bluuebunny/crossref_metadata_2025 huggingface dataset:
Double‐Shelled Phosphorus and Nitrogen Codoped Carbon Nanospheres as Efficient Polysulfide Mediator for High‐Performance Lithium–Sulfur Batteries
Authors: Wang Jin , Yang Hao , Chen Zhen , Zhang Lili , Liu Jilei , Liang Pei , Yang Hui , Shen Xiaodong , Shen Ze Xiang
Published: September 2018

Lithium–sulfur batteries are regarded as very promising energy storage devices due to their high energy density, low cost, and environmental friendliness; however, their insulating properties and the instability of sulfur‐based electrodes impede the practical applications of Li–S batteries. Here, a versatile strategy to synthesize double‐shelled nitrogen and phosphorus codoped carbon spheres (NPDSCS) as an efficient sulfur host for Li–S batteries is reported. With strong trapping, good affinity, high adsorption for polysulfides, and the bifunctional catalyzing for sulfur redox processes, the developed NPDSCS cathodes with a high S loading of 72.4% exhibit large specific discharge capacity of 1326 mAh g−1 at 0.1C, high Coulombic efficiency, good rate capability, and excellent cycling performance with a reversible capacity of 814 mAh g−1 at 1C after 500 cycles.
Plasma Amyloid as Prescreener for the Earliest Alzheimer Pathological Changes
Authors: Verberk Inge M. W. , Slot Rosalinde E. , Verfaillie Sander C. J. , Heijst Hans , Prins Niels D. , van Berckel Bart N. M. , Scheltens Philip , Teunissen Charlotte E. , van der Flier Wiesje M.
Published: September 2018

Objective

We investigated the association of plasma amyloid beta (Abeta)40, Abeta42, and total tau (tTau) with the presence of Alzheimer pathological changes in cognitively normal individuals with subjective cognitive decline (SCD).

Methods

We included 248 subjects with SCD (61 ± 9 years, 42% female, Mini‐Mental State Examination = 28 ± 2) from the SCIENCe project and Amsterdam Dementia Cohort. Subjects were dichotomized as amyloid abnormal by cerebrospinal fluid (CSF) and positron emission tomography (PET). Baseline plasma Abeta40, Abeta42, and tTau were measured using Simoa technology. Associations between plasma levels and amyloid status were assessed using logistic regression analyses and receiver operating characteristic analyses. Association of plasma levels with risk of clinical progression to mild cognitive impairment (MCI) or dementia was assessed using Cox proportional hazard models.

Results

Fifty‐seven (23%) subjects were CSF‐amyloid abnormal. Plasma Abeta42/Abeta40 ratio and plasma Abeta42 alone, but not tTau, identified abnormal CSF‐amyloid status (plasma ratio: area under the curve [AUC] = 77%, 95% confidence interval [CI] = 69–84%; plasma Abeta42: AUC = 66%, 95% CI: 58–74%). Combining plasma ratio with age and apolipoprotein E resulted in AUC = 83% (95% CI = 77–89%). The Youden cutoff of the plasma ratio gave a sensitivity of 76% and specificity of 75%, and applying this as a prescreener would reduce the number of lumbar punctures by 51%. Using PET as outcome, a comparable reduction in number of PET scans would be achieved when applying the plasma ratio as prescreener. In addition, low plasma ratio was associated with clinical progression to MCI or dementia (hazard ratio = 2.0, 95% CI = 1.4–2.3).

Interpretation

Plasma Abeta42/Abeta40 ratio has potential as a prescreener to identify Alzheimer pathological changes in cognitively normal individuals with SCD. Ann Neurol 2018;84:656–666
Influence of novel X‐ray imaging technology on radiation exposure during chronic total occlusion procedures
Authors: Busse Tilmann , Reifart Joerg , Reifart Nicolaus
Published: September 2018

Objectives

We assessed whether use of the novel X‐ray imaging technology AlluraClarity (Philips Healthcare, Best, The Netherlands) results in a meaningful reduction of radiation exposure for patients during coronary intervention on chronic total occlusions (CTO‐PCI) compared to its predecessor Allura Xper (Philips Healthcare, Best, The Netherlands).

Background

Percutaneous coronary intervention on chronic total occlusion causes 2‐ to 10‐fold higher radiation burden on patients and operators compared to standard PCI. To avoid iatrogenic damage to our patients and personnel, all efficient ways to reduce radiation should be identified and implemented.

Methods

Radiation exposure of 196 consecutive CTO patients treated in the same laboratory by a single experienced operator (total experience: > 2,500 CTOs, annual experience: > 100 CTOs/year) was analyzed. Ninety‐eight CTO‐PCIs (n1) were performed with the Allura Xper system and 98 patients (n2) were treated using AlluraClarity.

Results

The two groups had similar BMI (n1: mean 28.43 kg/m2; n2: mean 28.41 kg/m2), procedure duration (n1: mean 75.9 min; n2: mean 70.7 min), and J‐CTO scores (n1: mean 2.99; n2: mean 2.82). The success rates did not differ (n1: 86/98 successful). n2: 87/98 successful). The radiation doses, however, revealed significant differences in kerma area product (KAP; absolute reduction of 34%; n1: mean 61.5 Gycm2; n2: mean 40.8 Gycm2; P < 0.002) and cumulative air kerma (AK; absolute reduction of 30%; n1: mean 966.8 mGy; n2: mean 675.9 mGy; P < 0.002).

