bluuebunny/crossref_metadata_2025 huggingface dataset:
Rational use of rasburicase for the treatment and management of tumor lysis syndrome
Authors: Shaikh Suhail A , Marini Bernard L , Hough Shannon M , Perissinotti Anthony J
Published: January 2017

Purpose

There is a lack of high-level evidence identifying meaningful outcomes and the optimal place in therapy of rasburicase in patients with, or at high risk for tumor lysis syndrome. The primary objective of this study was to evaluate and characterize outcomes resulting from an institution-specific guideline emphasizing supportive care, xanthine oxidase inhibitors, and lower doses of rasburicase.

Methods

In this retrospective chart review, we compared conservative rasburicase dosing, in accordance with newly developed UMHS tumor lysis syndrome guidelines, with aggressive rasburicase in adult patients (≥ 18 years of age) with hematological or solid tumor malignancies, and a uric acid level between 8 and 15 mg/dL. The primary efficacy outcome assessed the difference in the proportion of patients achieving a uric acid level <8 mg/dL within 48 h using a one-sided noninferiority test. The principle safety outcomes analyzed included incidence of acute kidney injury and hemodialysis requirement.

Results

One hundred sixty-one patients met inclusion criteria and were included in the study. Within 48 h of an elevated uric acid level, treatment was successful in 97.03% of patients in the conservative group, as compared with 98.33% in the aggressive group (difference, 1.3 percentage points; 95% confidence interval [CI], −3.33 to 5.93). Furthermore, there was no difference in the proportion of patients requiring hemodialysis (2.97% vs. 10.0%, p-value 0.079), or incidence of acute kidney injury (4.0% vs. 12.5%, p-value 1.00) between the treatment group and control group, respectively.

Conclusions

Conservative rasburicase use was noninferior to aggressive rasburicase use in patients with or at high risk for tumor lysis syndrome.
Dangerous liaisons: undercover journalism, standpoint theory and social revelation
Authors: Avieson Bunty , McDonald Willa
Published: January 2017

Standpoint Theory suggests that those who can bring the most insight to the workings of society are those on its edges and its margins. People living in circumstances of disempowerment are better placed because of their standpoint to perceive what is really occurring across the social and cultural domain; it is their standpoint, which is the most revealing. When a journalist works undercover, they are attempting to better understand, as far as is possible for an outsider, the standpoint of the people whose stories are being told. This article examines the methods of three undercover print journalists through the lens of standpoint theory, arguing that it is an ethical approach to uncover the lived realities of the disadvantaged.
The Health Behavior Checklist: Factor structure in community samples and validity of a revised good health practices scale
Authors: Hampson Sarah E , Edmonds Grant W , Goldberg Lewis R
Published: January 2017

This study examined the factor structure and predictive validity of the commonly used multidimensional Health Behavior Checklist. A three-factor structure was found in two community samples that included men and women. The new 16-item Good Health Practices scale and the original Wellness Maintenance scale were the only Health Behavior Checklist scales to be related to cardiovascular and metabolic risk factors. While the other Health Behavior Checklist scales require further validation, the Good Health Practices scale could be used where more objective or longer measures are not feasible.
The association between stress, resilience, and emotional symptoms in Norwegian adolescents from 13 to 18 years old
Authors: Moksnes Unni K , Lazarewicz Magdalena
Published: January 2017

This study investigated associations between stress, resilience factors, and symptoms of depression and anxiety in a cross-sectional sample of 1183 adolescents 13–18 years old. The results showed a positive significant association between stress and symptoms of depression and anxiety. Personal competence was significantly negatively associated with depression and anxiety, whereas social support was significantly negatively associated with anxiety. Significant interaction effects were found between gender by personal competence and gender by structured style in relation to anxiety, with stronger associations for girls. A compensatory role of resilience was found on the relation between stress and emotional symptoms.
The prevalence and the predictors of insomnia among refugees
Authors: Al-Smadi Ahmed Mohammad , Tawalbeh Loai Issa , Gammoh Omar Salem , Ashour Ala , Tayfur Malak , Attarian Hrayr
Published: January 2017

This study aimed to investigate the prevalence of insomnia and associated sociodemographic factors among refugees in Jordan. A cross-sectional survey was undertaken with a representative sample of 373 refugees. The majority of refugees had moderate to severe insomnia ( n = 196, 52.2%). Older age, living in the city of Mafraq, having secondary education or below, unemployed, and lacking easy access to medication were the predictors of higher insomnia. More attention by health care providers including nurses should be given to older refugees and those with a lower level of education, as these groups tend to be more liable to suffer from insomnia.
When food becomes an obsession: Overweight is related to food-related obsessive-compulsive behavior
Authors: Houben Katrijn , Jansen Anita
Published: January 2017

In this study, it was examined whether overweight is associated with food-related obsessions and compulsions. Participants with a healthy weight ( n = 27) and participants who were overweight ( n = 33) filled out the Yale-Brown-Cornell Eating Disorder Scale, the Eating Obsessive-Compulsive Scale, and the Emotional and Behavioral Reactions to Intrusions Questionnaire to assess frequency, distress, control, and reactance associated with food-related preoccupations and compulsions. Overweight participants showed increased food-related preoccupations, compulsive eating, and heightened emotional and behavioral reactance compared to participants with a healthy weight. Increased food-related obsessive-compulsiveness was also associated with unhealthy eating patterns.
Seeing crime, feeling crime: Visual evidence, emotions, and the prosecution of domestic violence
Authors: Moore Dawn , Singh Rashmee
Published: January 2017

