardiopulmonary bypass (CPB) (n=71, Group A) or automatic 80 bpm intra-aortic ballon pump (IABP) induced pulsatile CPB (n=87, Group B). We evaluated hemodynamic response by Swan-Ganz catheter, inflammation by cytokines, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate and renal function (estimated glomerular filtration rate (eGFR), creatinine, and incidence of renal insufficiency and failure).

Results

IABP induced Surplus Hemodynamic Energy was 15.8±4.9 mmHg, with higher mean arterial pressure during cross-clamping (p=0.001), and lower indexed systemic vascular resistances during cross-clamping (p=0.001) and CPB discontinuation (p=0.034). IL-2 and IL-6 were lower, while IL-10 proved higher in Group B (p<0.05). Group B showed lower chest drainage (p<0.05), transfusions (p<0.05), INR (p<0.05), and AT-III (p=0.001), together with higher platelets, aPTT (p<0.05), fibrinogen (p<0.05) and D-dimer (p<0.05). Transaminases, bilirubin, amylase, lactate were lower in Group B (p<0.05); eGFR was better in Group B from ITU-arrival to 48 hours, both in preoperative kidney disease Stages 1–2 (p<0.03) and Stage 3 (p<0.05), resulting in lower creatinine from ITU-arrival to 48 hours (p<0.03). Incidence of renal insufficiency (p=0.004) and need for renal replacement therapy (p=0.044) was lower in Group B Stage 3. Group B PaO2/FiO2 and lung compliance improved from aortic declamping to the first day (p<0.003) with shorter intubation time (p=0.01).

Conclusion

Pulsatile flow by IABP improves whole-body perfusion during CPB.
Vitamin D: Physiology and Pathophysiology
Authors: Gallieni Maurizio , Cozzolino Mario , Fallabrino Giuditta , Pasho Sabina , Olivi Laura , Brancaccio Diego
Published: January 2018

Although vitamin D was initially considered a nutrient, it has been recognized that the molecules derived from vitamin D metabolism are best considered as a complex endocrine system. In this review article we summarize the basic concepts regarding vitamin D metabolism, transport, and genomic activity through the vitamin D receptor, facilitating activation or suppression of target genes. We also examine non-genomic actions, biological responses to vitamin D in classic target organs (intestine, bone, kidneys, and parathyroid glands), and in organs and tissues not related to mineral homeostasis.
Computer-Simulated Fluid Dynamics of Arterial Perfusion in Extracorporeal Circulation: From Reality to Virtual Simulation
Authors: Fukuda Ikuo , Osanai Satoshi , Shirota Minori , Inamura Takao , Yanaoka Hideki , Minakawa Masahito , Fukui Kozo
Published: January 2018

Background

Atheroembolism due to aortic manipulation remains an unsolved problem in surgery for thoracic aortic aneurysm. The goal of the present study is to create a computer simulation (CS) model with which to analyze blood flow in the diseased aorta.

Method

A three-dimensional glass model of the aortic arch was constructed from CT images of a normal, healthy person and a patient with transverse aortic arch aneurysm. Separately, a CS model of the curved end-hole cannula was created, and flow from the aortic cannula was recreated using a numerical simulation.

Results

Comparison of the data obtained by the glass model analyses revealed that the flow velocity and the vector of the flow around the exit of the cannula were similar to that in the CS model. A high-velocity area was observed around the cannula exit in both the glass model and the CS model. The maximum flow velocity was as large as 1.0 m/s at 20 mm from the cannula exit and remained as large as 0.5 to 0.6 m/s within 50 mm of the exit. In the aortic arch aneurysm models, the rapid jet flow from the cannula moved straight toward the lesser curvature of the transverse aortic arch. The locations and intensities of the calculated vortices were slightly different from those obtained for the glass model.

Conclusions

The proposed CS method for the analysis of blood flow from the aortic cannulae during extracorporeal circulation can reproduce the flow velocity and flow pattern in the proximal and transverse aortic arches.