bluuebunny/crossref_metadata_2025 huggingface dataset:
Ventilator System Concept
Authors: Lei Yuan
Published: August 2017

‘Ventilator System Concept’ develops the idea that the equipment for mechanical ventilation is a ventilator system with six essential parts. Using a simple balloon model, it explains the operating principle and composition of a ventilator system, and it describes how the system generates intermittent positive airway pressure. The chapter ends by describing the conditions required for a ventilator system to function properly.
Special Ventilation Functions
Authors: Lei Yuan
Published: August 2017

‘Special Ventilation Functions’ examines those hard-to-classify features such as standby; sigh; temporary oxygen enrichment or 100% O2; apnoea backup or apnoea ventilation; and tube resistance compensation, also known as tube compensation or automatic tube compensation. It describes each function in depth, including indications for use and details on typical implementations, providing examples from popular ventilators.
An Introduction to Major Incident Management
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 1 covers information on what a major incident is, definitions and classifications including chemical, biological, radiological and nuclear (CBRN), special arrangements, historical and recent major incidents, mass fatalities, the Civil Contingencies Act 2004, nomenclature, and the Joint Emergency Services Inter-operability Programme (JESIP). The phases and objectives of a response to a major incident are described. This chapter also outlines the generic structured approach including command and control, safety (including zones and cordons), communication, assessment, triage and categorization systems, casualty treatment, roles and responsibilities, and casualty transportation.
Casualty and Scene Medical Management
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 5 covers the declaration of a major incident and practice of the initial situation report from the scene. A summary is given of the systematic approach and organization of the on-scene medical response including key medical roles and responsibilities at scene, triage, decontamination, personal protective equipment, dealing with the dead and human remains, evacuation, survivor reception, mass fatalities and national emergency mortuary arrangements, management of contaminated fatalities, and the role of the police senior investigation manager.
Biological Incidents
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 9 covers information on recognition of a biological incident, natural disease outbreaks, accidental release of pathogenic organisms, bioterrorism incidents, features of an intentional biological agent release, recognition of an intentional biological agent release, bioterrorism surveillance, and biological agent biodromes, initial management of a suspected biological agent release incident, general incident management principles, universal (standard) precautions, personal protective equipment, decontamination at scene, biological agent transmissibility and public health impact, mathematical models of infection spread, pre- and post-exposure prophylaxis, the hospital response to a biological incident, primary care, cardinal signs and tips for key biological agents, the role of hospital clinicians, and the unidentified biological agent and ‘white powder’ incidents.
The Hospital Response
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 12 covers information on the phases of the response, planning—principles and priorities, the structured approach to the hospital response and surge management, the emergency department, the hospital coordination team, documentation and patient tracking, communications, action cards, equipment, training, hierarchy, declaration and activation of a major incident response, reception, triage, resuscitation, surgical and non-surgical (medical) care, forensic considerations, recovery/business continuity, post-incident recovery, special incidents, CBRN, multiple burns casualties, and multiple paediatric casualties.
Databases, registries, and quality of care
Authors: Danchin Nicolas , Ecarnot Fiona , Schiele François
Published: August 2017

This chapter will describe what databases and registries can provide for clinicians and researchers. It will also describe the respective position of randomized clinical trials and databases/registries as complementary pillars of evidence-based medicine, and how they are of particular importance in the field of acute cardiac care. Finally, the importance of databases in quality of care processes will be discussed.
Non-invasive ventilation
Authors: Masip Josep , Planas Kenneth , Mas Arantxa
Published: August 2017

During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
Biomarkers in acute heart failure
Authors: Choudhary Rajiv , Shah Kevin , Maisel Alan
Published: August 2017

Acute heart failure continues to be a worldwide medical problem, associated with frequent readmissions, high mortality, and a profound economic impact on national health care systems. In the past decade, biomarkers have shifted the way in which acute heart failure is managed by the cardiologist. The search for the ideal biomarker to aid in the diagnosis, prognosis, and treatment of acute heart failure is ongoing. The natriureticfc peptides have proved extremely useful in determining whether acute dyspnoea has a cardiac aetiology. In addition, recent trials have demonstrated the use of natriuretic peptides in inpatient and outpatient prognosis, as well as in titrating medications in outpatients with chronic heart failure to prevent acute heart failure hospitalizations. Other emerging acute heart failure biomarkers include mid-regional pro-adrenomedullin, mid-regional proatrial natriuretic peptide, troponin, ST2, and neutrophil gelatinase-associated lipocalin.
Percutaneous coronary interventions in acute coronary syndromes
Authors: Kočka Viktor , Kristensen Steen Dalby , Wijns William , Toušek Petr , Widimský Petr
Published: August 2017

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
Bleeding and haemostasis disorders
Authors: Mannucci Pier Mannuccio
Published: August 2017

