bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contemporary Endovascular Outcomes for Critical Limb Ischemia Are Still Failing to Meet Society for Vascular Surgery Objective Performance Goals
Authors: Latz Christopher A. , Wang Linda J. , Boitano Laura , DeCarlo Charles , Sumpio Brandon , Schwartz Samuel , Lee Cheong J. , Dua Anahita 
Published: October 2020

Objectives: The Society for Vascular Surgery (SVS) created Objective Performance Goals (OPGs) for critical limb ischemia (CLI) in 2009. It was previously shown that endovascular therapy for CLI was not meeting these benchmarks. The OPG for all peripheral interventions is <8% for major adverse cardiac events (MACE), <8% for major adverse limb events (MALE), and <3% for major amputation. The goal of this study is to evaluate if outcomes have improved for CLI in recent years, specifically 2015-2018. Methods: The Targeted Vascular Module from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried to identify patients who underwent endovascular intervention for critical limb ischemia from 2011-2018. Cohorts were divided into 2011-2014 and 2015-2018. Primary 30-day outcomes were MACE, MALE, and major amputation. Univariate analyses were performed using the Fisher’s exact test and the Wilcoxon rank-sum test. Multivariate analysis comparing groups was performed using inverse probability weights and trend over time analysis was performed using logistic regression with year of intervention as a continuous variable. Results: From 2011 to 2018, 7,168 patients underwent an endovascular intervention for CLI. 28% were classified as “OPG high anatomic risk,” and 17% were classified as “OPG high clinical risk.” The 2015-2018 cohort vs. the 2011-14 cohort experienced MACE in 3.3% vs. 2.7% (p = .23), MALE in 9.1% vs. 8.9% (p = 0.83), and amputation in 4.0% vs. 4.2% (p = 0.71). When only high anatomic risk patients were considered (n = 1988), MACE was experienced in 2.4% vs. 2.2% (p = 0.87), MALE by 9.5% vs. 10.6% (p = 0.47) and amputation by 5.1% vs. 6.0% (p = 0.40). When only high clinical risk patients were considered (n = 1224), MACE was experienced in 5.2% vs. 3.9% (p = 0.33), MALE by 8.0% vs. 7.4% (p = 0.74) and amputation by 3.9% vs. 3.7% (p = 0.88). Comparing 2015-2018 to the reference 2011-2014, MALE adjusted odds ratio (AOR) = 0.99, 95% CI [0.83-1.18], MACE AOR = 1.19 95% CI [0.88-1.60], and major amputation AOR = 0.91 95% CI [0.70-1.17]. There were no decreases in the trend over time for MALE (AOR per year 0.97, CI [.94-1.02], major amputation (AOR per year: 0.97, CI [0.91-1.03], nor for MACE (AOR per year: 1.05, CI [.98-1.13]). Conclusion: Outcomes following endovascular interventions for CLI continue to underperform when compared to OPG benchmarks for MALE and amputations. There is no decrease over time for these target outcomes. Target MACE events remain acceptable despite the increasing clinical complexity of patients being treated.
Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease
Authors: Bolt Alexander M. , Giele Henk , McNab Ian S. H. , Spiteri Michelle 
Published: October 2020

We report long-term outcomes of proximal interphalangeal joint arthrodesis for treatment of severe recurrent joint contractures secondary to Dupuytren’s disease. The patients had at least two previous procedures for Dupuytren’s contracture that involved the same joint, before undergoing joint fusion. Patient demographics, satisfaction, functional outcome, complications, revision and re-operation rates are reported. Eleven patients were included with a mean age of 64 years (range 53–73). The mean proximal interphalangeal joint contracture at presentation was 102° (range 80°–120°). None required revision surgery at a mean of 8 years and 9 months (range 9–199 months). All patients were able to perform their activities of daily living and would recommend this operation to family and friends. This series shows that proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren’s disease. Level of evidence: IV
Efficacy and safety of prolonged release budesonide granules in mesalazine‐refractory ulcerative colitis: A multi‐centre Phase IIa study (TOPICAL‐1)
Authors: Fellermann Klaus , Schiefke Ingolf , Rácz István , Derova Jelena , Jonaitis Laimas , Wehrum Sarah , Nacak Tanju , Greinwald Roland 
Published: October 2020