Changes in prosecutorial strategies vis-a-vis domestic violence introduced new models of investigation that privilege images of victims. Drawing on case law, we argue these visual artefacts of victims’ injuries as well as their videotaped sworn statements describing their assaults constitute what Haggerty and Ericson call a ‘data double’, a virtual doppleganger who is meant to stand, often antagonistically in the stead of the flesh and blood victim. We further suggest, following theorizing on the emotional impact of images, that these pictures and videos, presented in court, have an emotional stickiness that differently affects both judges and juries as compared to the testimony of the flesh and blood victim. Thinking through temporality and notions of femininity we conclude that the truth effect of these images is that the victim’s data double becomes more human than human, forcing us to rethink the relationships between victims, images, and the machinations of justice.
The European Union: Sword or shield? Comparing counterterrorism law in the EU and the USA after 9/11
Authors: Hamilton Claire
Published: January 2017

Drawing on the developing literature on a ‘European penology’ this article seeks to use counterterrorism as a lens through which to re-examine arguments concerning penal moderation in Europe. Counterterrorism measures adopted in the EU and the USA in the post-9/11 period are therefore scrutinized for the lessons they hold about the role of European values and institutions as a ‘shield’ against punitiveness or indeed their ability to, swordlike, cut deep into citizens’ freedoms. The resulting analysis raises questions about the need for a more refined approach to the question of ‘European’ penal values as well as pointing up the continued existence of a culture of rights in the USA.
Regional differences in mortality, hospital discharges and primary care contacts for cardiovascular disease
Authors: Haraldsdottir Sigridur , Gudmundsson Sigurdur , Thorgeirsson Guđmundur , Lund Sigrun H. , Valdimarsdottir Unnur A.
Published: January 2017

Aims: Surveillance of geographical variations in cardiovascular health is important in order to achieve the objectives of reducing regional health disparities. We aimed to explore differences in cardiovascular disease (CVD) mortality and prevalence of CVD diagnoses made in primary and in-patient care, as well as risk factor distribution by geographic regions (urban/rural) in Iceland. Methods: From nationwide health registers, we obtained data on CVD mortalities ( N = 7113), primary healthcare CVD contacts ( N = 58,246) and hospital CVD discharges ( N = 14,039), as well as data on CVD risk factors from a national health survey ( N = 5909; response rate 60.3%). Age-standardised annual mortality, primary healthcare contact and hospital discharge rates due to CVD were calculated per 100,000 population inside (urban) and outside (rural) the Capital Area (CA). Logistic regression was used to explore regional differences in CVD risk factors. Results: We observed slightly higher total CVD mortality rates among women outside compared to inside the CA (Standardised Rate Ratio (SRR) 1.06 (95% confidence interval (CI) 1.05–1.07)), particularly due to atrial fibrillation (SRR 1.47 (95% CI 1.46–1.48)), heart failure (SRR 1.29 (95% CI 1.27–1.31)) and ischemic heart disease (SRR 1.11 (95% CI 1.10–1.12)), while reduced mortality risk for cerebrovascular disease (SRR 0.81 (95% CI 0.80–0.83)). The rates of hospital discharges and primary care contacts for these diseases, as well as prevalence of several modifiable risk factors, were generally higher outside the CA, particularly among women. Conclusions:The higher prevalence of modifiable risk factors and CVD in rural areas, especially among women, calls for refined treatment and health-promoting efforts in rural areas.
Mortality rates in OECD countries converged during the period 1990–2010
Authors: Bremberg Sven G.
Published: January 2017

Aims: Since the scientific revolution of the 18th century, human health has gradually improved, but there is no unifying theory that explains this improvement in health. Studies of macrodeterminants have produced conflicting results. Most studies have analysed health at a given point in time as the outcome; however, the rate of improvement in health might be a more appropriate outcome. Methods: Twenty-eight OECD member countries were selected for analysis in the period 1990–2010. The main outcomes studied, in six age groups, were the national rates of decrease in mortality in the period 1990–2010. The effects of seven potential determinants on the rates of decrease in mortality were analysed in linear multiple regression models using least squares, controlling for country-specific history constants, which represent the mortality rate in 1990. Results: The multiple regression analyses started with models that only included mortality rates in 1990 as determinants. These models explained 87% of the intercountry variation in the children aged 1–4 years and 51% in adults aged 55–74 years. When added to the regression equations, the seven determinants did not seem to significantly increase the explanatory power of the equations. Conclusions: The analyses indicated a decrease in mortality in all nations and in all age groups. The development of mortality rates in the different nations demonstrated significant catch-up effects. Therefore an important objective of the national public health sector seems to be to reduce the delay between international research findings and the universal implementation of relevant innovations.
Results and Future of Carotid Endarterectomy in a Medium-Sized Finnish Central Hospital
Authors: Jokinen J. J. , Huusari H. M. T. , Lehtonen J. Y. , Korpela A. A.
Published: January 2017

Background and Aims:

Carotid endarterectomies (CEA) should, by general agreement, be performed only at specialised institutions and on patients who are expected to have a low rate of complications, i.e., a 6% surgical risk for patients with symptomatic and a 3% risk for patients with asymptomatic carotid artery disease. We have reviewed the midterm results after CEA in amedium-sized Finnish central hospital to audit whether our results fulfil current quality standards.

