bluuebunny/crossref_metadata_2025_split huggingface dataset:
The problem of strict image-based inclusion criteria for mechanical thrombectomy – an analysis of stroke patients with an initial low CBV-ASPECTS score
Authors: Schnieder M , Psychogios MN , Maier IL , Tsogkas I , Schregel K , Kleinknecht A , Knauth M , Bähr M , Liman J , Behme D 
Published: May 2019

Introduction Endovascular treatment for acute ischaemic stroke with large artery occlusion has become the standard of care. However, the question if a subgroup of patients, with a low cerebral blood volume Alberta Stroke Program Early CT score (CBV-ASPECTS) ≤ 7 should be excluded from endovascular treatment remains open. Therefore; we investigated the difference of outcome between patients who were treated by endovascular treatment vs patients who did not receive endovascular treatment. Methods We retrospectively analysed our stroke database for all patients who presented within six hours of onset with unfavourable imaging findings and who received endovascular treatment or best medical treatment alone. Unfavourable imaging was defined as a CBV-ASPECTS ≤ 7, which was an exclusion criterion for endovascular treatment at our institution before 2015. Results From 60 patients with an initial CBV-ASPECTS ≤ 7, 40 received best medical treatment and 20 were treated with endovascular treatment. Arterial hypertension and atrial fibrillation was more present in patients without endovascular treatment, the other baseline characteristics and percentage of patients treated with intravenous recombinant tissue plasminogen activator were not significantly different in both groups. At discharge, 40% of the interventional treated patients had a favourable outcome (eight of 20 (40%) vs six of 40 (15%; p = 0.031). The median values of the National Institute of Health Stroke Score and modified Rankin Scale at discharge were significantly lower in the treated cohort (6.5 (2.5–10.5) vs 16 (9.5–22.5); p = 0.006; 3 (0–5.5) vs 5 (4.5–5.5); p = 0.003). Conclusion Patients with a CBV-ASPECTS ≤ 7 are likely to benefit from therapy and therefore may not be excluded from endovascular treatment. Further randomised trials are warranted to validate the data.
HDL: Fact, fiction, or function? HDL cholesterol and cardiovascular risk
Authors: Allard-Ratick Marc P , Kindya Bryan R , Khambhati Jay , Engels Marc C , Sandesara Pratik B , Rosenson Robert S , Sperling Laurence S 
Published: May 2019

Abstract
The measurement of high-density lipoprotein cholesterol is highly utilized by clinicians to help predict cardiovascular risk, but this measure is not causally associated with atherosclerotic cardiovascular disease events. The use of Mendelian randomization studies has led to a change in investigative attention from the high-density lipoprotein cholesterol concentration to its physiological functions. High-density lipoprotein plays key roles in important pathways related to the development of atherosclerotic disease including reverse cholesterol transport, oxidation and inflammation, and endothelial function as well as in other physiological systems including immune system modulation, cellular apoptosis, and endothelial progenitor cell homeostasis. The identification of dysfunctional high-density lipoprotein may better predict future cardiovascular events compared to numerical high-density lipoprotein cholesterol and aid in enhanced clinical risk stratification. The emergence of discrete physiological measurements of high-density lipoprotein, such as cholesterol efflux capacity and the high-density lipoprotein inflammatory index, may provide an opportunity for clinical application in the future. However, the validity of these measurements and their commercial availability remain barriers to a realistic transition to clinical medicine.
Full recovery from extreme hypernatremia in an elderly woman with hyperosmolar hyperglycemic syndrome and abnormal electroencephalogram
Authors: Galili Yehuda , Gonzalez Chad , Lytle Meghan , Carlan SJ , Madruga Mario 
Published: May 2019