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drug usage (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), such thrombotic microangiopathies as thrombotic thrombocytopenic purpura and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.
Microsurgery Simulator of Cerebral Aneurysm Clipping with Interactive Cerebral Deformation Featuring a Virtual Arachnoid
Authors: Shono Naoyuki , Kin Taichi , Nomura Seiji , Miyawaki Satoru , Saito Toki , Imai Hideaki , Nakatomi Hirofumi , Oyama Hiroshi , Saito Nobuhito
Published: August 2017

BACKGROUND

A virtual reality simulator for aneurysmal clipping surgery is an attractive research target for neurosurgeons. Brain deformation is one of the most important functionalities necessary for an accurate clipping simulator and is vastly affected by the status of the supporting tissue, such as the arachnoid membrane. However, no virtual reality simulator implementing the supporting tissue of the brain has yet been developed.

OBJECTIVE

To develop a virtual reality clipping simulator possessing interactive brain deforming capability closely dependent on arachnoid dissection and apply it to clinical cases.

METHODS

Three-dimensional computer graphics models of cerebral tissue and surrounding structures were extracted from medical images. We developed a new method for modifiable cerebral tissue complex deformation by incorporating a nonmedical image-derived virtual arachnoid/trabecula in a process called multitissue integrated interactive deformation (MTIID). MTIID made it possible for cerebral tissue complexes to selectively deform at the site of dissection. Simulations for 8 cases of actual clipping surgery were performed before surgery and evaluated for their usefulness in surgical approach planning.

RESULTS

Preoperatively, each operative field was precisely reproduced and visualized with the virtual brain retraction defined by users. The clear visualization of the optimal approach to treating the aneurysm via an appropriate arachnoid incision was possible with MTIID.

CONCLUSION

A virtual clipping simulator mainly focusing on supporting tissues and less on physical properties seemed to be useful in the surgical simulation of cerebral aneurysm clipping. To our knowledge, this article is the first to report brain deformation based on supporting tissues.
Stellar Abundances for Galactic Archaeology Database. IV. Compilation of stars in dwarf galaxies
Authors: Suda Takuma , Hidaka Jun , Aoki Wako , Katsuta Yutaka , Yamada Shimako , Fujimoto Masayuki Y. , Ohtani Yukari , Masuyama Miyu , Noda Kazuhiro , Wada Kentaro
Published: August 2017

We have constructed a database of stars in Local Group galaxies using the extended version of the SAGA (Stellar Abundances for Galactic Archaeology) database that contains stars in 24 dwarf spheroidal galaxies and ultra-faint dwarfs. The new version of the database includes more than 4500 stars in the Milky Way, by removing the previous metallicity criterion of [Fe/H] ≤ −2.5, and more than 6000 stars in the Local Group galaxies. We examined the validity of using a combined data set for elemental abundances. We also checked the consistency between the derived distances to individual stars and those to galaxies as given in the literature. Using the updated database, the characteristics of stars in dwarf galaxies are discussed. Our statistical analyses of α-element abundances show that the change of the slope of the [α/Fe] relative to [Fe/H] (so-called “knee”) occurs at [Fe/H] = −1.0 ± 0.1 for the Milky Way. The knee positions for selected galaxies are derived by applying the same method. The star formation history of individual galaxies is explored using the slope of the cumulative metallicity distribution function. Radial gradients along the four directions are inspected in six galaxies where we find no direction-dependence of metallicity gradients along the major and minor axes. The compilation of all the available data shows a lack of CEMP-s population in dwarf galaxies, while there may be some CEMP-no stars at [Fe/H] ≲ −3 even in the very small sample. The inspection of the relationship between Eu and Ba abundances confirms an anomalously Ba-rich population in Fornax, which indicates a pre-enrichment of interstellar gas with r-process elements. We do not find any evidence of anti-correlations in O–Na and Mg–Al abundances, which characterizes the abundance trends in the Galactic globular clusters.
Observational study on the fine structure and dynamics of a solar jet. I. Energy build-up process around a satellite spot
Authors: Sakaue Takahito , Tei Akiko , Asai Ayumi , Ueno Satoru , Ichimoto Kiyoshi , Shibata Kazunari
Published: August 2017