Patients, Materials and Methods:

There were 116 consecutively operated patients at the Päijät-Häme Central Hospital during the years 1999–2003 on whom 122 CEAs were made. All CEAs were performed by conventional methods and shunts and patches were used when necessary.

Results:

The overall survival rate was 81.0% during the 3.6 ± 1.5 years [range 1.3–6.3 years] follow-up. The incidence of early major stroke was 2.5% and of late major stroke 1.6%. Other complications included cranial nerve deficit (2.5%), wound haematoma (3.3%) and postoperative hypertension (3.3%) or hypotension (2.5%). Significant changes in medication were needed after surgery in several patient subgroups.

Conclusions:

The results of CEA at the Päijät-Häme Central Hospital are at least acceptable. The primary prevention of strokes with pharmacotherapy needs aggressive improvement.
Service Comparison between Vascular and General Surgery in the Treatment of Chronic Venous Insufficiency with Special Reference to Preoperative Doppler Techniques
Authors: Oinonen A. , Sugano N. , Lehtola A. , Suokas N. , Keränen U. , Lepäntalo M.
Published: January 2017

Aims:

To compare the ability of vascular and general surgical services to abolish reflux in superficial venous system with aspecial reference to preoperative use of Doppler techniques.

Materials and Methods:

68 lower limbs operated on for venous insufficiency based on either preoperative Duplex evaluation and Doppler marking in avascular surgical unit (Vascular Surgical Service, VSS: 33 limbs, clinical class C2–C6) or clinical findings in a general surgical unit (General Surgical Service, GSS: 35 limbs, clinical class C2–C4) were re-examined clinically and with duplex scanning for reflux some three years postoperatively.

Results:

Marked superficial or perforator vein reflux was observed in 27 of 68 (39.7 %) operated limbs, thirteen of which in VSS and fourteen in GSS. However, axial reflux at saphenofemoral or thigh level was observed significantly less in VSS compared to GSS (3 vs 13, p = 0, 006).

Conclusion:

Total ablation of any reflux appeared difficult irrespective of the preoperative assessment. Preoperative Duplex examination, however, aided in identifying and treating axial reflux at thigh level.
Unrestricted Weight Bearing and Intensive Physiotherapy after Uncemented Total Hip Arthroplasty
Authors: Ström H. , Huss K. , Larsson S.
Published: January 2017

Background and Aims:

The effectiveness of partial weightbearing after hip surgery has been questioned as well as the need of intensive physiotherapy.

Material and Methods:

36 patients (average age 54.4, 19 women) operated with uncemented hip arthroplasty were randomized either to unrestricted weightbearing (UWB) combined with intensive physiotherapy or to partial weightbearing (PWB) for 3 months combined with a short self-training program. The load during walking and the muscle strength (MS) in abduction was measured preoperative and subsequent up to 12 months.

Results:

The average peak load on the operated leg at one week was 39.0 kg for the UWB and 25.8 for the PWB group (P = 0.009) while at three months 70.0 and 31.7 (P = 0.001) respectively. At 6 and 12 months there were no differences between the groups. The muscle strength increased in both groups up to six months but there were no differences between the groups.

Conclusions:

Even though patients applied more load than the recommended 15 kg most patients were able to comply with partial weightbearing fairly well. The effect of intensive physiotherapy on the muscle strength after hip arthroplasty is questionable.
The developing in the developed
Authors: Farja Yanay , Gimmon Eli , Greenberg Zeev
Published: January 2017

This study explores differentiating factors in employment growth between young small and medium-sized enterprises in rural regions and their application in developing economies. We applied a mixed-method approach, including a survey of 155 new ventures in Israel, an economy whose rural regions exhibit similarities to those of less developed countries, and 10 in-depth interviews with academics and practitioners. The results suggest that the economic development of rural areas through the cultivation of entrepreneurship should be carried out by providing potential business owners with two resources that are scarcer in these areas: funding and knowledge.
Challenges faced by women entrepreneurs in rural India
Authors: Pathak Atul Arun , Varshney Sanjeev
Published: January 2017

Malavika Sharma, an Indian woman rural entrepreneur, founded Avika, a venture which produced traditional, hand-embroidered Indian garments. Avika grew rapidly and now provides employment to over 700 rural women. This case highlights various challenges that an entrepreneurial venture run by a woman, in a rural location within a traditional patriarchal society such as India, faces. The case also helps understand the inevitable inter-twining of business and social issues, given the rural context.
Stilling the Punch: Boxing, Violence and the Photographic Image
Authors: Nead Lynda
Published: January 2017