BackgroundIn patients with mesalazine‐refractory ulcerative colitis, systemic corticosteroids are the treatment of choice.ObjectiveTo evaluate the efficacy and safety of prolonged release budesonide granules for the induction of remission in patients with mesalazine‐refractory ulcerative colitis.MethodsPatients with mesalazine‐refractory ulcerative colitis discontinued mesalazine at baseline and received 9 mg prolonged release budesonide granules daily for 8 weeks in this open‐label, phase IIa study, followed by a 2‐week follow‐up phase wherein patients continued treatment on alternate days (EudraCT number 2014‐005635‐14; ClinicalTrials.gov identifier NCT02550418). The primary endpoint was clinical remission (Clinical Activity Index ≤4; stool frequency <18 per week; absence of rectal bleeding) at Week 8. Secondary endpoints included clinical, endoscopic and histological measures of disease at Week 8. A post hoc analysis assessed histo‐endoscopic mucosal healing. Treatment‐emergent adverse events and morning cortisol levels were assessed throughout the treatment and follow‐up phases.ResultsA total of 61 patients were included in the intention‐to‐treat population; 50 were included in the follow‐up analysis set. Clinical remission was achieved in 29 patients (47.5%; 95% confidence interval: 34.6–60.7%) by Week 8. Mean stool and bloody stool frequency decreased significantly from 32.5 to 22.9 per week (p <0.0001) and from 17.6 to 8.1 per week (p <0.0001), respectively. Rates of mucosal healing, endoscopic remission and histological remission were 58.0%, 54.0% and 36.0%, respectively. Histo‐endoscopic mucosal healing was achieved by 34.0% of patients. Twenty‐four patients (39.3%) experienced treatment‐emergent adverse events, of which gastrointestinal disorders (16.4%) were the most common. Mean morning cortisol levels were not significantly suppressed by Week 8.ConclusionsTreatment with prolonged release budesonide granules for 8 weeks was associated with clinical, endoscopic and histological remission and demonstrated a favourable safety profile in patients with mesalazine‐refractory ulcerative colitis. These results warrant further investigation into the potential of prolonged release budesonide granules as an alternative treatment for this patient population.
The First North American Experience Using Glycosorb Immunoadsorption Columns for Blood Group–Incompatible Kidney Transplantation
Authors: Pavenski Katerina , Buchholz Megan , Cheatley Patti Lou , Krok Elizabeth , Anderson Monique , Prasad GV Ramesh , Qureshi Mohammed Azfar , Meliton Galo , Zaltzman Jeffrey 
Published: October 2020

Background: Blood group incompatibility (ABOi) is the most common barrier to living donor kidney transplantation. Options for such recipients include kidney paired donation (KPD) or desensitization methodology to reduce blood antibody response. Objective: The objective of this study is to report on the first North America experience in ABOi living donor kidney transplantation using Glycosorb ABO immunoadsorption columns. Design: Retrospective observational cohort study. Setting: Renal transplant program at St. Michael’s Hospital, Unity Health Toronto, University of Toronto. Patients: Twenty-six ABOi living donor transplants from August 2011 through February 2020 were undertaken at our center. Measurements: Renal allograft and patient survival postdesensitization for ABOi living donor transplants and isohemagglutinin titer reduction. Methods: Preoperative immunosuppressive regimen consisted of a single dose of Rituximab 375 mg/m2 IV on day −28; tacrolimus, mycophenolic acid, and prednisone to start on day −7. Immunoadsorption treatments with Glycosorb A or B columns were performed on day −7 through day −1 based on anti-A or anti-B titers on Spectra Optia Apheresis System. Immunosuppression included basiliximab, solumedrol followed by oral prednisone, once-daily tacrolimus, and mycophenolic acid. The mean follow-up was 53 months (3-96 months). Results: A total of 26 individuals underwent an attempt at desensitization of whom 24 patients underwent immediate transplant. One patient had a rebound in titers and subsequently was transplanted from a blood group compatible living donor. A second patient had an unrelated medical issue and desensitization was discontinued. Five-year patient survival was 96% and death censored allograft survival was 92%. Posttransplant anti-A or anti-B titers were monitored daily for the first 7 days posttransplant and every 2 days from days 7 to 14. There were no acute rejections seen in this cohort of transplant recipients. Limitations: As our protocol was first initiated as proof of concept, a few recipients had low initial isohemagglutinin titers. This may have contributed to improved clinical outcomes. Conclusions: ABO column immunoadsorption with specific columns is a safe and effective method for ABOi living donor kidney transplantation, and an option when KPD is less than ideal. Trial not registered as this was a retrospective cohort review.
Pre- and postoperative offset and femoral neck version measurements and validation using 3D computed tomography in total hip arthroplasty
Authors: Geijer Mats , Kiernan Sverrir , Sundberg Martin , Flivik Gunnar 
Published: October 2020