Conclusion

Use of the novel X‐ray imaging technology resulted in a meaningful and significant reduction in patient radiation exposure during complex coronary interventions (CTO‐PCI) compared to use of its predecessor. Similar success rates support the operator's subjective impression of similar, and in some cases superior, image quality.
Fenestrated ASD device “angioplasty”: How to adjust a “pop‐off” mechanism when needed
Authors: Tufaro Vincenzo , Butera Gianfranco
Published: September 2018

We report on three cases of atrial septal defect (ASD) closure where a handmade fenestration had to be modified after device implantation. Two patients suffered from left ventricular diastolic dysfunction and one had severe pulmonary arterial hypertension. Amplatzer ASD occluder fenestration was created in all patients. Devices were implanted using an “over‐the‐wire” implantation technique. Due to a sub‐optimal hemodynamic result, fenestration was upsized by using a new technique.
Emergency trans‐catheter coronary intervention for left main compression secondary to pulmonary hypertension in a 4‐year‐old child
Authors: Butera Gianfranco , Mansour Nizar Ben , De Marco Federico
Published: September 2018

Here, we report on the case of a 4‐year‐old child with large atrial septal defect (ASD) and severe pulmonary hypertension presenting an ischemic cardiomyopathy secondary to left main (LM) compression by a dilated pulmonary artery trunk. Despite of surgical treatment consisting in ASD closure and coronary artery bypass grafting, the patient was not weanable from ECMO. Control coronarography showed a near‐occlusion of the left mammary bypass. A rescue percutaneous LM angioplasty with drug‐eluting stent implantation was performed.
Valve‐in‐valve‐in‐valve: Balloon expandable transcatheter heart valve in failing self‐expandable transcatheter heart valve in deteriorated surgical bioprosthesis
Authors: Schaefer Andreas , Deuschl Florian , Conradi Lenard , Schäfer Ulrich
Published: September 2018

Valve‐in‐valve (ViV) procedures for failing bioprostheses carry a certain risk for device malfunction. We herein report a case of a failing Evolut R in a deteriorated Mitroflow, treated with a Sapien 3.

An 81 year old female patient received surgical aortic valve replacement and was treated by ViV due to deterioration. Three years later, echocardiography revealed a pressure gradient of peak/mean 105/63 mmHg. Subsequently, a second ViV procedure with initial intentional rupture of the bioprosthetic stent was performed. Immediate stent recoil of the Evolut R prompted implantation of a Sapien 3. In 30‐day follow‐up, mean pressure gradient of 30 mmHg and nearly complete symptom relief was documented.

Fracture of a surgical bioprosthetic stent is feasible in a ViV configuration. Supra‐annular placement of a balloon‐expandable THV as ViV‐in‐valve is feasible with suboptimal hemodynamic results in this case. Risk of re‐do surgery should be weighted against anticipated hemodynamic and clinical results.
Contrast volume to estimated glomerular filtration rate ratio for prediction of contrast‐induced acute kidney injury after cardiac catheterization in adults with congenital heart disease
Authors: Gellis Laura , Gauvreau Kimberlee , Ferguson Michael , Bergersen Lisa , Shafer Keri , Porras Diego
Published: September 2018

Background

Adults with congenital heart disease (ACHD) are vulnerable to contrast‐induced acute kidney injury (CI‐AKI) after cardiac catheterization. The aim of this study was to identify risk factors for clinically significant CI‐AKI and evaluate the predictive value of contrast volume to estimated glomerular filtration rate ratio (V/eGFR) for the risk of CI‐AKI following catheterization in the ACHD population.

Methods

ACHD patients who underwent catheterization at Boston Children's hospital between 1/2011 and 1/2017 were retrospectively analyzed. CI‐AKI was defined as an increase in serum creatinine ≥0.3 mg/dL within 48 hr or ≥1.5 times baseline within 7 days of procedure. Controls without CI‐AKI were matched for calendar year of catheterization with cases using a 3:1 ratio.

Results

Of 453 catheterizations meeting inclusion criteria, 27 catheterizations (5.9%) were complicated by CI‐AKI, with dialysis being used to manage renal dysfunction in five of these events. Older age, male gender, admission prior to catheterization, and V/eGFR ratio were found to be related to risk of CI‐AKI. Patients with a V/eGFR ≥ 2.6 had a significantly higher risk of CI‐AKI (OR = 6.4; 95% CI = 2.0–20.4; P = 0.002). Survival at 3 years post‐catheterization, was significantly shorter for CI‐AKI cases compared to controls (49% versus 97%; P < 0.001) even in those with return to baseline renal function prior to discharge (60% versus 97%, P < 0.001).

Conclusion

In ACHD patients undergoing cardiac catheterization, a higher V/eGFR ratio is a strong predictor of clinically significant CI‐AKI. Development of CI‐AKI is a poor prognostic indicator and is associated with decreased survival in this population.
Premounted stents for branch pulmonary artery stenosis in children: A short term solution
Authors: Ooi Yinn Khurn , Kim Sung In H. , Gillespie Scott E. , Kim Dennis W. , Vincent Robert N. , Petit Christopher J.
Published: September 2018

Objective

Define outcomes of premounted stent implantation (PMS) for branch pulmonary artery stenosis (BPAS).

Background

PMS for BPAS in children raises concern of long term viability, with limited maximal expansion.

Methods

We reviewed our cardiac database over an 11‐year period ending in 2013. Primary endpoint was need for surgical stent intervention (SSI). Other endpoints included acute results and repeat interventions (RI).

