bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of transvenous lead extraction using the TightRail™ mechanical rotating dilator sheath and excimer laser sheath
Authors: Misra Satish , Swayampakala Kamala , Coons Patricia , Cerbie Claire , Guifarro Angello , Lesiczka Magdalena , Holshouser John W. , Madjarov Jeko , Love Charles , Mehta Rohit 
Published: May 2021

AbstractBackgroundTransvenous lead extraction (TLE) is an important part of comprehensive lead management. The selection of tools available has expanded in recent years but data on their efficacy is limited.ObjectiveTo evaluate outcomes using the TightRail™ mechanical rotating mechanical dilator sheath in comparison to excimer laser sheaths and describe factors predictive of successful extraction.MethodsPatients undergoing TLE at a single tertiary center (2013–2019) were included in a prospective registry. Leads targeted for extraction with either an SLS II/Glidelight™ or TightRail™ sheath were included. Outcomes were analyzed on a per‐lead basis. Generalized estimating equation (GEE) models were used to assess differences in lead extraction success by extraction tool used while adjusting for nonindependence of multiple leads extracted from the same patient. Covariates included patient comorbidities, lead characteristics, and sheath size.ResultsA total of 575 leads extracted from 372 patients were included. Overall success rate was 97%. TightRail™ was the first tool used in 180 (31.3%) leads with success rate of 61.7%; laser sheaths were the first tool in 395 leads (68.7%) with success rate of 67.8%. Predictors of successful extraction included lead age, lead type, and sheath sizing. Extraction success did not differ based on whether a laser or TightRail™ sheath was used (adjusted odds ratio = 0.94; 95% confidence interval = 0.59–1.50).ConclusionThe TightRail™ sheath is an effective tool for TLE. Lead age, lead type, and sheath sizing were predictive of successful extraction but sheath type was not. These findings are hypothesis generating and warrant further investigation in a prospective, randomized study.
Pulmonary vein isolation guided by moderate ablation index targets combined with strict procedural endpoints for patients with paroxysmal atrial fibrillation
Authors: Wang Yan‐Jiang , Tian Ying , Shi Liang , Zeng Li‐Jun , Xie Bo‐qia , Li Xue‐xun , Yang Xin‐Chun , Liu Xing‐Peng 
Published: May 2021

AbstractIntroductionAblation index (AI)‐guided radiofrequency ablation has been increasingly used for the treatment of drug‐resistant paroxysmal atrial fibrillation (AF)，but the optimal AI targets remain to be determined. We aimed to examine the efficacy and safety of catheter ablation guided by moderate AI values but more strict procedural endpoints in patients with paroxysmal AF.MethodsWe conducted a retrospective review of a consecutive series of patients who received their first AI‐guided ablation for paroxysmal AF from 2017 to 2018. The standard procedural protocol recommends AI targets as follows: anterior: 400–450; posterior: 280–330; and roof/inferior wall: 380–430. After circumferential pulmonary vein isolation (PVI), we performed bipolar pacing along the ablation line, adenosine triphosphate (ATP)‐provocation, and waited for 30 min to verify PVI. The primary clinical outcome was the rate of freedom from AF recurrence at 12 months.ResultsA total of 140 consecutive patients were included. The mean procedure and ablation times were 132.2 ± 30.2 min and 24.2 ± 7.9 min, respectively. The first‐pass isolation and final isolation rates were documented in 49.3% and in 100% of the patients, respectively. At 12 months, single‐procedure freedom from atrial tachyarrhythmias was observed in 92.1% of patients. No major procedure‐related complications were encountered.ConclusionsModerate AI‐guided catheter ablation is highly effective for the treatment of drug‐refractory paroxysmal AF in real‐world settings. Over 90% of patients achieved single‐procedure arrhythmia‐free survival at 1 year. The outcome was obtained without major complications and the procedure involved relatively short procedure and ablation times.
Durability of mitral isthmus ablation with and without ethanol infusion in the vein of Marshall
Authors: Ishimura Masayuki , Yamamoto Masashi , Himi Toshiharu , Kobayashi Yoshio 
Published: May 2021