Background: Hyperosmolar hyperglycemic state is a life-threatening endocrine disorder that most commonly affects adults with type 2 diabetes mellitus. The condition results from an osmotic diuresis-induced loss of water exceeding that of sodium. Altered mental status, hypernatremia and hyperglycemia are characteristic features at presentation. Abnormal electroencephalogram findings have been reported. Successful therapy requires judicious fluid replacement and close monitoring. Case: A 78-year-old Hispanic female with a significant past medical history of type 2 diabetes mellitus was admitted with altered mental status, severe hypernatremia and hyperglycemia. She was diagnosed with hyperosmolar hyperglycemic state, and fluid therapy was started. A continuous electroencephalogram revealed left frontocentral and temporal periodic lateralized epileptiform discharges that resolved as her hypernatremia and dehydration were treated. She survived and was discharged after 1 week of treatment. Conclusion: Abnormal electroencephalogram findings consistent with nonconvulsive seizure activity may be temporary and reversible and do not suggest a poor prognosis in an elderly patient suffering from hyperosmolar hyperglycemic state and altered mental status.
Comparison of lower limb segment forces during running on artificial turf and natural grass
Authors: McMurtry Shea , Fiedler Goeran 
Published: May 2019

Introduction: Artificial turf, soon after being introduced in the 1980s, became associated with an increased injury incidence in football players. While more recent generations of artificial turf have mitigated the problem, perception of the material is still widely negative. So, the decision to play the 2015 Fe'de'ration Internationale de Football Association Women s World Cup in Canada on artificial turf was met with vocal criticism by many players. One common approach is to assess injury incidence to quantify risk differences in playing surfaces. This, however, does not account for possible confounding variables or chronic injuries. Direct measurement of ground reaction forces is difficult because conventional multicamera-based motion capture and force plate equipment are limited in its use outside of dedicated laboratories. Methods: We describe a method of generating realistic force data by using miniature load cells that are installed directly into the weight-bearing structure of the body. Results: Pilot data show a significant (p<0.01) difference in peak forces on artificial turf (272% of body weight) and natural grass (229% of body weight). Discussion: Invasive surgical procedures were avoided by installing the load cell into the prosthesis of an athlete with lower limb loss. As modern prosthetic devices allow a close approximation of able-bodied kinematics and kinetics, such prosthesis-based data are transferable to a general population.
T1a renal cell carcinoma on unenhanced CT: analysis of detectability and imaging features
Authors: Gobara Aiko , Yoshizako Takeshi , Yoshida Rika , Nakamura Megumi , Shiina Hiroaki , Kitagaki Hajime 
Published: May 2019

Background Increasing use of unenhanced computed tomography (CT) has been associated with the increasing incidental detection of renal cell carcinoma (RCC) at an earlier stage. Purpose To evaluate the characteristics in detecting and differentiating T1a RCCs on unenhanced CT. Material and Methods We retrospectively reviewed 68 patients with 68 T1a RCCs and 39 benign regions. Two radiologists interpreted the images on unenhanced axial CT and performed a blinded and independent review of T1a RCCs. The readers evaluated the presence of RCC and differentiated the detected lesions. Results The consensus of two readers detected 53 (78%) RCCs. Of the 53 detected RCCs, 42 (62%) RCCs were correctly diagnosed and 11 (16%) masses were misdiagnosed as benign. Of the 39 benign regions, 29 (74%) cysts were diagnosed correctly, but 10 (26%) cysts were misdiagnosed as malignant. The following values of the radiologists were obtained by consensus: sensitivity = 61.8% (42/68); specificity = 74.4% (29/39); positive predictive value = 80.8% (42/52); negative predictive value = 55.0% (29/55); accuracy = 66.4% (71/107). The receiver operating characteristic curve of consensus was 0.754. Inter-observer correlation was κ = 0.849. There was a significant difference in tumor size ( P = 0.019) and the contour type of tumor ( P = 0.0207) between correctly diagnosed RCCs and not correctly diagnosed RCCs. Conclusion Our findings showed that tumor size and contour type could affect the detection and differentiation of T1a RCC on unenhanced CT. To detect and differentiate T1a RCC on unenhanced CT is difficult. However, the findings from this study may help detection of RCCs on unenhanced CT.
Early Experience With Sacubitril/Valsartan in Adult Patients With Congenital Heart Disease
Authors: Lluri Gentian , Lin Jeannette , Reardon Leigh , Miner Pamela , Whalen Katrina , Aboulhosn Jamil 
Published: May 2019