Results

82 PMS were implanted in 60 children for BPAS. Median weight was 6.3 (25th‐75th 4.6–9.8) kg. Median stent diameter was 6 (range 4–9) mm. Acutely, vessel diameter improved from 2.0 (25th‐75th 1.6–3.4) to 5.0 (25th‐75th 4.2–5.9) mm (p < 0.001), pressure gradient decreased from 41 (25th‐75th 29–50) to 11 (25th‐75th 7–18) mmHg (n = 47, p < 0.001), RV:Ao pressure ratio decreased from 100% (25th‐75th 85–110%) to 59% (25th‐75th 49–74%) (n = 40, p < 0.001). Freedom from SSI was 81% at 1 year and 35% at 5 years. Freedom from RI was 50% at 1 year and 14% at 5 years. 86% of PMS underwent SSI during a concomitant planned cardiac surgery. 45% patients had stent redilation, improving stent diameter from 4.6 (25th‐75th 4.1–5.4) to 5.7 (25th‐75th 4.9–7) mm (p < 0.001). 1 stent (3%) was able to be fractured longitudinally.

Conclusions

PMS is an effective short term solution for BPAS in children. PMS is associated with expected early need for transcatheter reintervention to accommodate for growth, but also has high rates of SSI.
Coronary intervention and arteria lusoria—Not simple as it may seem
Authors: Rafiq Arsalan , Chutani Surendra , Krim Nassim R.
Published: September 2018

We reviewed the letter from Dr. Walter W. Woody and would like to thank him for showing his interest in our article and providing his opinion and point of view. However, we respectfully disagree with few points that have been raised. Switching to a femoral approach was considered to be a safer alternative for percutaneous intervention due to the presence of arteria lusoria. Risks and possible complications would include increased contrast use, increased radiation exposure, aortic dissection and even cerebral stroke, all of which have been reported extensively in literature. One single procedural methodology cannot be applied to a particular clinical scenario, whether simple or challenging. We have multiple different catheters and multiple different interventional approaches at our disposal to help and guide us through a case, in the best interest of the patient.
Transfemoral aortic valve implantation following lithoplasty of iliac artery in a patient with poor vascular access
Authors: Gorla Riccardo , Cannone Gaspare Sergio , Bedogni Francesco , De Marco Federico
Published: September 2018

Transfemoral approach is considered the preferred route to perform transcatheter aortic valve implantation (TAVI) by most operators due to the low invasiveness and good outcome, as compared to non‐transfemoral approach. However, transfemoral access is not always feasible particularly in patients with small and calcific vessels. Recently, catheter‐based lithoplasty has emerged as a new technique based on the use of circumferential pulse pressure waves to disrupt calcific plaques. This technology may help to expand eligibility for transfemoral TAVI to patients with calcific ileo‐femoral vessels and at high risk for non‐transfemoral approach. We present the case of an 87‐year‐old woman with poor vascular access who successfully underwent transfemoral TAVI following lithoplasty of iliac artery.
Use of Amplatzer vascular plugs and Amplatzer duct occluder II additional sizes for occlusion of patent ductus arteriosus: A multi‐institutional study
Authors: VanLoozen Dennis , Sandoval Juan Pablo , Delaney Jeffrey W. , Pedra Carlos , Calamita Paulo , Dalvi Bharat , Kenny Damien , Cleary Aoife , Amin Zahid
Published: September 2018

Background

Variable patent ductus arteriosus (PDA) morphology and the need to close PDAs in small size patients has led physicians to use Amplatzer Vascular Plugs (AVP) and recently available Amplatzer Duct Occluder II ‐ Additional Sizes (ADO II AS). The purpose of this study was to analyze the safety, efficacy, and complication rates of the ADO II AS and AVPs, specifically AVP II.

Methods

All patients undergoing PDA closure with an AVP or ADO II AS from 2011 to 2016 were included. Clinical, echocardiographic, and angiographic data were collected and reviewed.

Results

Four hundred and sixty‐nine patients were included. Median age was 27 months (0.75–852) and the median weight was 11.4 kg (1–92). There were 51 patients ≤5 kg. Type A PDA was most common in 48% (n = 225), followed by type E (27.5%, n = 129), type D (13%, n = 61), type C (10.2%, n = 48), and type B (1.3%, n = 6). Devices included AVP II (n = 421), ADO II AS (n = 30), and AVP IV (n = 18), left pulmonary artery stenosis occurred in 4.3% (n = 20). One patient required surgery for severe stenosis; the remaining cases were mild and required no intervention. Device embolization occurred in 3 patients (10%) with the ADO II AS. Successful device closure was achieved in 98.9% of cases.

Conclusions

The AVP II was highly effective for closing PDAs in smaller babies with varying morphologies and is safe when used in small sized patients with relatively low risk of complications. More studies are warranted to clarify the risks of ADO II AS.
MAGnesium‐based bioresorbable scaffold and vasomotor function in patients with acute ST segment elevation myocardial infarction: The MAGSTEMI trial: Rationale and design
Authors: Brugaletta Salvatore , Cequier Angel , Alfonso Fernando , Iñiguez Andrés , Romaní Sebastian , Serra Antonio , Salinas Pablo , Goicolea Javier , Bordes Pascual , del Blanco Bruno García , Hernández‐Antolín Rosana , Pernigotti Alberto , Gómez‐Lara Josep , Sabaté Manel
Published: September 2018

Aim

Use of a Bioresorbable Scaffolds (BRS) either in clinical practice or in the setting of an acute myocardial infarction (MI) is controversial. Despite an overall high rate of thrombosis, vascular healing response following BRS implantation tend to superiority as compared to metallic drug‐eluting stent in ST‐segment elevation myocardial infarction (STEMI) patients.

We sought to compare the in‐stent/scaffold vasomotion between metallic BRS and sirolimus eluting stent (SES) at 12‐month angiographic follow‐up in the setting of patients with STEMI treated by primary PCI.