AbstractIntroductionEthanol infusion in the vein of Marshall (EIVOM) effectively creates a linear ablation lesion in the mitral isthmus (MI). However, data on the long‐term success rates of MI ablation is limited.Methods and ResultsOur cohort consisted of 560 patients with nonparoxysmal atrial fibrillation (AF) who underwent an initial MI ablation. Ablations were performed by only radiofrequency (RF) in 384 (RF group) or by RF and EIVOM in 176 (EIVOM/RF group) patients; 5 ml anhydrous ethanol was used to perform EIVOM in advance of RF. Following EIVOM, RF pulses were delivered to the lateral MI line. Bidirectional MI block was fully achieved in 353/384 (92%) (First 318, Re‐do 35) patinents in the RF group and 171/176 (97%) (First 128, Re‐do 43) patients in the EIVOM/RF group (p = .09 in the first, p = .10 in the re‐do ablation cases). In cases with complete MI line block, recurrent AF or atrial tachycardia was observed in 130/353 (37%) patients in the RF group and in 64/171 (37%) patients in the EIVOM/RF group (log‐rank p = .12 in the first, and p = .30 in the re‐do ablation cases). Of the total 560 patients, 123 proceeded to the subsequent ablation session. Reconduction across MI line block was observed in 39/80 (49%) patients in the RF group and 25/43 (58%) patients in the EIVOM/RF group (p = .32).ConclusionEIVOM effectively ensures MI line block; however, the reconduction rate was similar between the two groups.
Prevalence and incidence of patients with paroxysmal supraventricular tachycardia in the United States
Authors: Rehorn Michael , Sacks Naomi C. , Emden Maia R. , Healey Bridget , Preib Madison T. , Cyr Philip L. , Pokorney Sean D. 
Published: May 2021

AbstractBackgroundParoxysmal supraventricular tachycardia (PSVT) encompasses a range of heart rhythm disorders leading to rapid heart rates. By virtue of its episodic nature, diagnosing PSVT is difficult and estimating incidence and prevalence on a population level is challenging. The objective of this study was to estimate the incidence and prevalence of PSVT in the United States (US) in contemporary practice.Methods and ResultsAn observational retrospective longitudinal study using claims, enrollment, and demographic data from the IBM MarketScan® Commercial Research database (age < 65) and the Medicare Limited Data Set (age ≥ 65) from 2008 to 2016. Patients with a PSVT diagnosis code (ICD‐9: 427.0; ICD‐10: I47.1) on ≥2 outpatient, ≥1 emergency room, or ≥1 inpatient visit were considered as having PSVT. Patients with atrial fibrillation/atrial flutter (AF/AFL) were excluded from the initial analysis given the potential for misclassification. Incidence was estimated by assessing diagnoses made during year 5 of continuous enrollment. Finally, a sensitivity analysis was performed by including patients with both PSVT and AF/AFL diagnoses. Period prevalence and incidence rate were estimated to be 332.9 (323.2–342.9) and 57.8 (52.8–63.3) per 100 000 individuals, respectively, when excluding patients with AF/AFL. Projected to the 2018 US Census, prevalence and incidence are 1.26 million (1.21–1.30 million) and 188,981 (172,891–206,943), respectively. Including patients with AF/AFL, the prevalence may increase to 479.7 (467.9–491.8) with an incidence of 93.4 (86.9–100.5) per 100 000 individuals or a prevalence of 2.06 million (2.01–2.12 million).ConclusionsApproximately 1 in 300 people in the US had PSVT with the highest rates in older and female patients.
A randomised controlled trial (MindChamp) of a mindfulness‐based intervention for children with ADHD and their parents
Authors: Siebelink Nienke M. , Bögels Susan M. , Speckens Anne E. M. , Dammers Janneke T. , Wolfers Thomas , Buitelaar Jan K. , Greven Corina U. 
Published: May 2021