Background Restoration of a correct biomechanical situation after total hip arthroplasty is important. Purpose To evaluate proximal femoral symmetry of acetabular and femoral offset and femoral neck anteversion pre- and postoperatively in hip arthroplasty by semi-automated 3D-CT and to validate the software measurements by inter- and intraobserver agreement calculations. Material and Methods In low-dose CT on 71 patients before and after unilateral total hip arthroplasty, two observers used a digital 3D templating software to measure acetabular offset, true and functional femoral offset, and femoral neck anteversion. Observer agreements were calculated using intraclass correlation. Hip measurements were compared in each patient and between pre- and postoperative measurements. Results Preoperatively, acetabular offset (2.4 mm), true (2.2 mm), and functional global offset (2.7 mm) were significantly larger on the osteoarthritic side without side-to-side differences for true and functional femoral offset or femoral neck anteversion. Postoperatively, acetabular offset was significantly smaller on the operated side (2.1 mm) with a concomitantly increased true (2.5 mm) and functional femoral offset (1.5 mm), resulting in symmetric true and functional global offsets. There were no differences in postoperative femoral neck anteversion. Inter- and intraobserver agreements were near-perfect, ranging between 0.92 and 0.98 with narrow confidence intervals (0.77–0.98 to 0.94–0.99). Conclusion Acetabular and concomitantly global offset are generally increased in hip osteoarthritis. Postoperative acetabular offset was reduced, and femoral offset increased to maintain global offset. 3D measurements were reproducible with near-perfect observer agreements. 3D data sets should be used for pre- and postoperative measurements in hip arthroplasty.
Silencing of miR-223 expression inhibits the apoptosis of H2O2-induced cardiomyocytes by increasing the activity of the IGF-1R/PI3K/AKT pathway
Authors: Zhou Qianqian , Li Yufen , Gu Tianjin 
Published: October 2020

To study the: (1) function of micro (mi)R-223 on H2O2-induced H9C2 cells; (2) relationship between miR-223 and insulin-like growth factor 1 receptor (IGF-1R); and (3) role of miR-223 on the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway. H9C2 cells were selected to establish the H2O2-injury model. Overexpression/low expression of miR-223 in H9C2 cells was constructed, respectively. Flow cytometry and western blotting were applied to measure the apoptosis, cell activity, and expression of related proteins. Dual-luciferase reporter gene assays (DLRGAs) were applied to test if miR-223 targeted IGF-1R. Overexpression/low expression of IGF-1R was constructed to test if miR-223 regulated IGF-1R expression negatively. Increases in miR-223 expression were observed in H2O2-induced H9C2 cells. miR-223 absence improved H2O2-induced H9C2-cell apoptosis accompanied by an increase in B-cell lymphoma (Bcl)-2 expression and decrease in expression of Bax and cleaved caspase-3 ( P < 0.05). miR-223 silencing increased expression of IGF-1R, p-PI3K, and p-AKT in H2O2-induced H9C2 cells ( P < 0.05). miR-223 overexpression aggravated H2O2-induced H9C2-cell apoptosis and reduced expression of the proteins of IGF-1R, p-PI3K, and p-AKT. DLRGAs showed IGF-1R to be a downstream gene of miR-223. IGF-1R silencing significantly inhibited expression of p-PI3K and p-AKT proteins ( P < 0.05). miR-223 negatively regulated IGF-1R expression for H9C2-cell apoptosis and the PI3K/AKT pathway. miR-223 absence can ameliorate H2O2-induced cardiomyocyte apoptosis by targeting IGF-1R to regulate PI3K/AKT activity.
Lateral Trochlear Inclination Angle: Measurement via a 2-Image Technique to Reliably Characterize and Quantify Trochlear Dysplasia
Authors: Joseph Sheeba M. , Cheng Chris , Solomito Matthew J. , Pace J. Lee 
Published: October 2020