Background: Heart failure (HF) is the leading cause of hospitalizations and death in patients with adult congenital heart disease (ACHD). Sacubitril/valsartan is a new agent in the treatment of HF, but its effects have not been assessed in ACHD. Methods: We retrospectively studied all 15 patients with ACHD at our center who were prescribed sacubitril/valsartan between June 2017 and June 2018. We assessed baseline characteristics and clinical and laboratory changes after initiation of sacubitril/valsartan. Adverse events, including renal function, medication intolerance, and worsening HF were documented. Results: The median age was 53.2 (27.6-83.6) years, with a median follow-up duration of 69 (8-419) days. At baseline, all patients had refractory HF despite guideline-directed medical therapy, with ten (67%) patients as New York Heart Association (NYHA) class II, and five (33%) patients NYHA class III. The medication was discontinued in one (7%) patient secondary to worsening kidney function. No patients reported clinical deterioration; four NYHA class III patients with complex CHD, pulmonary hypertension, and cyanosis reported significant improvement to NYHA class II. Baseline creatinine was 1.1 (0.9-1.7) and two weeks after starting sacubitril/valsartan it was 1.3 (0.8-2.5, P = .22). Conclusions: Sacubitril/valsartan seems to be well tolerated in patients with ACHD who present with refractory HF symptoms. Patients with complex CHD associated with cyanosis and pulmonary hypertension could benefit the most, but larger studies are needed to assess the safety as well as the effectiveness of sacubitril/valsartan in this patient population.
Assessment of the Reconstructed Pulmonary Circulation With Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals
Authors: Wise-Faberowski Lisa , Irvin Matthew , Lennig Michael , Long Jin , Nadel Helen R. , Bauser-Heaton Holly , Asija Ritu , Hanley Frank L. , McElhinney Doff B. 
Published: May 2019

Background: Pulmonary vascular supply in tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) is highly variable. Our approach to surgical management of this condition emphasizes early repair including unifocalization and reconstruction of the pulmonary circulation, incorporating all lung segments and addressing stenoses both proximal to and within the lung, in addition to ventricular septal defect closure. At our institution, we have over 15 years of experience using lung perfusion scintigraphy (LPS) to assess the distribution of pulmonary blood flow after complete unifocalization and repair. Methods: We reviewed clinical and quantitative LPS data in 310 patients who underwent complete unifocalization and repair of TOF/MAPCAs from 2003 to 2018 at our institution. Postrepair relative lung perfusion distributions were determined from LPS initially obtained at our institution within 60 days after repair and thereafter. Results: Total lung perfusion to the right and left lungs was 58.0% ± 14.2% and 42.0% ± 14.2%, respectively. Perfusion was balanced in 75% of patients and unbalanced in 25%, including 11% in whom it was extremely unbalanced. On multivariable analysis, older age at repair, surgery other than a single-stage complete unifocalization, and native anatomy consisting of unilateral pulmonary blood supply through a ductus arteriosus were associated with unbalanced perfusion. Conclusion: We present our experience using LPS as an outcome measure after surgical repair of TOF/MAPCAs. Balanced lung perfusion was present in the majority of patients who had complete repair of TOF/MAPCAs performed at our center.
Effective nutritional status screening in orthopaedic oncology patients and post-operative complications
Authors: Eu Cheong Wei , Ajit Singh Vivek , Yasin Nor Faissal 
Published: May 2019