BackgroundFamily mindfulness‐based intervention (MBI) for child attention‐deficit/hyperactivity disorder (ADHD) targets child self‐control, parenting and parental mental health, but its effectiveness is still unclear.MethodsMindChamp is a pre‐registered randomised controlled trial comparing an 8‐week family MBI (called ‘MYmind’) in addition to care‐as‐usual (CAU) (n = 55) with CAU‐only (n = 48). Children aged 8–16 years with remaining ADHD symptoms after CAU were enrolled together with a parent. Primary outcome was post‐treatment parent‐rated child self‐control deficits (BRIEF); post hoc, Reliable Change Indexes were explored. Secondary child outcomes included ADHD symptoms (parent/teacher‐rated Conners’ and SWAN; teacher‐rated BRIEF), other psychological symptoms (parent/teacher‐rated), well‐being (parent‐rated) and mindfulness (self‐rated). Secondary parent outcomes included self‐ratings of ADHD symptoms, other psychological symptoms, well‐being, self‐compassion and mindful parenting. Assessments were conducted at post‐treatment, 2‐ and 6‐month follow‐up.ResultsRelative to CAU‐only, MBI+CAU resulted in a small, statistically non‐significant post‐treatment improvement on the BRIEF (intention‐to‐treat: d = 0.27, p = .18; per protocol: d = 0.33, p = .11). Significantly more children showed reliable post‐treatment improvement following MBI+CAU versus CAU‐only (32% versus 11%, p < .05, Number‐Needed‐to‐Treat = 4.7). ADHD symptoms significantly reduced post‐treatment according to parent (Conners’ and SWAN) and teacher ratings (BRIEF) per protocol. Only parent‐rated hyperactivity impulsivity (SWAN) remained significantly reduced at 6‐month follow‐up. Post‐treatment group differences on other secondary child outcomes were consistently favour of MBI+CAU, but mostly non‐significant; no significant differences were found at follow‐ups. Regarding parent outcomes, significant post‐treatment improvements were found for their own ADHD symptoms, well‐being and mindful parenting. At follow‐ups, some significant effects remained (ADHD symptoms, mindful parenting), some additional significant effects appeared (other psychological symptoms, self‐compassion) and others disappeared/remained non‐significant.ConclusionsFamily MBI+CAU did not outperform CAU‐only in reducing child self‐control deficits on a group level but more children reliably improved. Effects on parents were larger and more durable. When CAU for ADHD is insufficient, family MBI could be a valuable addition.
Computational fluid dynamics analysis of cabinet‐type solar dryer
Authors: Chaudhari Vishal D. , Kulkarni Govind N. , Sewatkar Chandrashekhar M. 
Published: May 2021

AbstractOne of the major constraints in the acceptability of solar dryer in industrial and commercial applications is lack of control on the drying process due to variable, periodic, and dilute availability of solar heat. For reliable operation, process control with auxiliaries become essential in industrial solar dryers. Integration of solar dryers with auxiliaries is also not studied substantially. This research document focuses on CFD simulation of cabinet‐type solar dryer integrated with auxiliaries, which can be operated under different operating conditions. The dryer is equipped with auxiliary heaters and blowers to have precise control over the temperature inside the chamber. The simulations are carried out for drying temperature of 318 K. The results showed that as the day progresses (radiation intensity increases), the region of average temperature increases. The extent of temperature distribution also helps to locate the region of temperature around the drying temperature. Also to facilitate the control of input energy by the auxiliary heaters, a region is located where the average temperature of air inside the drying chamber can be obtained for varying operating conditions. The region lies about 1.2–1.6 m on X‐ordinate, 0.8–1.0 m on Y‐ordinate, and 0.7–1.2 and 3.7–4.3 m on Z‐ordinate. Thus, a feedback loop developed can modulate the input and make it possible to operate the dryer with maximum effectiveness.Practical ApplicationsThe potential for utilization of solar thermal energy in commercial and industrial drying applications up to air temperature of 80°C is remarkable. Solar dryers integrated with an auxiliary heating arrangement assure to save a lot of fossil fuel energy. Reliability and uninterrupted operation are the major requirements from a solar dryer. The manuscript presents computational fluid dynamics analysis of the solar dryer equipped with auxiliary heating. The extent of temperature distribution is determined for dryer with and without auxiliary heating and it clearly reveals that proper auxiliary heating control, helps to maintain temperature inside the dryer. Also the effect of variation of geometry and variation of solar radiation is studied and common region is found which can help to modulate the auxiliary heating. It provided sound background for feedback control mechanism design that will keep temperature near the drying temperature of product and improve drying product quality.
Patient participation in shared decision‐making in palliative care – an integrative review
Authors: Kuosmanen Lotta , Hupli Maija , Ahtiluoto Satu , Haavisto Elina 
Published: May 2021