We report on a solar jet phenomenon associated with successive flares on 2014 November 10. These explosive events were involved with the satellite spots’ emergence around a δ-type sunspot in the decaying active region NOAA 12205. The data for this jet were provided by the Solar Dynamics Observatory, the X-Ray Telescope aboard Hinode, and the Interface Region Imaging Spectrograph and Domeless Solar Telescope at Hida Observatory, Kyoto University. These abundant data enabled us to present this series of papers to discuss the entire process of the observed phenomena, including the energy storage, event trigger, and energy release. In this paper, we focus on the energy build-up and trigger phases, by analyzing the photospheric horizontal flow field around the active region by an optical flow method. The analysis shows the following results: (1) The observed explosive phenomena involved three satellite spots, the magnetic fluxes of which successively reconnected with their pre-existing ambient fields; (2) All of these satellite spots emerged in the moat region of a pivotal δ-type sunspot, especially near its convergent boundary with the neighboring supergranules or moat regions of adjacent sunspots; (3) Around the jet ejection site, the positive polarities of the satellite spot and adjacent emerging flux encountered the global magnetic field with a negative polarity in the moat region of the pivotal δ-type sunspot, and thus the polarity inversion line was formed along the convergent boundary of the photospheric horizontal flow channels.
Agronomic Performance and Economics of Yield Loss Associated With Angular Leaf Spot Disease of Common Bean in the Southern Highlands of Tanzania
Authors: Mongi Rose , Tongoona Pangirayi , Shimelis Hussein , Sibiya Julia
Published: August 2017

Angular leaf spot (ALS) caused by Pseudocercospora griseola is among the devastating diseases of common bean (Phaseolus vulgaris L.) in the Southern Highlands of Tanzania (SHT). This study was conducted to assess the agronomic performance and economics of yield loss associated with the disease on five bean cultivars that are widely grown by farmers. The cultivars were evaluated in a split plot design with a randomized complete block arrangement during 2012/2013 and 2013/2014. The main plots were two rates of fungicide and a control whereas the subplots consisted of cultivars. Data were collected on disease severity, yield, and yield components. Analysis of variance was done and marginal rate of returns determined using partial budget. Results indicated significant decrease in yields, number of pods, seeds, and seed weight at P < 0.05 for untreated plots. Decreases in yield were associated with ALS disease severity that in turn was influenced by cultivar and rate of fungicide used. Higher grain yield losses of as much as 61% and the lowest marginal rate of returns were recorded for unsprayed plots during heavy rains. Fungicide usage at the recommended rates should be considered during heavy rains and breeding for resistance should be taken as an economical and sustainable strategy for managing the disease.
Disease Resistance to Multiple Fungal and Oomycete Pathogens Evaluated Using a Recombinant Inbred Line Population in Pepper
Authors: Naegele R. P. , Granke L. L. , Fry J. , Hill T. A. , Ashrafi H. , Van Deynze A. , Hausbeck M. K.
Published: August 2017

Incorporating disease resistance into cultivars is a primary focus of modern breeding programs. Resistance to pathogens is often introgressed from landrace or wild individuals with poor fruit quality into commercial-quality cultivars. Sites of multiple disease resistance (MDR) are regions or “hot spots” of the genome with closely linked genes for resistance to different pathogens that could enable rapid incorporation of resistance. An F2-derived F6 recombinant inbred line population from a cross between ‘Criollo de Morelos 334’ (CMM334) and ‘Early Jalapeno’ was evaluated in inoculated fruit studies for susceptibility to oomycete and fungal pathogens: Phytophthora capsici, P. nicotianae, Botrytis cinerea, Fusarium oxysporum, F. solani, Sclerotinia sclerotiorum, Alternaria spp., Rhizopus oryzae, R. stolonifer, and Colletotrichum acutatum. All isolates evaluated were virulent on pepper. Significant differences in disease susceptibility were identified among lines for each of the pathogens evaluated. P. capsici was the most virulent pathogen, while R. oryzae and one Sclerotinia isolate were the least virulent. Quantitative trait loci associated with resistance were identified for Alternaria spp. and S. sclerotiorum. Positive correlations in disease incidence were detected between Alternaria spp. and F. oxysporum, F. solani, and C. acutatum, as well as between C. acutatum and Botrytis spp., F. oxysporum, F. solani, and P. capsici. No sites of MDR were identified for pathogens tested; however, positive correlations in disease incidence were detected among pathogens suggesting there may be genetic linkage among resistance genes in CM334 and Early Jalapeno.
Endovascular Treatment of Acute Ischemic Stroke Under General Anesthesia: Predictors of Good Outcome
Authors: Athiraman Umeshkumar , Sultan-Qurraie Ali , Nair Bala , Tirschwell David L. , Ghodke Basavaraj , Havenon Adam D. , Hallam Danial K. , Kim Louis J. , Becker Kyra J. , Sharma Deepak
Published: August 2017

Background:

The choice of anesthetic technique, general anesthesia (GA) versus Monitored Anesthesia Care, may impact the outcome of patients undergoing endovascular treatment of acute ischemic stroke (AIS). The aim of this study was to identify the factors associated with good discharge outcome in patients receiving GA for AIS.

Materials and Methods:

Electronic medical records of patients above 18 years old who underwent endovascular treatment of AIS under GA at a Comprehensive Stroke Center from 2010 to 2014 were reviewed. Good outcome was defined as discharge modified Rankin Score 0 to 2 and poor outcome as modified Rankin Score 3 to 6; logistic regression analysis was performed to examine the association between the clinical characteristics and the outcome.