Boxing is arguably one of the most visually arresting of sports; its images as potent and corporeal as the sport itself. This paper focuses on one category of boxing picture, the photograph of a head punch – the image taken at the moment when the gloved fist of a boxer makes contact with the opponent’s face. Features distorted by the force of the blow, the head recoiled with its weight and power, the image is both fascinating and repulsive. To understand the aesthetics of this genre of boxing image is to comprehend some of the most fundamental questions concerning the pleasures and horrors of visual representation. To gaze at the stilled moment of this attack on the face is to reflect on the complex historical relationship between violence and the photographic image
Contemporary Art and Transitional Justice in Northern Ireland: The Consolation of Form
Authors: Bell Vikki
Published: January 2017

Contemporary artworks in Northern Ireland are explored here as critical constellations, in Walter Benjamin’s sense, that engage the cultural processes of transition through their problematization of it. It is argued that the artworks become sites in which the assumptions of transition are opened up for critical reflection, requesting attention to the foreclosing of the meanings of memory, of past-and-future, of community. A mode of critical questioning of the present renders the present problematic not in terms of exclusions nor with reference to a past that cannot or will not be erased, but in terms of the present’s inability to be conceived through a linear conception of time. That is, the past and its relation to both the present and to the future are set in oscillation as artworks explore the complex temporalities of a present self-consciously attempting to narrate itself away from the past. The artworks, ‘without the bigotry of conviction’ as Seamus Deane put it, suggest that the task of dealing with the past is flawed wherever the past is conceived as a history that can be rendered present to be judged by subjects who are thereby placed beyond it. That is the illusion of a present ‘no-time’ that dovetails with the desires of commercial enterprise and neo-liberal conceptions of freedom. If this suggests an unceasing restlessness, the consolation is that this questioning does take a form, not as judgement or political decision but as artworks which by definition, remain open to reinterpretation and new understandings. These issues are discussed with reference to the work of four artists in Northern Ireland: the paintings of Rita Duffy, the photography and installation work of Anthony Haughey, and the sculptural works of Philip Napier and Mike Hogg.
Reliability and Predictive Validity of Preschool Web-Based Phonological Awareness Assessment for Identifying School-Aged Reading Difficulty
Authors: Carson Karyn L.
Published: January 2017

This study examined whether web-based phonological awareness (PA) assessment in early childhood, specifically the year preceding formal schooling, could help educators reliably predict children’s risk for reading difficulties in the first year of school. Ninety Australian children participated in several web-based PA tasks with a high priority focus on phoneme-level knowledge at 4- and 4.5 years of age. Real and non-real-word reading ability were examined at age 5. Measures of internal consistency using Cronbach’s alpha were above .7 for all PA tasks, while test-retest reliability correlations were significant ( p < .001). Regression analyses indicated that web-based PA measures at 4.5 years of age, alongside preschool-entry language ability, accounted for 79.52% and 74.08% of the variance in 5-year-old real-word and non-real-word decoding ability. Web-based PA assessment focused on phoneme-level skills may be a reliable and valid method of identifying risk for reading difficulties in the year preceding school entry.
Risk Factors for Posttransplant Diabetes Mellitus: A Review of the Literature
Authors: Driscoll Carolyn J.
Published: January 2017

The development of diabetes after solid organ transplantation is a known complication, and many published studies have examined prevalence rates and risk factors for specific categories of transplant recipients. However, fewer articles have compared rates of posttransplant diabetes and risk factors among different types of transplant recipients. This article provides an overview of the literature on this subject and compares similarities and differences related to posttransplant diabetes for different categories of organ transplant recipients. Awareness of the various risk factors for different organ transplant recipients will enhance transplant clinicians' knowledge related to this complication so that appropriate monitoring can be started.
Does Family Disagreement Affect Donation Decisions by Next of Kin?
Authors: Rodrigue James R. , Cornell Danielle L. , Howard Richard J.
Published: January 2017

Context

Information about the relationship between family disagreement and donation decisions may facilitate development of strategies to help families resolve conflict and possibly increase donation consent rates.

Objective

To assess how family interactions influence next-of-kin decisions about organ donation.

Design

Semistructured survey.

Setting and Participants

Next of kin of potential donors (147 donors, 138 non-donors) from 1 organ procurement organization participated in a semistructured telephone interview, answering questions about the presence and influence of others during decision making related to organ donation.

Results

When others were actively involved in the donation decision (68%), disagreement about the donation decision occurred in 32% of cases. Compared with families initially in agreement, families not in agreement were less likely to donate ( P <.001), took longer to make a decision ( P <.001), and were less likely to make the same decision now ( P <.001). Family disagreement was significantly associated with having more family members involved in the discussion, characteristics of the deceased (younger age, not married, nonwhite race, fewer days in the hospital, trauma-related death), next-of-kin characteristics (less education, less favorable organ donation beliefs), not knowing the deceased's donation intentions, less satisfaction with the health care team, and perceptions of a less compassionate donation requester.