Study design

This is an investigator‐driven, prospective, multicenter, randomized, single blind, two‐arm, controlled trial (ClinicalTrials.gov number: NCT03234348). This trial will randomize ~148 patients 1:1 to SES or BRS. Primary end‐point is the in‐stent/scaffold change in mean lumen diameter after nitroglycerin administration at 12‐month angiographic follow‐up. Besides, patient‐oriented combined endpoint of all‐cause death, any MI, and any revascularization, together with scaffold/stent thrombosis rate and device‐oriented endpoint of cardiac death, target vessel (TV)‐MI and TVR at 1 year will be also evaluated. Clinical follow‐up will be scheduled yearly up to 5 years.

Conclusion

This trial will shed light on the vascular vasomotion following BRS implantation in the complex scenario of STEMI.
Feasibility and clinical outcome of rotational atherectomy in patients presenting with an acute coronary syndrome
Authors: Allali Abdelhakim , Abdelghani Mohammad , Mankerious Nader , Abdel‐Wahab Mohamed , Richardt Gert , Toelg Ralph
Published: September 2018

Objectives

We aimed to investigate the feasibility, safety, and outcome of rotational atherectomy (RA) in the setting of acute coronary syndrome (ACS).

Background

Limited data are available on the use of RA in patients presenting with ACS.

Methods

This analysis is from an observational registry, which enrolled all consecutive patients undergoing RA in a tertiary center. Between 2002 and 2015, 433 patients with stable coronary artery disease (SCAD) were treated with RA. Within the same period, 108 patients with ACS (8 STEMI and 100 NSTE‐ACS) were treated with RA. Procedural success was similar between the ACS and the SCAD groups (96.6% vs. 96.4%, P = 0.90), and no significant difference was observed in procedural complications (slow‐flow: 0.8% vs. 2.8%, P = 0.32; coronary dissection: 6.8% vs. 7.2%, P = 1.00; coronary perforation: 0.8% vs. 1.7%, P = 0.69). In‐hospital MACE rates were comparable (3.7% vs. 3.2%, P = 0.77). The risk of MACE within 24 months was higher in ACS patients (39.9% vs. 22.4%, log‐rank P = 0.002; HR: 1.39; 95% CI: 1.12–1.73; P = 0.003). Multivariable Cox regression analysis identified left ventricular ejection fraction (HR 0.97; 95% CI: 0.85–0.99; P = 0.001), treatment with a BMS (HR 2.22, 95% CI: 1.15–4.25, P = 0.02) or early generation drug eluting stent (HR 1.99; 95% CI 1.09–3.64; P = 0.03), as well as ACS presentation (HR 1.53; 95% CI: 1.02–2.29; P = 0.04) as predictors of MACE at two years.

Conclusions

RA is technically feasible and safe in high risk patients presenting with ACS. However, successful application of RA did not mitigate the higher rate of long term cardiovascular events.
Radioprotective strategies for interventional echocardiographers during structural heart interventions
Authors: Corrigan Frank E. , Hall Michael J. , Iturbe Jose Miguel , Condado Jose F. , Kamioka Norihiko , Howell Sharon , Thourani Vinod H. , Clements Stephen D. , Babaliaros Vasilis C. , Lerakis Stamatios
Published: September 2018

Objective

We investigated radioprotective strategies for the interventional echocardiographer (IE) during structural heart interventions in comparison with the interventional cardiologist (IC).

Background

Structural heart interventions are expanding in complexity with increased reliance on IE. Recent reports have demonstrated concerning exposure and higher radiation to the IE.

Methods

We monitored 32 structural interventions — 19 transcatheter aortic valve replacements (TAVR), 6 transcatheter mitral valve repairs, 5 paravalvular leak closures, and 2 atrial septal defect closures. Seventeen utilized transesophageal echocardiography (TEE) while 15 used transthoracic echocardiography (TTE). Members of the IC and IE teams wore multiple dosimeters on different sites of the body to measure radiation dose to the total body, lens of the eye, and hand. During each case, IE utilized dedicated radiation shielding.

Results

Mean doses were higher for the primary IC than the primary IE: IC#1–99, 222, 378; IE#1–48, 52, 416 (body, lens, and hand doses in μSv). IE radioprotective strategies were able to reduce body and lens doses compared to IC during both TTE and TEE‐guided procedures. Hand equivalent dose remained higher for the IE driven by exposure during TEE‐guided procedures (IC#1 294 vs. IE#1 676 μSv). In a subgroup using radioprotective drapes during TTE‐guided TAVR, IC dose was reduced without effect on the IE.

Conclusions

Radiation exposure during structural heart interventions is concerning. With dedicated shielding, IE received lower doses to the body and lens than IC. Further optimization of structural suite design and shielding is needed.
One‐stop shop: Simultaneous direct mitral annuloplasty and percutaneous mitral edge‐to‐edge repair in a patient with severe mitral regurgitation
Authors: Braun Daniel , Näbauer Michael , Massberg Steffen , Hausleiter Jörg
Published: September 2018

Percutaneous edge‐to‐edge repair of severe mitral regurgitation has been established as an alternative treatment option for patients at high risk for cardiac surgery. More recently, the introduction of the Cardioband system enabled percutaneous direct annuloplasty. Here, we present a case of simultaneous percutaneous direct annuloplasty with edge‐to‐edge repair. Moreover, annuloplasty did facilitate clip implantation bei approximating the anterior and posterior mitral leaflet. In conclusion, the combination of direct annuloplasty with edge‐to‐edge repair is feasible in a single procedure.
Novel approach to coronary artery perforation repair
Authors: Ingrassia Joseph , Youn Young Jin , Lee Juyong , Azrin Michael , Khalid Salman
Published: September 2018