Results:

In total, 88 patients (56 males), aged 63±15 years with median National Institute of Health Stroke Scale (NIHSS) score 16 (range, 4 to 38) were included. Nineteen (22%) patients had good outcome and 78 (88%) had systolic blood pressure below the guideline recommended 140 mm Hg under GA. After adjusting for age and NIHSS score, the independent predictors of good discharge outcomes were higher maximum end-tidal carbon dioxide (odds ratio [OR], 1.14; confidence interval [CI], 1.02-1.28; P=0.02) and extubation after endovascular treatment (OR, 26.31; CI, 4.80-144.12; P<0.0001). A secondary analysis was performed after excluding 25 patients emergently intubated in the Emergency Department for airway protection. In the logistic regression analysis controlling for age and NIHSS score, postprocedure extubation was still associated with higher odds of good outcomes (OR, 13.35; CI, 2.58-68.90; P=0.002).

Conclusions:

These findings indicate the importance of ventilation management and extubation after endovascular intervention under GA in patients with AIS.
Intraoperative Nerve Monitoring With a Handheld Intraoperative Biphasic Stimulator: Evaluation of Use During the Latarjet Procedure
Authors: Rimmke Nathan A. , Jones Grant L. , Bishop Julie Y.
Published: August 2017

The Latarjet procedure is well known to be technically challenging, with an incidence of neurological complications ranging from 1.8% to 20.6%. Recently, intraoperative neuromonitoring has been used to define the stages of the Latarjet when the nerves are at the highest risk. Our objective is to present short-term neurological outcomes and technique of using a biphasic handheld nerve stimulator. We retrospectively evaluated the charts of all patients who had undergone a Latarjet procedure by the senior author once we began using the biphasic handheld intraoperative nerve stimulator. Data collection included age, sex, number of prior surgeries, body mass index, length of surgery, and anesthetic. Surgical technique was the same for all procedures. Neurological examinations were documented at first postoperative visit. In total, 37 patients underwent a Latarjet procedure between May 2012 and September 2014. Average age was 23, with 35 males and 2 females. No nerve deficits were detected during surgery, nor were any deficits clinically detectable in sensory or motor examinations at first postoperative visit. This technology may be very helpful and practical to utilize during this complex surgery.
Interprofessional Competency Toolkit for Internationally Educated Health Professionals: Evaluation and Pilot Testing
Authors: Arain Mubashir , Suter Esther , Hepp Shelanne , Nanayakkara Shyama , Harrison Elizabeth L. , Mickelson Grace , Bainbridge Lesley , Grymonpre Ruby E.
Published: August 2017

Introduction:

Internationally Educated Health Professionals (IEHPs) constitute a major health care workforce in Canada. Interprofessional education is particularly important for IEHPs to integrate into the Canadian health care system. We designed an online interprofessional education curriculum for IEHPs. The curriculum is designed to cover the six interprofessional competency domains defined in the Canadian Interprofessional Health Collaborative National Interprofessional Competency Framework. In this article, we are presenting findings from the pilot testing of the curriculum with a cohort of IEHPs and educators.

Methods:

We conducted surveys and interviews with IEHPs and educators from four provinces (British Columbia, Alberta, Saskatchewan, and Manitoba). We aimed to include seven healthcare professionals: licensed practical nurses, registered nurses, registered psychiatric nurses, pharmacists, physicians, occupational therapists, and physical therapists. We also used a pre- post- self-assessment tool and a set of reflective questions to measure the effectiveness of the curriculum.

Results:

Thirty IEHPs and five educators reviewed the online curriculum and participated in this evaluation. Postintervention confidence scores for all items under the role clarification and patient-centered care domains increased significantly (P = <0.01) after module completion. The scores also increased for most questions in team functioning, collaborative leadership, and communication domains. The postassessment scores increased for only half of the questions in conflict management domains. Participants agreed with the appropriateness of the content in terms of language, scenarios, and cultural aspects covered in the online curriculum on interprofessional education.

Discussion:

The content of the curriculum improved IEHPs' understanding of interprofessional collaboration in Canada. The interprofessional curriculum is a creative and useful resource to improve collaborative practice among internationally educated health professionals in Canada.
Ex Vivo Induction of Multiple Myeloma-specific Immune Responses by Monocyte-derived Dendritic Cells Following Stimulation by Whole-tumor Antigen of Autologous Myeloma Cells
Authors: Vasileiou Spyridoula , Baltadakis Ioannis , Delimpasi Sosanna , Karatza Maria-Helena , Liapis Konstantinos , Garofalaki Maria , Tziotziou Eirini , Poulopoulou Zoe , Karakasis Dimitri , Harhalakis Nicholas
Published: August 2017