Conclusions

Family disagreement occurred in one-third of donation approaches when other family members were present. Such disagreement is most likely to contribute to donation refusal when the deceased's donation intentions are unknown. Recognizing and assessing the nature of family disagreement may increase donation consent.
The Relationship between the Sick Role and Functional Ability: One Center's Experience
Authors: Cerrato Annette , Avitable Matthew , Hayman Laura L.
Published: January 2017

Objective

To determine the impact of the sick role on posttransplant functional ability.

Methods

A convenience sample of 97 kidney transplant recipients (mean age, 45.8 years; SD, 12.8 years; 47% female; 68% African American) participated in this exploratory cross-sectional study. Self-report data were collected during a posttransplant clinic visit via the Response to Illness Questionnaire used to measure sick-role perceptions, the Functional Status Questionnaire used to measure functional ability, and an investigator-developed Demographic Data Sheet used to measure sociodemographic data and comorbidities.

Results

Factor analysis of the Response to Illness Questionnaire yielded 7 distinct factors that accounted for 62.2% of total score variance. Multiple regression analysis indicated a significant relationship between those 7 factors and the 5 factors revealed by the Functional Status Questionnaire. Demographic factors that also correlated with the functional status factors included type of work, gender, age, education, and donor source. Coping with illness and Resentment of illness were the strongest predictors of functional status in this sample. Patients with the strongest coping skills and the least resentment of illness consistently showed more advanced functional abilities.

Conclusions

Results suggest that individuals who have the strongest coping skills and the least resentment toward their illness seem best able to gain strength and reject the sick role as a permanent identity. Health care providers must acknowledge patients' illness perceptions and design interventions focused on optimizing functional ability in vulnerable transplant recipients.
Seatbelt Injury Resulting in Functional Loss of a Transplanted Kidney
Authors: McHugh Patrick P. , Clifford Timothy M. , Johnston Thomas D. , Banerjee Ambar S. , Gedaly Roberto , Jeon Hoonbae , Ranjan Dinesh
Published: January 2017

The transplanted kidney, lying heterotopically in the iliac fossa, is especially vulnerable to damage from blunt trauma, particularly compression by vehicle seatbelt. We present a case wherein a functioning renal allograft lying in the right iliac fossa was severely injured by seatbelt compression, resulting in significant functional compromise and eventual loss. The patient later underwent successful retransplantation with a second living donor kidney. Management of injured renal transplant recipients requires appreciation of mechanisms likely to cause damage to the graft, as well as familiarity with available treatment options, both surgical and nonsurgical. As functional life spans of renal allografts improve, this type of injury will most likely be encountered with increasing frequency.
One Kidney Transplant Center's Experience: Linking Process Improvements and Medicare/Medicaid Conditions of Participation
Authors: Escobedo Wendy , Hosseinpour Peter , Abe Marlene , Cecka J. Michael , Ruzics Ervin P.
Published: January 2017

Context

An institutional priority toward transplantation, dedicated team dynamics, aggressive clinical growth, and optimal care practices are essential for delivering exceptional care to transplant patients. The importance of multidisciplinary integration of these priorities throughout the continuum of patient care is widely recognized in the transplant arena as well as by the Centers for Medicare and Medicaid Services (CMS). In fact, it is the collaboration within these aspects of care that is necessary for certification by CMS.

Objectives

To establish institution-wide practices, systems, and mechanisms to optimize performance of transplant centers through the use of evidence-based protocols, clinical innovation, and data-driven quality improvements. To develop training programs and competency based orientation addressing the topics needed for transplant nurses, multidisciplinary caregivers, and clinical transplant coordinators who provide care to transplant patients. To comply with the CMS conditions of participation for transplant centers.

Methods

Formation of a renal transplant council and multidisciplinary care team. Flow chart of hospital course from admission to discharge, carefully examining patients' progression through the continuum of care, assessing for barriers to care and knowledge deficits of transplant practitioners.

Results

Development of multiple clinical process improvements resulting in the creation of an environment for continuous learning, optimal transplant care, and exceptional outcomes in transplantation as well as compliance with CMS conditions of participation for transplant centers.
Induction Immunosuppression for Orthotopic Heart Transplantation: A Review
Authors: Ensor Christopher R. , Cahoon William D. , Hess Michael L. , Kasirajan Vigneshwar , Cooke Richard H.
Published: January 2017

Objectives

To describe the appropriateness and safety of induction immunosuppression for patients at risk for fatal rejection, and to describe the safety and effectiveness profiles of the induction regimens available in the United States.

Data Sources

MEDLINE/PubMed database, EMBASE database, Google Scholar; references from pertinent articles were also reviewed to identify additional data.

Study Selection

A systematic literature review from January 1, 1980, through June 30, 2008, was performed. Included articles ranged from case series to prospective randomized controlled double-blind placebo-controlled trials that detailed the following topics with respect to induction immunosuppression: risk of fatal rejection, renal sparing, malignancy, OKT3, rabbit or equine antithymocyte globulin, daclizumab, basiliximab, and alemtuzumab.

Results

Patients at highest risk for fatal rejection experienced a survival benefit from induction immunosuppression, whereas all other patients experienced no benefit or harm. Most of the early data detail positive experiences with polyclonal antibody regimens. Several newer trials compare the use of polyclonal strategies with the use of anti-CD25 targeted monoclonal antibodies. Few researchers have assessed the usefulness of an anti-CD52 approach. Overall, induction therapy remains a poorly studied and widely variable practice among the major US heart transplant centers.