Coronary artery perforation (CAP) during percutaneous coronary intervention is a rare but serious complication. Treatment options of CAP include prolonged balloon inflation, covered stent, and coil embolization. Although most cases of CAP can be treated with prolonged balloon inflation, some cases, especially Ellis grade III CAP require covered stents or coiling. Covered stents may require a large bore guide catheter and have a high rate of restenosis, which can be a limiting factor in patients with severe peripheral arterial disease. Coil embolization is generally used in distal CAP because coiling in the proximal vessels results in a large territory of infarction. We present a case of an Ellis grade III CAP during rotational atherectomy successfully treated with a novel coiling technique whereby the thrombogenic coil extends through the perforation outside of the vessel, and the intraarterial portion of the coil is excluded from the lumen by drug‐eluting stent placement over the proximal portion of the coil.
Study of biodegradable occluder of atrial septal defect in a porcine model
Authors: Li Bo‐Ning , Xie Yu‐Mei , Xie Zhao‐Feng , Chen Xian‐Miao , Zhang Gui , Zhang De‐Yuan , Liu Xiang‐Dong , Zhang Zhi‐Wei
Published: September 2018

Objective

To evaluate the safety and feasibility of a modified poly(l‐lactic acid) (PLLA) atrial septal defect (ASD) occluder.

Methods

Forty‐five piglets were divided into two groups: an experimental group (n = 27) and a control group (n = 18). The experimental group underwent percutaneous implantation of a modified PLLA ASD device while the control group underwent percutaneous implantation of a widely used metal ASD device. X‐ray imaging, transthoracic echocardiography (TTE), electrocardiogram (ECG), histopathology and electron microscopic examination were performed at 7 days, 1, 3, 6, and 12 months after implantation.

Results

Twenty‐seven experimental piglets and 18 control piglets were all successfully implanted with modified biodegradable and metal ASD devices, respectively. While both devices exhibited very good occluding effects, the modified PLLA ASD devices were completely endothelialized at 3 months after implantation, and the endothelialization appeared to be more complete compared to the control group. Degradation of the PLLA devices was noted at 12 months follow‐up with no loss of integrity at the atrial septum.

Conclusion

This animal model with implanting of the occluders was effective and not associated with complications. The modified PLLA ASD devices are more controllable and practical than our previous devices. The implanted devices demonstrated good endothelialization and degradability in short and moderate term follow‐up. Long‐term studies are now underway to further evaluate the biodegradability of this novel device.
Caffeine content of pre‐workout supplements commonly used by Australian consumers
Authors: Desbrow Ben , Hall Susan , O'Connor Helen , Slater Gary , Barnes Katelyn , Grant Gary
Published: September 2018

The stimulant properties of caffeine are often promoted in pre‐workout supplements (PWS) to assist with training, reduce the perception of fatigue, and for some brands, assist body fat loss. While manufacturers of PWS often indicate the inclusion of significant amounts of caffeine, no independent verification of the caffeine content of these products exists. The aim of this investigation was to independently assess the caffeine content of popular PWS in Australia and compare these values to nutrition information panel data. Fifteen PWS were tested for their caffeine content (both within and between batches of the same product). The caffeine content of selected PWS ranged from 91 to 387 mg·serve−1. Only 6 of the 15 PWS nutrition information panels included details on caffeine content. The percent of caffeine present ranged from 59% to 176% of packaging claims. All but one PWS contained a variation of caffeine within and between batches that was considered “practically” significant (ie, ≥40 mg·serve−1 variation). Consumers are likely to be exposed to large and variable caffeine doses if ingesting PWS. Product information panels do little to improve consumer awareness of likely caffeine intakes.
Effects of slightly acidic electrolyzed water on the microbial quality and shelf life extension of beef during refrigeration
Authors: Sheng Xiaowei , Shu Dengqun , Tang Xiajun , Zang Yitian
Published: September 2018

Studies on slightly acidic electrolyzed water (SAEW) for decontamination and shelf life extension of beef are limited. This study aimed to evaluate the effects of SAEW and tea polyphenols (Tpp) on the microbiological, physicochemical, and sensory qualities of fresh beef during storage. The changes in total viable count, thiobarbituric acid content, pH, total volatile basic nitrogen, and sensory scores revealed that the required quality standard of the beef treated with distilled water, Tpp, and SAEW was maintained for up to 6–8, 12–14, and 14–16 days, respectively. These results demonstrated that SAEW could effectively extend the shelf life of beef in comparison with that of other treatments. However, there were no significant differences (p > 0.05) between the untreated and SAEW‐treated group in the content of thiobarbituric acid, suggesting that SAEW does not possess antioxidant activity. Therefore, further studies are required to increase its antioxidant activity. This study suggests that SAEW treatment is an effective and promising method to prolong the shelf life of beef by around 8 days at 4°C.
Physiological strain and decision making affected by different cooling tactics following live‐fire training
Authors: Hemmatjo Rasoul , Zare Sajad , Hajaghazadeh Mohammad , Allahyari Teimour , Kazemi Reza
Published: September 2018

Multiple factors, including different environmental, physical, and psychophysiological agents, influence firefighters’ health and safety in real fire and rescue operations. This experimental study investigated the effect of live‐fire training and cooling strategies on both physiological response and decision making. Twenty‐three healthy male firefighters performed live‐fire tasks in four separate conditions: namely rest or without cooling method (WCM), cool vest (CV), forearm immersion (FI), and cool vest and forearm immersion (CV + FI). Cooling effects of the employed interventions were evaluated based on heart rate (HR), tympanic temperature (TT), and Iowa gambling task (IGT) scores. At the end of the four experimental conditions, HR and TT increased, whereas IGT scores as a measure of decision making decreased relative to baseline. HR (beats per minute) and TT (°C) were significantly lower at the end of the experiment in the CV, FI, and CV + FI compared with the WCM conditions. There was no significant difference in Iowa scores between experimental conditions. These consequences demonstrate that live‐fire tasks are effective in raising the physiological and decision‐making responses following firefighting activities. It is concluded that CV, FI, and CV + FI were more effective than the WCM in attenuating physiological responses and decision making during live‐fire training.
Varieties of being “social”: Cognitive work analysis, symbolic interactionism, and sociotechnical systems
Authors: Kant Vivek
Published: September 2018