Purpose: This study aims to determine the prevalence of malnutrition among orthopaedic oncology patients with malignant tumour during preoperative period. Methods: This is a prospective observational study involving patients from the orthopaedic oncology unit who were undergoing surgery. They were assessed with Patient Generated Subjective Global Assessment (PG-SGA), Malnutrition Screening Tool (MST) and 3-minute Nutritional Screening (3MinNS) questionnaires. Anthropometric data such as body mass index, mid upper arm circumference (MUAC) and blood parameters such as serum albumin, total lymphocyte count and haemoglobin were also investigated. Patients were then followed up for 3 months. Post-operative complications were divided into infectious and non-infectious groups. Length of stay and unplanned readmission were also documented. Results: Prevalence of malnutrition ranged from 13.3% to 45.8% under different nutritional assessment methods. Patients who were determined as malnourished were significantly associated with both infectious and non-infectious post-operative complications ( p < 0.001). PG-SGA and 3MinNS values were also significant in univariate and multivariate analysis, respectively. Low serum albumin (<35 g/L) was associated with post-operative infectious complications, especially surgical site infection ( p < 0.001), prolonged hospital stay ( p = 0.009) and unplanned readmission ( p = 0.017). 3MinNS and Charlson Comorbidity Index were predictive of non-infectious complications, whereas serum albumin and the presence of metastasis were predictive of infectious complications. Conclusion: This pilot study of patients with soft tissue and bone sarcoma of upper and lower limbs showed that malnutrition is a significant independent factor related to infectious and non-infectious complications which leads to unplanned readmission and prolonged length of stay. Periodic screening using the PG-SGA or 3MinNS questionnaires, MUAC and evaluation of serum albumin levels is recommended during clinic session and pre-surgery assessment rounds to identify those predisposed to malnutrition and help in reducing incidence of post-operative complications.
Clinical course of asymptomatic deep vein thrombosis after total knee arthroplasty in Japanese patients
Authors: Tateiwa Toshiyuki , Ishida Tsunehito , Masaoka Toshinori , Shishido Takaaki , Takahashi Yasuhito , Onozuka Atsuko , Nishida Jun , Yamamoto Kengo 
Published: May 2019

Purpose: The purpose of the present study was to follow up Japanese patients with deep vein thrombosis (DVT) after total knee arthroplasty (TKA) and also to examine factors associated with residual thrombus within the sixth postoperative month. Methods: DVT evaluation was performed by noninvasive venous ultrasonography. We retrospectively reviewed 88 Japanese patients (88 knees) receiving primary unilateral TKA, who had no preoperative DVT. We examined the influence of the following four factors on postoperative DVT: (1) patient factors (age, sex, body height, body weight, and body mass index), (2) surgical factors (operation time, bleeding amount, avascularization time, and anesthesia method), (3) postoperative factors (bleeding amount, period to ambulation, period of venous foot pump use, and ratio of graduated compression stocking use), and (4) DVT conditional factors (location, length, number of vein branches, and the presence of >5 mm vasodilatation). Results: The total prevalence of venous thromboembolism (VTE) was 62.5% (55 of the 88 patients). Among the 55 VTE patients, the rates of distal and proximal DVT were 96.4% and 3.6%, respectively. Bilateral DVT was found in 34.5%, while unilateral DVT on the surgical and nonsurgical sides were 52.7% and 12.7%, respectively. Asymptomatic pulmonary embolism was 1.8%. DVT was exacerbated in five patients (11.9%), of whom three showed additional thrombus formation. The remaining two patients had thrombus elongation or propagation from distal to proximal veins. In comparisons between thrombus-unresolved and -resolved groups within the sixth postoperative month, statistical significances were found in the incidence of bilateral DVT (50.0% vs. 15.4%, p = 0.02) and unilateral DVT (43.8% vs. 76.9%, p = 0.02). On the other hand, operation time (107.0 ± 17.3 min vs. 94.5 ± 11.9 min, p = 0.01) and avascularization time (99.8 ± 17.6 min vs. 88.0 ± 11.5 min, p = 0.01) in bilateral DVT patients were significantly longer than in unilateral ones. Conclusion: Our results suggest that an extended operation and avascularization time may be a risk factor for bilateral DVT and residual thrombus over 6 months.
Rural Hospital Nursing Skill Mix and Work Environment Associated With Frequency of Adverse Events
Authors: Smith Jessica G. , Plover Colin M. , McChesney Moira C. , Lake Eileen T. 
Published: May 2019