Conclusion

At present, the unrestricted use of induction for all patients does not seem prudent. Induction should be individualized for each patient on the basis of a well-designed protocol, careful analysis of the transplant center's demographics, and the effectiveness and safety profiles of the regimens used.
Stability of Levothyroxine Sodium 0.4 μg/mL in 0.9% Sodium Chloride Injection
Authors: Stadalman Kelli A. , Kelner Michael J. , Box Kevin , Dominguez Alex , Rigby Joseph F.
Published: January 2017

Context

Intravenous levothyroxine therapy decreases vasopressor requirements and prevents cardiovascular collapse in hemodynamically unstable patients eligible for organ donation. The stability of levothyroxine when used in this manner is unknown.

Objective

To determine the stability of levothyroxine solution for intravenous use at a concentration of 0.4 μg/mL diluted in 0.9% sodium chloride.

Design

Triplicate sample sets were prepared by reconstituting levothyroxine 200 μg for injection with 5 mL of 0.9% sodium chloride with further dilution in 500 mL of 0.9% sodium chloride. One sample set was protected from light and the other was left unprotected. Both sample sets were stored at room temperature, and samples from each were analyzed for initial concentration and 4, 8, 12, and 24 hours later.

Conclusions

Levothyroxine sodium 0.4 μg/mL in 500 mL 0.9% sodium chloride is stable for 24 hours at room temperature when protected from light.
Education Before Kidney Transplantation
Authors: Rosaasen Nicola , Mainra Rahul , Shoker Ahmed , Wilson Jay , Blackburn David , Mansell Holly
Published: January 2017

Context:

Poor knowledge about immunosuppressive (IS) medications remains a major problem for patients in the posttransplant setting. Therefore, more effective educational strategies in the pretransplant setting are being considered as a possible method to improve knowledge and readiness for the challenges of posttransplant care. However, the most effective/relevant content of a pretransplant educational program is yet to be determined.

Objective:

To identify pretransplant education topics from the posttransplant patient perspective.

Design:

A focus group meeting was conducted among 7 high-functioning, stable adult kidney transplant recipients recruited from the Saskatchewan Transplant Program. Demographic information including age, gender, occupation, background/ethnicity, and time since transplant were recorded. A moderator, assistant moderator, and research assistant facilitated the 90-minute focus group meeting using a predetermined semistructured interview guide. The session was audio recorded and transcribed verbatim. Nvivo software was used to code the data and identify emerging themes exploring views of participants relating to the educational information required for pretransplant patients.

Results:

Patients were satisfied with the education they had received. Ideas were classified into the following major themes—patient satisfaction, transplant waitlist, surgery, medications, posttransplant complications, lifestyle and monitoring, knowledge acquisition, illusion of control, and life changes posttransplant. Knowledge gaps were identified in all areas of the transplantation process and were not exclusive to IS medications.

Conclusion:

Misconceptions regarding transplantation were identified by a group of high-functioning, stable adult recipients who were satisfied with their clinical care. Future educational strategies should aim to address the entire transplantation process and not be limited to medications.
Evidence-Based Strategies for Shortening Informed Consent Forms in Clinical Research
Authors: Corneli Amy , Namey Emily , Mueller Monique P. , Tharaldson Jenae , Sortijas Steve , Grey Thomas , Sugarman Jeremy
Published: January 2017

Long informed consent forms (ICFs) remain commonplace, yet they can negatively affect potential participants’ understanding of clinical research. We aimed to build consensus among six groups of key stakeholders on advancing the use of shorter ICFs in clinical research. Partnering with the HIV Prevention Trials Network (HPTN), we used a modified Delphi process with semistructured interviews and online surveys. Concerns about redundancy of information were common. Respondents supported three strategies for reducing ICF length: (a) 91% agreed or strongly agreed with grouping study procedures by frequency, (b) 91% were comfortable or very comfortable with placing supplemental information into appendices, and (c) 93% agreed or strongly agreed with listing duplicate side effects only once. Implementing these strategies will facilitate adoption of the proposed changes to U.S. regulations on ICF length, should they be enacted.
Practical Protective Tools for Occupational Exposure: 1) Double Focus Spectacles for the Aged with Highly Refracted Glass Lens 2) Remodeled Barrier for Radiation Protection
Authors: Kurokawa S. , Yabe S. , Takamura A. , Ishizaki H. , Aizawa S.
Published: January 2017

Two practical protective tools for occupational exposure for neurointerventional radiologists are presented. The first purpose of this study was to investigate the effectiveness of double focus spectacles for the aged with a highly refracted glass lens (special spectacles for the aged) for radiation protection of the crystalline lens of the eye in comparison with other spectacles on the market, based on the measurement of film density which was obtained by exposure of X-ray through those spectacles. As a result of the film densitometry mentioned above, the effectiveness of special spectacles for the aged in radiation protection was nearly equal to the effectiveness of a goggle type shield which is made with a 0.07 mm lead-equivalent plastic lens.