Cognitive work analysis (CWA) is a prominent framework for analyzing and modeling cognitive work in sociotechnical systems. It derives from both engineering‐ and psychological‐based approaches for the study of human knowing and acting in technological contexts. Nonetheless, in its current form, the social dimension of CWA is underdeveloped. This study extends CWA as a requirements gathering framework for sociotechnical systems in terms of a broader meaning of “social,” derived from interpretive sociology. Specifically, this is achieved by providing convergence to the approaches of CWA, symbolic interactionism (SI) and sociotechnical systems. To achieve this convergence, CWA is extended in two significant ways. First, deriving from a hermeneutic (interpretive) viewpoint of SI, the ethnographic analysis is conducted. Along with this first extension, the fourth phase of CWA, Social, Organizational and Cooperation Analysis, is also extended using a hermeneutic mesh. These various concepts are demonstrated using an example of research in the work domain of small‐scale (micro and nano) robotics.
Optimization of user experience in interaction design through a Taguchi‐based hybrid approach
Authors: Li Yongfeng , Zhu Liping
Published: September 2018

User experience (UX), which encompasses all aspects of a user’s interaction with an interactive product, has been recognized as central to interaction design. This paper proposes a Taguchi‐based hybrid approach to realize the optimal UX design. In this approach, design analysis is first used to identify design patterns and UX characteristics. According to the results, a Taguchi experiment is conducted and the signal‐to‐noise ratios are computed. Subsequently, the preference weights for the UX characteristics are obtained by using analytical hierarchy process‐based group decision making. A multiperformance characteristic index is then defined based on the gray relational grade (GRG) obtained through gray relational analysis. On the basis of the GRG, the optimal design can be obtained. A mobile health application design was used to demonstrate the proposed approach. The results show that this approach can effectively enhance UX quality and be used as a universal design approach for optimizing UX.
How to foster frontline employee knowledge sharing within service‐oriented enterprises: Empirical evidence from China
Authors: Zhou Fei , Chen Qinlan , Wu Yenchun
Published: September 2018

Based on the context of Chinese workplace, the present research aims to explore the combined effects of proactive personality, supervisor–subordinate guanxi (s–s guanxi), and leaders’ innovation expectations on the knowledge sharing of frontline employees (FLEs). Questionnaire data from a sample of 301 FLEs within service‐oriented enterprises in China were used in this study. The results show that proactive personality and leaders’ innovation expectations are both positively related to employees’ psychological empowerment and knowledge sharing, and s–s
guanxi significantly impacts psychological empowerment, but has a nonsignificant effect on knowledge sharing. This study expands the understanding of FLEs’ knowledge sharing behavior and enriches our understanding of the
guanxi construction process during the interaction between supervisors and subordinates.
The effects of short‐term and long‐term exposure to extreme cold environment on the body’s physiological responses: An experimental study
Authors: Saedpanah Keivan , Aliabadi Mohsen , Motamedzade Majid , Golmohammadi Rostam
Published: September 2018

There is little epidemiological data to make reliable conclusions about the effects of exposure to cold on the body’s physiological responses. The current study aimed to address this lacuna in the available research. The study sample consisted of 50 outdoor mechanic workers as a case group and 15 staff members as a control group used in the outdoor automechanic workshops. Air environmental factors, including dry‐bulb temperature and air velocity, were measured by the portable hot wire thermo anemometer in the workstation of each subject. The body’s physiological responses were also measured during daily activities in accordance with ISO 9886. Using Semmes–Weinstein monofilament, touch sensory tests were conducted for determining hands’ sensorineural functions. The baseline measurements showed the mechanic workers had lower finger sensation levels and finger skin temperatures than the control group (p < 0.05). This may be attributed to long‐term exposure to acute cold air during cold seasons. However, after short‐term exposure to extreme cold environment, the mechanic workers showed lower losses in finger skin temperatures and finger sensation levels than the control group (
p < 0.05). The findings confirmed that prolonged localized cold exposure among mechanic workers can result in localized habituation of vasoconstrictor responses.
Predictive value of breast magnetic resonance imaging in detecting mammographically occult contralateral breast cancer: Can we target women more likely to have contralateral breast cancer?
Authors: Susnik Barbara , Schneider Lisa , Swenson Karen K. , Krueger Janet , Braatz Christina , Lillemoe Tamera , Tsai Michaela , DeFor Todd E. , Knaack Monica , Rueth Natasha
Published: September 2018

Background and Objectives

Preoperative breast magnetic resonance imaging (B‐MRI) staging in newly diagnosed breast cancer increases detection of synchronous contralateral findings, but may result in false‐positive outcomes. This study objective was to identify women more likely of having mammographically occult, MRI detected contralateral breast cancer (CBC).

Methods

We performed a retrospective review of patients who had preoperative B‐MRI prior to surgery from 2010 to 2015 and collected patient imaging and clinicopathologic data. Multivariate logistic regression was used to identify predictors of CBC.

Results

MRI resulted in contralateral findings in 201 of 1894 patients (10.6%). Overall 3.2% (60 of 1894) had synchronous CBC detected on B‐MRI. The majority of CBCs (n = 60) were stage 0 or IA (85.0%), hormone receptor positive (94.9%), human epidermal growth factor receptor 2 (HER2/neu) negative (89.7%), and low/intermediate pathological grade (87.2%). Women more likely to have CBC were older (P < .001), had lobular index cancer (P = .03), and estrogen receptor (ER)+ (P = .027) or progesterone receptor (PR)+ (P = .002) tumors. On multivariate analysis (receiver operating characteristic curve area = 0.75), PR + status (P = .022), and older age (P = .004) were predictive of CBC.