Background: Trochlear dysplasia (TD) is a risk factor for patellar instability (PI). The Dejour classification categorizes TD but has suboptimal reliability. Lateral trochlear inclination (LTI) is a quantitative measurement of trochlear dysplasia on a single axial magnetic resonance imaging (MRI) scan. Hypothesis: A modified LTI measurement technique using 2 different axial MRI scans that reference the most proximal aspect of the trochlear cartilage on 1 image and the fully formed posterior condyles on the second image would be as reliable as and significantly different from the single-image measurement technique for LTI. Further, the 2-image LTI would adequately represent overall proximal trochlear morphologic characteristics. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients aged 9 to 18 years treated for PI between 2014 and 2017 were identified. The Dejour classification was radiographically determined. Single-image LTI was measured on a single axial MRI scan at the most proximal aspect of visible trochlear cartilage. A 2-image LTI was measured from 2 separate MRI scans: 1 at the most proximal aspect of trochlear cartilage and the second at the fully formed posterior condyles. This 2-image LTI was repeated at 3 subsequent levels (the first measurement is referred to as LTI-1; repeated measurements are LTI-2, LTI-3, and LTI-4, moving distally). In total, 65 patients met the inclusion criteria, and 30 were randomly selected for reliability analysis. Results: Inter- and intrarater reliability trended toward more variability for single-image LTI (intraclass correlation coefficient [ICC], 0.86 and 0.88, respectively) than for 2-image LTI (ICC, 0.97 and 0.96, respectively). The Dejour classification had lower intra- and interrater reliability (ICC, 0.31 and 0.73, respectively). Average single-image LTI (9.2° ± 12.6°) was greater than average 2-image LTI-1 (4.2° SD ± 11.9°) ( P = .0125). Single-image LTI classified 60% of patients with PI as having TD, whereas the 2-image LTI classified 71% as having TD. The 2-image LTI was able to capture 91% of overall proximal trochlear morphologic characteristics. Conclusion: LTI has higher reliability when performed using a 2-image measurement technique compared with single-image LTI and Dejour classification. The strong correlation between 2-image LTI and average LTI shows that 91% of TD is represented on the most proximal axial image. Because the single-image measurement appears to underestimate dysplasia, previously described thresholds should be reexamined using this 2-image technique to appropriately characterize TD.
Lung Ultrasonography: An Emerging Practice
Authors: Kuchenmeister Melissa 
Published: October 2020

Objective: Sonography of the chest has traditionally been focused on chest wall and pleural space. Over time, clinicians have developed a practice of bedside lung ultrasonography (LUS) to supplement physical examination. In the wake of the SARS-COV-2 (COVID-19) pandemic, clinicians have increasingly turned to LUS as a tool to assess a patient’s condition. Methods: A literature search was performed using Google Scholar with access to articles through a major Midwestern university. Results: Computed tomography (CT) and radiographs are not always available in all treatment centers. While LUS may be limited, it is important to correlate findings with compatible imaging modalities. This review summarizes lung pathologies and the sonographic appearance of lung abnormalities. Conclusions: Radiology professionals have largely questioned the practice and findings of LUS. However, now, as the most qualified experts in the use of ultrasound, sonographers and radiologists have a duty to be educated in the use of LUS.
Application of transthoracic shear-wave ultrasound elastography in lung lesions
Authors: Kuo Yao-Wen , Chen Yen-Lin , Wu Huey-Dong , Chien Ying-Chun , Huang Chun-Kai , Wang Hao-Chien 
Published: October 2020