The second purpose of this study was to investigate the effectiveness of the protective barrier, which we remodeled for cerebral angiography or neuroendovascular therapy, for radiation exposure, based on the measurement in a simulated study with a head phantom, and on the measurement of radiation exposure in operaters during procedures of clinical cases. In the experimental study radiation exposure in supposed position of the crystalline lens was reduced to about one third and radiation exposure in supposed position of the gonadal glands was reduced to about one seventh, compared to radiation exposure without employing the barrier.

The radiation exposure was monitored at the left breast of three radiologists, in 215 cases of cerebral angiography. Employing the barrier in cerebral angiography, average equivalent dose at the left breast measured 1.49μ Sv during 10 min of fluoroscopy. In three kinds of neuroendovascular therapy in 40 cases, radiation exposure in an operator was monitored in the same fashion and the dose was recorded less than the result reported in previous papers in which any protective barrier have not been employed in the procedure1,2.

As a result, the two above mentioned protective tools are considered practical in clinical usage and very effective to reduce radiation exposure in an operator of interventional neuroradiolgy which may sometimes require many hours to complete the therapy under extended fluoroscopic time.
Limitation of Endovascular Treatment for Ruptured Cerebral Aneurysms: Results from the Protocol “GDC as the First Choice”
Authors: Mase M. , Yamada K. , Aihara N. , Banno T. , Watanabe K.
Published: January 2017

Since October, 1997, endovascular embolization using GDC has been our primary treatment for ruptured cerebral aneurysms in the acute stage. According to our protocol, an aneurysm more than 3 mm in diameter, without a wide-neck or massive intracranial hematoma is indicated for endovascular therapy. Under this protocol, we experienced 35 consecutive patients with aneurysmal subarachnoid hemorrhage, and 22 of them (62.8%) were treated endovascularly. The most common reason for the contra-indication of coil embolization was wide-necked aneurysm (9 cases). We experienced two cases with embolic stroke and one case with post-embolization hemorrhage as a complication after endovascular treatment. Morbidity rate due to the complications was 9.1%. In conclusion, a system that allows both surgical and endovascular treatments to be performed in any given case is necessary for the appropriate treatment of ruptured aneurysm. In order to avoid ischemic embolic complications, postoperative anticoagulation therapy is crucial. The safety of coil embolization for very thin-walled aneurysm is questionable.
Intraaneurysmal GDC Embolization for Ruptured Aneurysm in the Acute Stage
Authors: Ezura M. , Takahashi A. , Yoshimoto T.
Published: January 2017

This report focused on our treatment protcol and results on the intraaneurysmal GDC embolization for ruptured aneurysm in the acute stage.

Clinical materials of this study consist of 39 patients who were treated with intraaneurysmal GDC embolization within 72 hours after the onset of subarachnoid hemorrhage from March 1997 to May 1999.

Patients with cerebral aneurysms are always examined as a possible candidate for neurosurgical clipping. If the patient had any difficulties and/or problems on neurosurgical clipping (high age 24, poor grade 12, surgically difficult location 11, systemic disease 2), the patient was treated by intraaneurysmal GDC embolization. GDCs were inserted as tight as possible. Then, spinal drainage was set in patients with thick subarachnoid hemorrhage. Tissue plasminogen activator was administered via the drainage in patients with thicker subarachnoid hemorrhage. Two patients experienced rerupture during peritherapeutic period. Symptomatic vasospasm was observed in 2 patients (5.1%). Good outcome was obtained in 31 out of 34 surviving patients. Symptomatic complication caused by distal embolism occurred in 1 patient, parent artey occlusion in 3 patients. In conclusion, intraaneurysmal GDC embolization is thought to be sufficient regarding prevention of rerup tu re, incidence of vasospasm, and clinical outcome.
Carotid Stenting with the Use of Wallstent
Authors: Ishii A. , Mitsudo K. , Kikuta K. , Arakawa Y. , Hojo M. , Goto Y. , Ueno Y. , Yamagata S.
Published: January 2017

We performed carotid stenting with Wallstent for 22 cases. The mean stenosis was 74.3 ± 11.2% before stenting and 14.2 ± 8.8% after stenting. The technical success (<40% residual stenosis) was 100%. We experienced 2 embolic complications (one TIA and one minor stroke). Permanent neurological deficits were not encountered in all the patients (0%). Restenosis was observed in 2 cases (12.5%). The both lesions revealed intimal hyperplasia on intravascular ultrasound (IVUS). MRI diffusion weighted study showed that distal embolism happened more often (46.2%) than we expected although most of them were asymptomatic. We must wait for the long term result to conclude that carotid stenting has become one of the treatment modalities.
Superselective Arterial Chemotherapy for Inoperable Metastases in the Dura Mater and Cranium
Authors: Suzuki S. , Kurata A. , Takagi H. , Nakahara K. , Oka H. , Miyasaka Y. , Fujii K.
Published: January 2017

Diffuse metastases to the cranium and dura mater of the bilateral hemisphere do not allow surgical intervention. We describe an excellent case which was treated by intra-arterial chemotherapy using Epirubicine (Farumorbicine).