Conclusions

Preoperative MRI is most effective in detecting early stage, hormone receptor‐positive CBC in older women.
Neutrophil to lymphocyte ratio is an independent predictor of outcome for patients undergoing definitive resection for stage IV melanoma
Authors: Kanatsios Stefanos , Melanoma Project Melbourne , Li Wai Suen Connie S. N. , Cebon Jonathan Simon , Gyorki David E.
Published: September 2018

Background and Objectives

The aim of this study was to perform a retrospective analysis of survival rates and determine prognostic indicators for patients who underwent definitive surgical resection of stage IV melanoma.

Methods

Patients included were those who underwent complete resection of metastatic melanoma. Data was analyzed using IBM SPSS 2.0. Survival estimates were derived from Kaplan‐Meier, log‐rank, and Breslow tests.

Results

The study population (n = 95) consisted of 60 males and 35 females. Median overall survival (OS) from the first metastasectomy was 49 months (95% confidence interval, 31‐67 months). OS at 1, 2, and 5 years was 92%, 87%, and 50% respectively. Predictors of survival included clear surgical margins compared to patients with positive margins (median OS 53 vs 20 months,
P = .026). A preoperative neutrophil to lymphocyte ratio less than 5 experienced a median OS of 65 months compared to 15 months (
P = .006; multivariable analysis for OS: hazard ratio 3.590,
P = .009).

Conclusion

This study's results are consistent with previous findings demonstrating favourable long‐term outcomes following selective resection of metastatic melanoma. In addition to achieving clear surgical margins, a low preoperative neutrophil to lymphocyte ratio was associated with improved outcomes. These factors may help identify surgical candidates.
EC‐IC bypass for cerebral revascularization following skull base tumor resection: Current practices and innovations
Authors: Wolfswinkel Erik M , Landau Mark J , Ravina Kristine , Kokot Niels C , Russin Jonathan J , Carey Joseph N
Published: September 2018

Complex skull base tumors can involve critical vessels of the head and neck. To achieve a gross total resection, vessel sacrifice may be necessary. In cases where vessel sacrifice will cause symptomatic cerebral ischemia, surgical revascularization is required. The purpose of this paper is to review cerebral revascularization for skull base tumors, the indications for these procedures, outcomes, advances, and future directions.
Surrogate indicators of quality are associated with survival following surgical treatment for hepatocellular carcinoma
Authors: Roife David , Santamaria‐Barria Juan A. , Kao Lillian S. , Ko Tien C. , Wray Curtis J.
Published: September 2018

Introduction

Quality/core measures have been collected for over 10 years. Studies have demonstrated hospital performance is related to postoperative outcomes. We hypothesize that hospital quality measures are associated with long‐term survival following surgical resection for hepatocellular carcinoma (HCC).

Methods

The National Cancer Data Base was queried for all HCC cases. Individual hospitals were deidentified. Quality markers were defined as hospital‐specific median length of stay (LOS), 30‐day mortality rate and readmit rate. A Cox regression stratified by stage estimated survival. To minimize confounding, a landmark analysis was estimated for patients that survived greater than 30 days.

Results

A total of 16 202 HCC patients underwent surgical resection and 996 (6.1%) died within 30 days following surgery. Calculated by unique hospital, median 30‐day death rate was 4.6% (interquartile range [IQR]: 1.2% to 7.6%). Thirty‐day readmit rate was 2.6% (IQR: 0% to 5.9%) and median LOS was 8.0 days (IQR: 6.5 to 9.2). In the multivariate Cox regression, 30‐day death rate (hazard ratio [HR], 1.89; 95% confidence interval [CI]: 1.32 to 2.71) and longer LOS (HR, 1.02; 95% CI: 1.01 to 1.02) were associated with worse survival. Higher 30‐day readmission rate was associated with improved survival (HR, 0.61; 95% CI, 0.38 to 0.97).

Conclusions

Hospital‐level surrogate markers of surgical quality appear to be significantly associated with HCC survival following resection. Patients treated in higher 30‐day mortality centers, experienced worse outcomes. Individual hospitals should critically review disease‐specific outcomes following resection to identify areas for improvement.
CD90 expression in human intrahepatic cholangiocarcinoma is associated with lymph node metastasis and poor prognosis
Authors: Yamaoka Ryoya , Ishii Takamichi , Kawai Takayuki , Yasuchika Kentaro , Miyauchi Yuya , Kojima Hidenobu , Katayama Hokahiro , Ogiso Satoshi , Fukumitsu Ken , Uemoto Shinji
Published: September 2018

Background and Objectives

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer. However, its prognosis remains poor. Expression of cluster of differentiation 90 (CD90) has been identified as an indicator of poor prognosis in many cancers. Here, we examined the importance of CD90 expression in ICC.

Methods

We performed immunohistological assays for CD90 in human ICC surgical specimens and assessed its relationship with clinicopathological findings and prognosis. Moreover, we analyzed the characteristics of CD90+/− cells, mainly with respect to metastatic potential, using human ICC cell lines.

Results

CD90 expression was significantly associated with lymph node metastasis and was revealed to be an independent prognostic factor. The CD90+ cells present in ICC specimens did not appear to be cancer‐associated fibroblasts, as they did not express α‐smooth muscle actin. In vitro, CD90
+ cells exhibited greater migratory ability and higher expression of epithelial‐mesenchymal transition (EMT)–related genes, including CXCR4 and MMP7, than CD90− cells. Wnt/β‐catenin signaling pathway activation was also heightened in CD90+ cells. In such cells, EMT appeared to be induced by CXCR4 and MMP7 expression through activation of Wnt/β‐catenin signaling.