AbstractBackgroundShared decision‐making is a process where the decisions regarding patients’ care are done in collaboration with the patient, the patient's family and a healthcare professional or an interdisciplinary team. Shared decision‐making is considered to be a part of patient centred care, and it enables patient autonomy which is a cornerstone of palliative care. In the past, research on the experiences of palliative care patients’ participation in shared decision‐making involving a nurse has been limited as the focus has mainly been on specific medical interventions, rather than holistic palliative care.ObjectivesTo synthesise research findings on patient participation in shared decision‐making in palliative care.Research designAn integrative literature review.MethodsThe literature search was conducted by searching computerised databases (CINAHL, PubMed, PsychINFO and COCHRANE). The search resulted in 12 articles. The quality of the included articles was evaluated with JBI checklist, and the data analysis was done using inductive content analysis. Reporting was done according to a PRISMA checklist.FindingsPatients do participate in shared decision‐making and desire to participate in everyday nursing care decisions, treatment‐related medical decisions and end‐of‐life decisions. The prerequisites for patient participation in shared decision‐making are interdisciplinary teamwork, open communication, good patient–healthcare professional relationship, a favourable environment and mutual information.ConclusionPalliative care patients do participate and desire to participate in decisions that cover a much broader range of topics than just medical interventions and this should be addressed in future research and in practise. The main responsibility for successful patient participation in shared decision‐making lies with the healthcare professionals and the organisations providing palliative care. There is a need to conduct more research from the patient's perspective and explore the meaning of participating in shared decision‐making from the patient's point of view.
Structuring Mortgages for Macroeconomic Stability
Authors: CAMPBELL JOHN Y. , CLARA NUNO , COCCO JOÃO F. 
Published: May 2021

ABSTRACTWe study mortgage design features aimed at stabilizing the macroeconomy. We model overlapping generations of borrowers and an infinitely lived risk‐averse representative lender. Mortgages are priced using an equilibrium pricing kernel derived from the lender's endogenous consumption. We consider an adjustable‐rate mortgage with an option that during recessions allows borrowers to pay only interest on their loan and extend its maturity. The option stabilizes consumption growth over the business cycle, shifts defaults to expansions, and enhances welfare. The cyclical properties of the contract are attractive to a risk‐averse lender so that the mortgage can be provided at a relatively low cost.
Factors associated with the inconsistent diagnosis between frozen section and permanent pathologic examination in borderline ovarian tumors
Authors: Chen Ying‐Yi , Lin Hao , Wu Chen‐Hsuan , Lan Jui , Tsai Ching‐Chou , Fu Hung‐Chun , Ou Yu‐Che 
Published: May 2021

AbstractAimThe predictive accuracy of frozen sections for borderline ovarian tumors (BOTs) is suboptimal. The aim of this study was to determine the diagnostic accuracy of BOTs and factors associated with an upgrade to a permanent pathological diagnosis of invasive carcinoma in patients diagnosed with BOTs by frozen section.MethodsWe conducted a retrospective study between 2011 and 2018 at Kaohsiung Chang Gung Memorial Hospital (KCGMH). Two hundred and twenty‐five records of eligible patients with a diagnosis of BOT by frozen section or permanent diagnosis were reviewed. Positive predictive value and the diagnostic accuracy of frozen sections were calculated. Univariate and multivariate analyses were used to determine the clinicopathological factors associated with an upgrade of the diagnosis from a borderline tumor to malignancy.ResultsThe agreement between frozen section and permanent pathological diagnoses was 63.1%, and the positive predictive value was 72.1%. The multivariate analysis revealed that CA‐125 level > 136 U/mL (odds ratio [OR] = 2.96, 95% confidence interval [CI] = 1.3–6.9; p = 0.012), and tumor histologic type (clear cell/endometrioid vs. mucinous; OR:32.8, 95% CI = 6.9–154.8, p < 0.001; clear cell/endometrioid vs. serous: OR 48.1, 95% CI = 8.8–261.8, p < 0.001) were independent risk factors for an upgrade of the permanent diagnosis from a BOT to ovarian carcinoma.ConclusionAn elevated CA‐125 level (over 136 U/mL) and tumor histologic type (clear cell and endometrioid subtypes) were associated with an upgrade in the diagnosis of ovarian tumor from a BOT on frozen section to a permanent diagnosis of malignancy.
The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation
Authors: Hatirnaz Ebru , Hatirnaz Safak , Kanat‐Pektas Mine , Dokuzeylul Gungor Nur , Erol Onur , Kalyoncu Senol , Dahan Michael H. 
Published: May 2021