The introduction of novel agents has significantly expanded treatment options for multiple myeloma (MM), albeit long-term disease control cannot be achieved in the majority of patients. Vaccination with MM antigen-loaded dendritic cells (DCs) represents an alternative strategy that is currently being explored. The aim of this study was to assess the immunogenic potential of ex vivo–generated monocyte-derived DCs (moDCs), following stimulation with the whole-antigen array of autologous myeloma cells (AMC). MoDCs were loaded with antigens of myeloma cells by 2 different methods: phagocytosis of apoptotic bodies from γ-irradiated AMC, or transfection with AMC total RNA by square-wave electroporation. Twenty patients with MM were enrolled in the study. Following stimulation and maturation, moDCs were tested for their capacity to induce T-helper 1 and cytotoxic T lymphocyte responses in vitro. Both strategies were effective in the induction of myeloma-specific cytotoxic T lymphocyte and T-helper 1 cells, as demonstrated by cytotoxicity and ELISpot assays. On the whole, T-cell responses were observed in 18 cases by either method of DC pulsing. We conclude that both whole-tumor antigen approaches are efficient in priming autologous antimyeloma T-cell responses and warrant further study aiming at the development of individualized DC vaccines for MM patients.
Women Administered Standard Dose Imatinib for Chronic Myeloid Leukemia Have Higher Dose-Adjusted Plasma Imatinib and Norimatinib Concentrations Than Men
Authors: Belsey Sarah L. , Ireland Robin , Lang Kathryn , Kizilors Aytug , Ho Aloysius , Mufti Ghulam J. , Bisquera Alessandra , De Lavallade Hugues , Flanagan Robert J.
Published: August 2017

Background:

The standard dose of imatinib for the treatment of chronic-phase chronic myeloid leukemia (CML) is 400 mg·d−1. A predose plasma imatinib concentration of >1 mg·L−1is associated with improved clinical response. This study aimed to assess the plasma imatinib and norimatinib concentrations attained in patients with chronic myeloid leukemia administered standard doses of imatinib adjusted for dose, age, sex, body weight, and response.

Methods:

We evaluated data from a cohort of patients treated between 2008 and 2014 with respect to dose, age, sex, body weight, and response.

Results:

The study comprised 438 samples from 93 patients (54 male, 39 female). The median imatinib dose was 400 mg·d−1in men and in women. The plasma imatinib concentration ranged 0.1–5.0 mg·L−1and was below 1 mg·L−1in 20% and 16% of samples from men and women, respectively. The mean dose normalized plasma imatinib and norimatinib concentrations were significantly higher in women in comparison with men. This was partially related to body weight. Mixed effects ordinal logistic regression showed no evidence of an association between sex and plasma imatinib (P= 0.13). However, there was evidence of an association between sex and plasma norimatinib, with higher norimatinib concentrations more likely in women than in men (P= 0.02).

Conclusions:

Imatinib therapeutic drug monitoring only provides information on dosage adequacy and on short-term adherence; longer-term adherence cannot be assessed. However, this analysis revealed that approximately 1 in 5 samples had a plasma imatinib concentration <1 mg·L−1, which was suggestive of inadequate dosage and/or poor adherence and posed a risk of treatment failure. Higher imatinib exposure in women may be a factor in the increased rate of long-term, stable, deep molecular response (undetectable breakpoint cluster-Abelson (BCR-ABL) transcript levels with a PCR sensitivity of 4.5 log, MR4.5) reported in women.
Factors associated with reasons incontinent midlife women report for not seeking urinary incontinence treatment over 9 years across the menopausal transition
Authors: Waetjen L. Elaine , Xing Guibo , Johnson Wesley O. , Melnikow Joy , Gold Ellen B.
Published: August 2017

Objective:

We explored factors associated with reasons that women with urinary incontinence (UI) reported for not seeking treatment for their UI from a healthcare professional and whether reasons differed by race/ethnicity, socioeconomic status, or education.

Methods:

We analyzed questionnaire data collected from 1995 to 2005 in the Study of Women's Health Across the Nation. In visits 7 to 9, we elicited reasons that women with UI reported for not seeking treatment and condensed them into: UI not bad enough, beliefs about UI causes (UI is a normal consequence of aging or childbirth), and motivational barriers (such as feeling too embarrassed). We used Generalized Estimating Equations and ordinal logistic regression to evaluate factors associated with these reported reasons and number of reasons.

Results:

Of the 1,339 women reporting UI, 814 (61.0%) reported they did not seek treatment for UI. The most frequently reported reasons were as follows: “UI not bad enough” (73%), “UI is a normal part of aging” (53%), and “healthcare provider never asked” (55%). Women reporting daily UI had higher odds of reporting beliefs about UI causes (adjusted odds ratio UI 3.16, 95% CI 1.64-6.11) or motivational barriers (adjusted odds ratio UI 2.36, 95% CI 1.21-4.63) compared with women reporting less than monthly UI. We found no interactions by race/ethnicity, socioeconomic status, or education and UI characteristics in reasons that women reported for not seeking UI treatment.