Conclusion

CD90+ cells demonstrate high metastatic potential owing to Wnt/β‐catenin signaling activation and are associated with poor prognosis in ICC.
Testicular tumours discovered during infertility workup are predominantly benign and could initially be managed by sparing surgery
Authors: Lagabrielle Samuel , Durand Xavier , Droupy Stéphane , Izard Vincent , Marcelli François , Huyghe Eric , Ferriere Jean‐Marie , Ferretti Ludovic
Published: September 2018

Background and Objectives

To evaluate the pathological features and recurrence of incidental testis tumours treated by partial orchiectomy in a population of infertile men.

Methods

We retrospectively pooled, from four andrology referral centres, 32 patients diagnosed with testis mass during regular infertility workup. Patients included had an impaired sperm analysis and testis sparing surgery was performed to prevent secondary azoospermia or androgen therapy.

Results

Mean age was 36 (IQR, 32 to 37). The mean largest tumoral diameter was 8.5 mm (IQR, 5 to 10). A total of 25% (8 of 32) of patients had a malignant tumour (seminoma, 7 of 32, 22%; teratoma, 1 of 32, 3%) and 75% (24 of 32) had a benign lesion (Leydig cell tumour, 23 of 32, 72%; scar tissue, 1 of 32, 3%). Malignant tumours were then managed by total orchiectomy (six of eight) or by radiotherapy (two of eight). With a mean follow up of 26 months (IQR, 8 to 32), one patient (3%) had an homolateral recurrence, which was a Leydig cell tumour. Not a single patient developed metastasis.

Conclusion

Seventy‐five per cent of the tumours discovered during infertility management were of a benign pathology. A conservative approach could be proposed initially to avoid unnecessary orchiectomies. Orchiectomy and radiotherapy could be discussed as salvage therapies for malignant lesions.
Sentinel lymph node biopsy in patients with thin melanomas: Frequency and predictors of metastasis based on analysis of two large international cohorts
Authors: Isaksson Karolin , Nielsen Kari , Mikiver Rasmus , Nieweg Omgo E. , Scolyer Richard A. , Thompson John F. , Ingvar Christian
Published: September 2018

Background

Sentinel lymph node (SLN) metastasis in patients with thin melanomas (≤1 mm) is uncommon but adverse prognostic factors may indicate an increased risk. We sought to determine how often SLN biopsy (SLNB) was performed in patients with thin melanomas, establish the frequency of SLN metastasis and evaluate the predictive value of ulceration, tumor mitotic rate, and thickness for SLN involvement.

Methods

Melanoma patients with a Breslow thickness greater than or equal to 0.5 to less than or equal to 1 mm, diagnosed 2009‐2016, were identified in the Swedish Melanoma Register (SMR) and the Melanoma Institute Australia (MIA) Database.

Results

In total 8165 patients were included from the SMR and 1603 from MIA. SLNB was performed in 9.5% and 16.2% of patients, respectively. Corresponding figures for T1b (American Joint Committee on Cancer [AJCC] 7th Edition) were 19.5% and 24.6%. The SLN positivity rate were 4.4% (Sweden) and 5.8% (MIA). SLN metastasis was more frequent in tumors with ulceration, mitoses, and Breslow thickness greater than or equal to 0.9 mm but none were statistically significant. Younger age was identified as a significant risk factor for SLN positivity at MIA.

Conclusions

A minority of patients with thin melanomas had SLNB performed and the SLN positivity rate was low. This study did not confirm tumor ulceration, mitoses, or thickness as statistically significant predictors for SLN metastasis.
NARCA: A novel prognostic scoring system using neutrophil‐albumin ratio and Ca19‐9 to predict overall survival in palliative pancreatic cancer
Authors: Tingle Samuel J. , Severs George R. , Goodfellow Michael , Moir John A. , White Steven A.
Published: September 2018

Background and Objectives

Several serum based‐markers and ratios have been investigated for their prognostic value in pancreatic ductal adenocarcinoma (PDAC). This cohort study aimed to combine these into a novel prognostic scoring system.

Methods

A retrospective cohort study was performed on 145 patients with unresectable histologically‐confirmed PDAC. Based on the existing literature the following markers were investigated: neutrophil‐lymphocyte ratio (NLR), neutrophil‐albumin ratio (NAR), platelet‐lymphocyte ratio (PLR), fibrinogen, and Ca19‐9. These values were dichotomized about their medians for Kaplan‐Meier and Cox regression analysis.

Results

Univariate Cox regression revealed statistically significant prognostic value for: NLR, NAR, PLR, fibrinogen, and Ca19‐9. When combining these using Cox regression analysis adjusting for other prognostic indicators, only NAR (hazard ratios [HR] = 3.174, P = 0.022) and Ca19‐9 (HR = 2.697, P = 0.031) were independent predictors of survival. Combining NAR and Ca19‐9 we split the cohort into three “NARCA” groups: NARCA0 = NAR ≤ 0.13 and Ca19‐9 ≤ 770, NARCA1 = either NAR > 0.13 or Ca19‐9 >770, NARCA2 = NAR > 0.13 and Ca19‐9 > 770. Median survival was 20.5, 9.7 and 4.1 months in NARCA0, 1, and 2 respectively (
P < 0.0005, log‐rank test). A separate validation cohort confirmed the prognostic significance of the score (
P = 0.048).

Conclusions

Combining NAR and Ca19‐9 into a prognostic score allows stratification of unresectable PDAC patients into groups with significantly different overall survival.