bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study
Authors: Mohr Grímur Høgnason , Søndergaard Kathrine B , Pallisgaard Jannik L , Møller Sidsel Gamborg , Wissenberg Mads , Karlsson Lena , Hansen Steen Møller , Kragholm Kristian , Køber Lars , Lippert Freddy , Folke Fredrik , Vilsbøll Tina , Torp-Pedersen Christian , Gislason Gunnar , Rajan Shahzleen 
Published: January 2019

Background:
Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA.

Methods:
Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001–2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics.

Results:
In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66–0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48–0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively).

Conclusion:
No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.
Rural–urban comparison of routine immunization utilization and its determinants in communities in Anambra States, Nigeria
Authors: Sibeudu Florence Tochukwu , Uzochukwu Benjamin SC , Onwujekwe Obinna E 
Published: January 2019

Objectives: The study determined the levels of geographic differences in the utilization of routine immunization between households in an urban and a rural community. It also identified and compared the determinants of utilization of routine immunization in the two geographic areas. Method: The study was undertaken in two randomly selected communities (one rural and one urban) in Anambra State, Nigeria. Interviewer-administered questionnaires were used to collect information on utilization of immunization services from households. Data were analyzed using descriptive and multiple logistic regression analyses. Result: Households in the urban community had a higher level of utilization of routine immunization (95.5%) than those in the rural community (75.3%) and the difference was statistically significant (p < 0.05). It was also found that more rural dwellers (83.3%) received immunization services from public health facilities compared to the urban dwellers (42%; p < 0.05). Health facilities were nearer to households in the urban community than the rural community (p < 0.05). Mean cost of service per visit was higher in the urban community (p < 0.05), but the difference in the mean cost of transportation per visit was not significant (p = 0.125). Regression analysis shows that place of residence was highly significant for utilization of routine immunization services (p < 0.05). Conclusion: Urban–rural differences exist in utilization of routine immunization services. Health facilities are more proximal to consumers in the urban community than the rural community, with higher travel costs among rural dwellers. Ensuring that there is a functional primary healthcare center in every ward and provision of routine immunization services in market places on local market days can help to increase utilization and reduce rural–urban differences in utilization of immunization services.
Technical feasibility of EUS‐guided antegrade dilation for hepaticojejunostomy anastomotic stricture using novel endoscopic device (with videos)
Authors: Ueshima Kazuya , Ogura Takeshi , Nishioka Nobu , Miyano Akira , Okuda Atsushi , Imanishi Miyuki , Higuchi Kazuhide 
Published: January 2019

BackgroundA novel endoscopic dilation device (EZ Dilator; Zeon Medical Co, Tokyo, Japan) is now available in Japan that might affect dilation for biliary strictures under endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) guidance because it has good push ability. We evaluated the technical feasibility of this device under EUS guidance in a case series of patients with hepaticojejunostomy anastomotic stricture (HJAS) that led to further complications.MethodWe enrolled 14 patients with HJAS leading to obstructive jaundice or repeated cholangitis in this study. Technical success was defined as insertion of the EZ Dilator into the intestine across the stricture site without the need for other dilation devices. Deployed plastic stents were removed after three months to evaluate anastomosis sites.ResultsThe median procedural duration was 25 minutes. Rates of technical and clinical success were 100% and 78.5%, respectively. One patient developed an adverse event of abdominal pain. Contrast medium flowed across the anastomosis site in 11 patients after stent removal, indicating a clinical success rate of 78.5% (11 of 14). Plastic stents were deployed again in the remaining three patients.ConclusionAlthough a prospective evaluation with long‐term follow up is needed, the EZ Dilator shows clinical promise for treating benign biliary strictures under ERCP and EUS guidance.
Should primary microsurgical ligation of varicocele be the gold standard approach?
Authors: Jallad Samer , Khan Muhammad Jamal , Desai Ankit , Kalsi Jas 
Published: January 2019