Conclusions:

Over half of women who did not seek treatment for their UI reported reasons that could be addressed by public health and clinical efforts to make UI a discussion point during midlife well-women visits.
A Prospective Randomized Study of Endoscopic versus Conventional Harvesting of the Radial Artery
Authors: Kiaii Bob B. , Swinamer Stuart A. , Fox Stephanie A. , Stitt Larry , Quantz Mackenzie A. , Novick Richard J.
Published: August 2017

Objective

The aims of the study were to determine whether endoscopic harvesting of the radial artery (RA) reduces morbidity due to pain, infection, and disability with improvement in satisfaction and cosmesis compared to the conventional technique and (2) to compare the 6-month angiographic patency of the RA harvested conventionally and endoscopically.

Methods

In a prospective randomized study, 119 patients undergoing coronary artery bypass grafting using the RA were randomized to have RA harvested either conventionally (n = 59) or endoscopically (n = 60).

Results

Radial artery harvest time (open wound time) was significantly reduced in the endoscopic group (36.5 ± 9.4 vs 57.7 ± 9.4 minutes, P < 0.001). Only one patient developed wound infection (1.6%) in the endoscopic group compared with six patients (10.2%), P = 0.061, in the conventional group. Although this was not statistically significant, clinically this was relevant in terms of reduction in postoperative morbidity. Postoperative pain in the arm incision was significantly lower in the endoscopic group at postoperative day 2 ( P < 0.001) and at discharge ( P < 0.001) and similar to the conventional open group at 6 weeks’ follow-up ( P = 0.103). Overall patient satisfaction and cosmesis were significantly better in the endoscopic group at postoperative day 2 ( P < 0.001), at discharge ( P < 0.001), and at 6 weeks’ follow-up ( P < 0.001). There was no difference in the arm disability postoperatively ( P = 0.505) between the two groups. Six-month angiographic assessment of 23 patients (12 endoscopic and 11 open) revealed no difference in the patency rate (10/12 in endoscopic and 9/11 in open group).

Conclusions

Endoscopic RA harvesting reduced the incidence of postoperative wound infection and wound pain and improved patient satisfaction and cosmesis compared with conventional harvesting technique. There was no difference in the 6-month angiographic patency of the RA harvested conventionally and endoscopically.
Microlobectomy: A Novel Form of Endoscopic Lobectomy
Authors: Dunning Joel , Elsaegh Mohamed , Nardini Marco , Gillaspie Erin A. , Horsleben Petersen Rene , Jessen Hansen Henrik , Helsel Bryan , Naase Hatam , Kornaszewska Malgorzata , Will Malcolm B. , Walker William S. , Wigle Dennis , Haley Blackmon Shanda
Published: August 2017

Objective

Microlobectomy is a novel form of videoscopic-assisted thoracic surgery lobectomy. Strict inclusion criteria consist of the following: no intercostal incisions greater than 5 mm, 12 mm subxiphoid port, subxiphoid removal of the specimen, total endoscopic technique with CO2 insufflation, vision through a 5-mm camera, stapling via the subxiphoid port, or with 5-mm stapling devices.

Methods

The combined early experiences of six hospitals from three countries were combined from September 2014 to May 2016. During that time, the study represents a consecutive cohort study of this technique.

Results

Seventy-two patients underwent microlobectomy. The median (range) age was 66 (27–82). Half of the patients were female. There were 48 right-sided resections and 24 on the left. There were four segmental resections and there was one right pneumonectomy. Four operations were performed robotically (with 8-mm intercostal incisions). The median (range) operative time was 180 (94–285) minutes and the blood loss was 118 (5–800) mL. There were three conversions to thoracotomy and two conversions to videoscopic-assisted thoracic surgery by means of an intercostal utility incision to complete the operation. The median (range)length of stay was 3(1–44) days and 30 patients (42%) when home by day 2 and 16 patients (22%) were discharged on day 1. There were no deaths. Five patients (7%) had a prolonged airleak. There were no wound infections and there was one incisional hernia.

Conclusions

We believe that microlobectomy is an interesting novel form of videoscopic-assisted thoracic surgery lobectomy and has several theoretical advantages. We have presented our early results and hope that this will stimulate others to investigate this type of videoscopic-assisted thoracic surgery lobectomy further.
Effect of Antiretroviral Therapy on Growth Parameters of Children With HIV Infection
Authors: Seth Anju , Malhotra Rajeev Kumar , Gupta Rohini , Chandra Jagdish , Kumar Praveen , Singh Sarita , Sharma Garima
Published: August 2017

Background:

Children living with HIV (CLHIV) commonly experience growth failure. We report growth parameters in CLHIV at baseline and during 3 years of antiretroviral therapy (ART).