A 58-year-old woman treated for breast cancer ten years ago was admitted to our hospital with headache and frontal mass lesions. Magnetic resonance (MR) imaging on admission revealed a remarkable enhanced lesion of the bilateral dura mater and cranium, and bilateral brain edema in the frontal lobe. Angiography disclosed a vascular rich tumour supplied by bilateral external carotid artery branches. We successfully treated the lesion using superselective intra-arterial chemotherapy with a minimal dose of Epirubicine followed by embolization of bilateral external carotid artery branches. Follow-up MR imaging two years after the endovascular treatment showed disappearance of the enhanced lesion and remodeling of the skull bone. The patient is neurologically free of symptoms.
Percutaneous Transluminal Cerebral Angioplasty and Stenting in Acute Vertebrobasilar Ischemic Stroke
Authors: Nistri M. , Mangiafico S. , Cellerini M. , Villa G. , Mennonna P. , Ammannati F. , Giordano G. P.
Published: January 2017

Reports of cerebral transluminal angioplasty and stenting in patients with vertebrobasilar ischemic stroke are scanty. Herein we report on the use of “monorail” coronary balloon angioplasty and stent balloon mounted catheters in two patients with acute vertebrobasilar ischemic stroke, focussing on the differences and possible advantages of the “monorail” technique in comparison with the “over-the-wire” technique. In both patients, the clinical picture was characterized by progressive brainstem symptoms followed by acute loss of consciousness related to an atherothrombotic occlusion and subocclusion of the dominant intracranial vertebral artery, respectively. In one patient, superselective thrombolytic therapy and balloon angioplasty resulted in a dissection flap at the vertebrobasilar junction. The latter was treated by successful deployment of a coronary stent. In the other patient, the subocclusive lesion was directly treated by angioplasty and stenting without thrombolytic therapy. The clinical outcome was poor for one patient (“locked in” syndrome) while the other had a complete clinical recovery.

In acute atherothrombotic vertebrobasilar stroke transluminal cerebral angioplasty and stenting may be successfully performed allowing vessel recanalization.
Arterial Dissection and Subarachnoid Haemorrhage in Human Immunodeficiency Virus-Infected Patients
Authors: Taylor A. , Lefeuvre D. , Levy A. , Candy S.
Published: January 2017

Cerebrovascular complications of AIDS have been reported as high as 34% in post mortem series. Most patients suffer from ischaemic strokes but there are a number of reports of patients presenting with subarachnoid haemorrhage (SAH) related specifically to aneurysm rupture. We present three patients with advanced HIV disease and low CD4 counts who present with SAH. In two of the patients the haemorrhage appeared to be caused by intracranial artery dissection which, to our knowledge, has not previously been described. Both patients were successfully treated endovascularly, one with segmental vessel trapping and the other with partial coil embolization of a false aneurysm. The pathological basis for HIV related arteriopathy is discussed in relation to these cases.
The So-Called Anterior Meningeal Artery: An Anatomic Study for Treatment Modalities
Authors: Shimizu S. , Garcia A.S. , Tanriover N. , Fujii K.
Published: January 2017

The so called anterior meningeal artery (AMA) is a branch of the vertebral artery (VA), which had been interpreted as a supplying vessel of the dura in the foramen magnum and upper cervical level.

In this study, we examined the anatomy of this artery and relationships to its surrounding structures for treatment modalities. With the aid of magnification, five adult cadaveric head and neck complex and five cervical spines were examined after perfusion of the vessels with colored silicone.

The AMA arose from the VA between the C2 and C3 level, and passed medially through the intrervertebral foramen anterior to the dural sheath of the third cervical nerve root. It ran upwards dorsal to the deep layer of the posterior longitudinal ligament (PLL) with anterior internal vertebral venous plexus. Rostrally, it formed an arcade above the apex of the odontoid process with its contralateral mate.

The AMA gave off several tiny branches to the deep layer of the PLL, ligaments and soft tissues above the apex of the odontoid process, and vertebral bodies of the axis. At the level of the foramen magnum, it ended in several small twigs to the dura. Anastomoses between the AMA system and adjacent vessels were observed. One was directed through the hypoglossal canal to the ascending pharyngeal artery and the other was with the V3 segment of the VA. The origin and course of the two AMA, and anastomoses were symmetric. Although the AMA feeds the ventral dura of the foramen magnum, the perfusion area is larger than its name suggests, including the bony and ligamentous structures in the craniovertebral junction.

Anatomical knowledge of the AMA, including its anastomoses and layer relationships to the surrounding structures, may help to perform treatment modalities in this region rationally.
A Five-Vessel Aortic Arch with an Anomalous Origin of Both Vertebral Arteries and an Aberrant Right Subclavian Artery
Authors: Brouwer P.A. , Souza M.P.S. , Agid R. , terBrugge K.G.
Published: January 2017

In this case presentation we describe a patient with an anomalous origin of the right vertebral artery arising from the right common carotid artery in combination with an aberrant right subclavian artery and a left vertebral artery originating from the arch between the left common carotid artery and left subclavian artery. Hence there were five vessels originating from the aortic arch. The possible embryological mechanism as well as a postulation on the importance of the level of entrance of the vertebral artery in the cervical transverse foramen is discussed.