Introduction: Although rural hospitals serve about one fifth of the United States, few studies have investigated relationships among nursing resources and rural hospital adverse events. Objectives: The purpose was to determine relationships among nursing skill mix (proportion of registered nurses [RNs] to all nursing staff), the work environment, and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals. Methods: Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential. Results: On average, 72% of nursing staff were RNs (range = 45%–100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events. Conclusion Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency.
Safety of endoscopic sphincterotomy in patients undergoing antithrombotic treatment: a retrospective study
Authors: Yamamiya Akira , Kitamura Katsuya , Ishii Yu , Mitsui Yuta , Yoshida Hitoshi 
Published: May 2019

Background: This study investigated the safety of endoscopic sphincterotomy in patients undergoing antithrombotic treatment. Methods: From January 2014 to December 2016, a single-center retrospective study was conducted. Of the 80 patients with naïve papilla receiving antithrombotic treatment who underwent endoscopic sphincterotomy, 76 patients were retrospectively analyzed. We divided the participants into two groups as follows: 45 patients who discontinued antithrombotic treatment (discontinuation group) and 31 patients who continued antithrombotic treatment (continuation group). We evaluated the safety of endoscopic sphincterotomy in patients with naïve papilla who received antithrombotic treatment. Results: The percentage of patients requiring emergency endoscopic retrograde cholangiopancreatography in the continuation group was significantly higher than that in the discontinuation group (55% vs 11%; p = 0.001). The incidence of adverse events did not differ significantly between the two groups. Neither bleeding nor perforation occurred in either group. The length of hospital stay did not differ significantly between the two groups. Conclusions: Endoscopic sphincterotomy in patients undergoing antithrombotic treatment may be safe if the guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment are followed.
From the pathophysiology of the human lung alveolus to epigenetic editing: Congress 2018 highlights from ERS Assembly 3 “Basic and Translational Science.”
Authors: Nikolić Marko Z. , Garrido-Martin Eva M. , Greiffo Flavia R. , Fabre Aurélie , Heijink Irene H. , Boots Agnes , Greene Catherine M. , Hiemstra Pieter S. , Bartel Sabine 
Published: May 2019

The European Respiratory Society (ERS) International Congress is the largest respiratory congress and brings together leading experts in all fields of respiratory medicine and research. ERS Assembly 3 shapes the basic and translational science aspects of this congress, aiming to combine cutting-edge novel developments in basic research with novel clinical findings. In this article, we summarise a selection of the scientific highlights from the perspective of the three groups within Assembly 3. In particular, we discuss new insights into the pathophysiology of the human alveolus, novel tools in organoid development and (epi)genome editing, as well as insights from the presented abstracts on novel therapeutic targets being identified for idiopathic pulmonary fibrosis.
Attenuation analysis of heavy oil sands based on laboratory measurements
Authors: Yuan Hemin , Han De-Hua , Zhao Luanxiao , Huang Qi , Zhang Weimin 
Published: May 2019

Analyzing elastic and attenuation characteristics of heavy oil sand is critical for understanding and interpreting sonic and seismic data for their use in exploration and reservoir monitoring. The attenuation characteristic of oil sands is inherently complicated because of its loose frame, large porosity, and highly temperature-dependent viscosity of heavy oil. During thermal production, the attenuation of heavy oil sands undergoes significant changes due to the effects of pressure, temperature, and gas. Therefore, we have performed laboratory measurements of heavy oil sands under different physical conditions. By applying spectral-ratio method on the recorded wave signals, we are able to investigate the attenuation of the oil sands under different pressure and temperature conditions. For the measured sample, the [Formula: see text] decreases from 0.083 to 0.043 for a differential pressure increasing from 1.38 to 9.65 MPa. A peak of [Formula: see text] occurs at the middle temperature (approximately 60°C) for the wet sample, whereas the weakest [Formula: see text] occurs at the low temperature. Comparisons between the as-is (partially saturated) and wet (fully saturated) samples suggest that attenuation ([Formula: see text]) of the oil sands can be significantly affected by the presence of gas at a high temperature (greater than 60°C). In the end, the Havriliak-Negami model is used to capture the temperature-dependent attenuation characteristics of fully saturated oil sands. Although the measurements are conducted at ultrasonic frequency, the presented results indicate some implications for field-reservoir monitoring and also offer insights into applying attenuation attribute to characterize heavy oil reservoir during thermal production.