Methods:

Records of CLHIV who had completed at least 3 years on ART were reviewed after excluding subjects who died, were lost to follow-up or developed treatment failure to assess impact of sustained administration of ART. Height-for-age (HFA) and body mass index for age (BFA) Z scores were calculated, and proportion of CLHIV with wasting and stunting estimated at baseline, 6, 12, 24 and 36 months after starting ART using the linear mixed model. Factors influencing significant changes in growth parameters were assessed.

Results:

HFA Z score improved steadily from −3.12 at baseline to −2.33 at 36 months of ART. The prevalence of stunting declined from 77.7% to 59.2% during this period. BFA Z scores improved from −1.2 at baseline to −0.4 at12 months on ART but declined to −1.0 at 36 months. The proportion of subjects with wasting was 29.3%, 9.7% and 16.7% at baseline, 12 and 36 months, respectively. Baseline clinical stage (1 + 2), absence of wasting and lower HFA Z score had significant positive influence on changes in HFA Z score, while younger age at ART initiation and a low baseline BFA Z score had a positive influence on catch-up in body mass index. Including data of children who died or developed treatment failure did not impact upon the results.

Conclusion:

Majority of CLHIV are stunted at the start of ART. ART was only partially effective in countering malnutrition and growth failure in CLHIV.
Age-dependent plasticity in endocannabinoid modulation of pain processing through postnatal development
Authors: Kwok Charlie H-T. , Devonshire Ian M. , Imraish Amer , Greenspon Charles M. , Lockwood Stevie , Fielden Catherine , Cooper Andrew , Woodhams Stephen , Sarmad Sarir , Ortori Catherine A. , Barrett David A. , Kendall David , Bennett Andrew J. , Chapman Victoria , Hathway Gareth J.
Published: August 2017

Significant age- and experience-dependent remodelling of spinal and supraspinal neural networks occur, resulting in altered pain responses in early life. In adults, endogenous opioid peptide and endocannabinoid (ECs) pain control systems exist which modify pain responses, but the role they play in acute responses to pain and postnatal neurodevelopment is unknown. Here, we have studied the changing role of the ECs in the brainstem nuclei essential for the control of nociception from birth to adulthood in both rats and humans. Using in vivo electrophysiology, we show that substantial functional changes occur in the effect of microinjection of ECs receptor agonists and antagonists in the periaqueductal grey (PAG) and rostroventral medulla (RVM), both of which play central roles in the supraspinal control of pain and the maintenance of chronic pain states in adulthood. We show that in immature PAG and RVM, the orphan receptor, GPR55, is able to mediate profound analgesia which is absent in adults. We show that tissue levels of endocannabinoid neurotransmitters, anandamide and 2-arachidonoylglycerol, within the PAG and RVM are developmentally regulated (using mass spectrometry). The expression patterns and levels of ECs enzymes and receptors were assessed using quantitative PCR and immunohistochemistry. In human brainstem, we show age-related alterations in the expression of key enzymes and receptors involved in ECs function using PCR and in situ hybridisation. These data reveal that significant changes on ECs that to this point have been unknown and which shed new light into the complex neurochemical changes that permit normal, mature responses to pain.
Bleeding out the quality-adjusted life years: evaluating the burden of primary dysmenorrhea using time trade-off and willingness-to-pay methods
Authors: Rencz Fanni , Péntek Márta , Stalmeier Peep F.M. , Brodszky Valentin , Ruzsa Gábor , Gradvohl Edina , Baji Petra , Gulácsi László
Published: August 2017

Primary dysmenorrhea (PD), or painful menstruation in the absence of identified uterine pathology, affects 5 to 9 in every 10 reproductive-aged women. Despite its high prevalence, just a few studies with very small patient numbers have focused on health-related quality of life impairment in PD. We aimed to assess health-related quality of life values for a severe and a mild hypothetical PD health state using 10-year time trade-off and willingness-to-pay methods. In 2015, a nationwide convenience sample of women, aged between 18 and 40 years, was recruited using an Internet-based cross-sectional survey in Hungary. Respondents with a known history of secondary dysmenorrhea were excluded. Data on 1836 and 160 women, with and without a history of PD, respectively, were analysed. Mean utility values for the severe and mild health states were 0.85 (median 0.95) and 0.94 (median 1), respectively. Participants were willing to pay a mean of €1127 (median €161) and €142 (median €16) for a complete cure from the severe and mild PD health states. Compared with the non-PD group, women with PD valued both health states worse according to willingness to pay (P< 0.05) but similar in the time trade-off. It seems that PD substantially contributes to the quality-adjusted life year loss in this age group, which is comparable with losses from chronic diseases such as type 1 diabetes, asthma, atopic eczema, or chronic migraine. Our findings provide a useful input to cost-effectiveness and cost-benefit analyses of PD treatments.
Long-term outcomes of transjugular intrahepatic portosystemic shunt in Indian patients with Budd–Chiari syndrome
Authors: Shalimar  , Gamanagatti Shivanand R. , Patel Arpan H. , Kedia Saurabh , Nayak Baibaswata , Gunjan Deepak , Ranjan Gyan , Paul Shashi B. , Acharya Subrat K.
Published: August 2017

Background/aim

Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in Budd–Chiari syndrome (BCS) based on current data. Our objective was to evaluate outcomes and assess prognostic factors in BCS patients undergoing TIPS.