AbstractObjectiveThis study aims to determine the effects of early and late onset estrogen supplementation on the immature oocyte retrieval, fertilization and clinical pregnancy rates in follicle stimulating hormone (FSH) and human chorionic hormone (hCG) primed in vitro maturation (IVM) cycles of the patients with polycystic ovary syndrome (PCOS).MethodsThis is a retrospective analysis of 161 patients with PCOS who underwent FSH and hCG primed IVM. Group 1 included 120 patients who received early onset estrogen supplementation while group 2 consisted of 41 patients who had late onset estrogen supplementation in primed IVM cycles. Immature oocyte (germinal vesicle and/or metaphase I) retrieval and fertilization rates were the primary outcomes, whereas clinical pregnancy and live rates were the secondary outcomes.ResultsGroup 1 patients had significantly higher body mass index and more previous IVF attempts (p = 0.001 and p = 0.008, respectively). All of the retrieved oocytes from the PCOS patients were either germinal vesicle or metaphase I oocytes and there were no metaphase II oocytes among the retrieved oocytes. Both groups had statistically similar numbers of metaphase I and fertilized oocytes (p > 0.05 for both). However, group 1 patients had significantly lower number of germinal vesicle oocytes but significantly higher number of metaphase II oocytes (p = 0.001 for both). Both groups had statistically similar fertilization (85.0% vs 78.0%), clinical pregnancy (49.2% vs 43.9%) and live birth (37.5% vs 39.0%) rates (p > 0.05 for all).ConclusionEarly onset estrogen supplementation appears to improve the quality of retrieved immature oocytes and contribute to the maturation of oocytes in stimulated IVM cycles.
Persistent fontanelles in Chihuahuas. Part I. Distribution and clinical relevance
Authors: Kiviranta Anna‐Mariam , Rusbridge Clare , Lappalainen Anu K. , Junnila Jouni J. T. , Jokinen Tarja S. 
Published: May 2021

AbstractBackgroundThe Chihuahua dog breed is known for frequent occurrence of a bregmatic fontanelle on the dorsal skull. A common conception is that this skull defect is a clinically irrelevant finding. No studies, however, describe its prevalence or whether it is accompanied by other persistent fontanelles (PFs). Although Chihuahuas are predisposed to Chiari‐like malformation (CM) and syringomyelia (SM), it is unknown whether PFs occur more commonly in dogs with clinical signs that are caused by CM or SM.Hypothesis/ObjectivesTo describe the number and location of PFs at cranial sutures (CSs) and to compare the occurrence of these PFs in dogs with and without CM/SM‐related clinical signs. We hypothesized that PFs also occur commonly at lateral and caudal cranial surfaces, affect a higher number of CSs, and are larger in dogs with CM/SM‐related clinical signs.AnimalsFifty client‐owned Chihuahuas with or without CM/SM‐related clinical signs.ResultsOf the 50 dogs evaluated, 46 (92%) had either 1 or several PFs. The mean ± SD number of PFs was 2.8 ± 3.0 (range, 0‐13). A total of 138 PFs occupied 118 CSs with 57 (48%) located dorsally, 44 (37%) caudally, and 17 (14%) laterally. The number of CSs affected by PFs was significantly higher (P ≤ .001) and total PF area was significantly larger (P = .003) in dogs with CM/SM‐related clinical signs.Conclusions and Clinical ImportancePersistent fontanelles are very common in this group of Chihuahuas and appear at dorsal, lateral, and caudal cranial surfaces. They are more numerous and larger in Chihuahuas with CM/SM‐related clinical signs.
Abnormal cholesterol metabolism underlies relative adrenal insufficiency in decompensated cirrhosis
Authors: Wentworth Brian J. , Haug Rebecca M. , Northup Patrick G. , Caldwell Stephen H. , Henry Zachary H. 
Published: May 2021

AbstractBackground and AimsRelative adrenal insufficiency (RAI) in patients with cirrhosis is associated with increased mortality. Although the pathogenesis of RAI remains unclear, disordered cholesterol metabolism may contribute.MethodsWe performed a prospective cohort study of 96 non‐critically ill subjects with decompensated cirrhosis at a tertiary care centre. Subjects were administered 250 µcg cosyntropin, with RAI defined as an increase in total cortisol <9 µg/dL. High‐density lipoprotein (HDL) levels and serum cholesterol esterification percentage (%CE), a validated surrogate marker of lecithin‐cholesterol acyltransferase (LCAT) activity, were measured to assess the relationship between disordered cholesterol metabolism and the presence of RAI. Subjects were followed until death, liver transplantation or a maximum of 6 months.ResultsSubjects with RAI had decreased levels of HDL (18 vs 29 mg/dL, P < .01) and %CE (64% vs 66%, P = .03). Correlation was seen between HDL and %CE (r = 0.7, R2 = 0.49; P < .01) and each integer decrease in %CE predicted an approximately 2% increase in the probability of RAI. Transplant‐free survival was reduced in subjects with RAI at both 6 months (43% vs 71%, P = .01) and 90 days (54% vs 81%, P < .01).ConclusionsDisruption in cholesterol metabolism contributes to the development of RAI in cirrhosis, as decreased LCAT activity leads to reduced HDL trafficking to the adrenal gland.