IntroductionTissue stiffness information may help in the diagnosis of lung lesions. This study aimed to investigate and validate the application of transthoracic two-dimensional shear-wave ultrasound elastography in differentiating malignant from benign subpleural lung lesions.MethodsThis study involved one retrospective observational derivation cohort from January 2016 to December 2017 and one prospective observational validation cohort from December 2017 to December 2019. The inclusion criterion was radiographic evidence of pulmonary lesions. The patients were categorised into air bronchogram and hypoechoic groups based on B-mode grayscale images. The elasticity of subpleural lung lesions with acceptable shear-wave propagation was measured. Diagnoses were made on the basis of pathology, microbiological studies or following up the clinical course for at least 6 months.ResultsA total of 354 patients were included. Among the 121 patients in the derivation cohort, a receiver operating characteristic curve was constructed and the cut-off point to differentiate benign from malignant lesions was 65 kPa with a Youden index of 0.60 and an accuracy of 84.3%. Among the 233 patients in the validation cohort, the diagnostic performance was maintained, with a Youden index of 0.65 and an accuracy of 86.7%. Upon applying the cut-off point to the air bronchogram group, the Youden index was 0.70 and the accuracy was 85.0%.ConclusionsThis study validated the application of transthoracic shear-wave ultrasound elastography for assessing lung malignancy. A cut-off point of 65 kPa is suggested for predicting lung malignancy. Furthermore, for pulmonary air bronchogram lesions with high elasticity, tissue proofing should be considered because of the high possibility of malignancy.
Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients
Authors: Shiraishi Masashi , Higashimoto Yuji , Sugiya Ryuji , Mizusawa Hiroki , Takeda Yu , Fujita Shuhei , Nishiyama Osamu , Kudo Shintarou , Kimura Tamotsu , Chiba Yasutaka , Fukuda Kanji , Tohda Yuji 
Published: October 2020

BackgroundAlthough the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with COPD are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD.MethodsPatients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DEmax). Ventilation parameters, including the change in inspiratory capacity (ΔIC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DEmaxand the ventilation parameters.ResultsThe DEmaxof patients with COPD was significantly lower than that of the controls (45.0±12.8 mmversus64.6±6.3 mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DEmaxin patients with COPD. During CPET, oxygen uptake/weight (V′O2/W) and minute ventilation (V′E) were significantly positively correlated with DEmax, whileV′E/V′O2andV′E/carbon dioxide output (V′CO2) were significantly negatively correlated with DEmaxin patients with COPD. DEmaxwas also significantly positively correlated with ΔIC, reflecting DLH, and withV′O2/W, reflecting exercise capacity.ConclusionReduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients.
miRNA-23b as a biomarker of culture-positive neonatal sepsis
Authors: Fatmi Ahlam , Rebiahi Sid Ahmed , Chabni Nafissa , Zerrouki Hanane , Azzaoui Hafsa , Elhabiri Yamina , Benmansour Souheila , Ibáñez-Cabellos José Santiago , Smahi Mohammed Chems-Eddine , Aribi Mourad , García-Giménez José Luis , Pallardó Federico V. 
Published: October 2020

Abstract
Background
Neonatal sepsis remains an important cause of morbidity and mortality. The ability to quickly and accurately diagnose neonatal sepsis based on clinical assessments and laboratory blood tests remains difficult, where haemoculture is the gold standard for detecting bacterial sepsis in blood culture. It is also very difficult to study because neonatal samples are lacking.

Methods
Forty-eight newborns suspected of sepsis admitted to the Neonatology Department of the Mother-Child Specialized Hospital of Tlemcen. From each newborn, a minimum of 1–2 ml of blood was drawn by standard sterile procedures for blood culture. The miRNA-23b level in haemoculture was evaluated by RT-qPCR.

Results
miR-23b levels increased in premature and full-term newborns in early onset sepsis (p < 0.001 and p < 0.005 respectively), but lowered in late onset sepsis in full-term neonates (p < 0.05) compared to the respective negative controls. miR-23b levels also increased in late sepsis in the negative versus early sepsis negative controls (p < 0.05). miR-23b levels significantly lowered in the newborns who died from both sepsis types (p < 0.0001 and p < 0.05 respectively). In early sepsis, miR-23b and death strongly and negatively correlated (correlation coefficient = − 0.96, p = 0.0019). In late sepsis, miRNA-23b and number of survivors (correlation coefficient = 0.70, p = 0.506) positively correlated.

Conclusions
Lowering miR-23b levels is an important factor that favours sepsis development, which would confirm their vital protective role, and strongly suggest that they act as a good marker in molecular diagnosis and patient monitoring.