Patients and methods

In this retrospective analysis of a propectively maintained database, all consecutive BCS patients undergoing TIPS from September 2010 to February 2017 were included. Complete response after TIPS was defined as resolution of symptoms (ascites/pedal edema) with no requirement of diuretics at the end of 4 weeks. The Cox proportional hazard regression model was used to assess predictors of outcome and complications.

Results

Eighty patients with BCS who underwent TIPS were included; 40 (50%) were male. The mean age at onset of symptoms was 24.2±8.7 years. The median (range) follow-up was 660 (2–2400) days. The 1-, 3-, and 5-year rates for TIPS stent patency were 89, 81, and 81%, respectively. Cumulative encephalopathy-free rates were 91, 86, and 86%, respectively, and survival rates were 93, 89, and 84%, respectively. Eight (10.0%) patients died during follow-up, five within the first year (three of these five had incomplete response). On univariate analysis, serum bilirubin, response to intervention, serum creatinine, Child class, model for end-stage liver disease, and All India Institute of Medical Sciences-hepatic venous outflow tract obstruction score were significantly different between survivors and nonsurvivors. On multivariate analysis, response to therapy after TIPS (hazard ratio: 8.37; 95% confidence interval: 1.60–43.82) was independently associated with mortality. The 1-year survival was 97% in patients with complete response, compared with 59% in those with incomplete response (P<0.004).

Conclusion

Incomplete symptom response after TIPS is associated with poor outcome and can be used for selection of patients for liver transplantation.
The Veterans Affairs Cardiac Risk Score
Authors: Sussman Jeremy B. , Wiitala Wyndy L. , Zawistowski Matthew , Hofer Timothy P. , Bentley Douglas , Hayward Rodney A.
Published: August 2017

Background:

Accurately estimating cardiovascular risk is fundamental to good decision-making in cardiovascular disease (CVD) prevention, but risk scores developed in one population often perform poorly in dissimilar populations. We sought to examine whether a large integrated health system can use their electronic health data to better predict individual patients’ risk of developing CVD.

Methods:

We created a cohort using all patients ages 45–80 who used Department of Veterans Affairs (VA) ambulatory care services in 2006 with no history of CVD, heart failure, or loop diuretics. Our outcome variable was new-onset CVD in 2007–2011. We then developed a series of recalibrated scores, including a fully refit “VA Risk Score—CVD (VARS-CVD).” We tested the different scores using standard measures of prediction quality.

Results:

For the 1,512,092 patients in the study, the Atherosclerotic cardiovascular disease risk score had similar discrimination as the VARS-CVD (c-statistic of 0.66 in men and 0.73 in women), but the Atherosclerotic cardiovascular disease model had poor calibration, predicting 63% more events than observed. Calibration was excellent in the fully recalibrated VARS-CVD tool, but simpler techniques tested proved less reliable.

Conclusions:

We found that local electronic health record data can be used to estimate CVD better than an established risk score based on research populations. Recalibration improved estimates dramatically, and the type of recalibration was important. Such tools can also easily be integrated into health system’s electronic health record and can be more readily updated.
Depression in Kidney Transplant Recipients
Authors: Srifuengfung Maytinee , Noppakun Kajohnsak , Srisurapanont Manit
Published: August 2017

This study examined the prevalence, risk factors, and disability associated with depression. We conducted a cross-sectional, observational study in 217 consecutive kidney transplant (KT) recipients routinely followed-up at a Kidney Transplantation Clinic in Northern Thailand. Participants were assessed using the Charlson Comorbidity Index (CCI), the nine-item Patient Health Questionnaire (PHQ-9), and the 12-item self-report of World Health Organization Disability Assessment Scale, Version 2.0 (WHODAS). Twenty-eight (12.9%) patients had depression (PHQ-9 score, ≥10). A binary logistic regression analysis found that the CCI score was significantly higher in KT recipients with depression (β = 0.54, p < 0.01). After the adjustment of education and glomerular filter rates, an ordinal logistic regression analysis revealed that the PHQ-9 scores were positively correlated with the WHODAS scores (β = 0.39, p < 0.01). In KT recipients, physical comorbidity is associated with depression, and depression is correlated with functional disability.