Introduction: Varicocele is a common condition affecting over one in 10 men, and in cases with abnormal semen parameters, varicocele is present in about one in four men. Several methods have been used to treat this condition, of which microsurgical treatment has the lowest failure and complication rates. We present a single-centre UK series of microsurgical repair of varicocele. Methods: All microsurgical varicocelectomy cases performed between 2013 and 2017 were retrospectively identified and reviewed. The approach used is low inguinal using a high-powered Leica microscope. Results: Microsurgical varicocele repairs were performed in 30 cases, with a median age of 34.7 years. There were 22 cases with chronic scrotal pain of which eight cases had failed previous embolisation with a success rate of 90.5%. There were eight with oligoasthenoteratozoospermia, showing an improvement of more than 75% in sperm count after repair. Conclusions: Microsurgical ligation is a very effective treatment for symptomatic varicoceles and should be considered when radiological embolisation has failed. It is also effective in improving semen parameters in all followed up oligoasthenoteratozoospermia cases. It should be considered a primary method of varicocele treatment in the UK. Level of evidence: 3.
Testicular cancer in men with undescended testis: Insights from the Thames Valley Testicular Cancer database
Authors: Bryant Richard J , Hobbs Catherine , Richardson Charlotte , Fox Sebastian , Joseph Johnson , Verrill Clare , Woodcock Victoria K , Sullivan Mark E , Protheroe Andrew S 
Published: January 2019

Objective: Undescended testis (UDT) increases the risk of testicular cancer (TCa) development. Historical evidence suggests that malignant transformation of uncorrected UDT primarily results in seminomas, whereas mixed germ cell tumours predominate in corrected UDT; however, the risk of malignancy in the ‘normal’ contralateral testis is unclear. We investigated the contemporary Oxford TCa cohort to report the frequency of prior UDT and types of tumours developing in the prior UDT and normal contralateral testis. Patients and Methods: A 607 patient contemporary TCa cohort within the Thames Valley Testicular Cancer database. Results: Of men with new TCa, 8% had a history of UDT. Of men with TCa and prior UDT, 61% developed seminomas, whereas 56% of men with TCa without previous UDT developed this subtype. Among men with prior UDT, 77% developed tumours in the UDT, whilst 23% developed TCa in the contralateral normal testis. Conclusion: Seminoma was the most frequent malignancy following UDT, with a greater frequency than without prior UDT. Around one in four TCa patients with UDT developed contralateral tumours, emphasising the need for self-examination of both testes. Advice should be given to any patient with a history of UDT stressing the importance of ongoing self-examination of both testes. Level of evidence: Level 4.
The associated factors for radiation dose variation in cardiac CT angiography
Authors: Alhailiy Ali B , Ekpo Ernest U , Kench Peter L , Ryan Elaine A , Brennan Patrick C , McEntee Mark 
Published: January 2019

Objective:
This study aimed to examine the associated factors for dose variation and influence cardiac CT angiography (CCTA) dose benchmarks in current CT imaging centres.

Methods:
A questionnaire was distributed to CT centres across Australia and Saudi Arabia. All participating centres collected data for adults who underwent a CCTA procedure. The questionnaire gathered information about the examination protocol, scanning parameters, patient parameters, and volume CT dose index (CTDI vol) and dose–length product (DLP). A stepwise regression analysis was performed to assess the contribution of tube voltage (kV), padding time technique, cross-sectional area (CSA) of chest and weight to DLP.

Results:
A total of 17 CT centres provided data for 423 CCTA examinations. The median CTDIvol, DLP and effective dose were 18 mGy, 256 mGy.cm and 5.2 mSv respectively. There was a statistically significant difference in DLP between retrospective and prospective ECG-gating modes (p = 0.001). Median DLP from CCTA using padding technique was 61% higher than CCTA without padding (p = 0.001). The stepwise regression showed that kV was the most significant predictor of DLP followed by padding technique then CSA while patient weight did not statistically significantly predict DLP. Correlation analysis showed a strong positive correlation between weight and CSA (r = 0.78), and there was a moderate positive correlation between weight and DLP (r = 0.42), as well as CSA and DLP (r = 0.48).

Conclusion:
Findings show radiation dose variations for CCTA. The associated factors for dose variation found in this study are scanning mode, kV, padding time technique and CSA of the chest. This results support the need to include CSA measurements in future dose survey and for setting DRLs.

Advances in knowledge:
The study provides baseline information that helps to understand the associated factors for dose variations and high doses within and between centres performing CCTA.
Should we be moving to a national standardized non-gadolinium MR imaging protocol for the surveillance of vestibular schwannomas?
Authors: Currie Stuart , Saunders David , Macmullen-Price Jeremy , Verma Sanjay , Ayres Philip , Tait Caroline , Harwood Ceryl , Scarsbrook Andrew , Craven Ian J 
Published: January 2019

Objectives:
To examine whether the model of Getting It Right First Time (GIRFT) could be relevant to the surveillance of non-operated vestibular schwannomas (vs) by testing the following hypotheses: (1) in the UK there is a great variation in the imaging protocol for the follow-up of vs; (2) high-resolution, T 2 weighted MRI (HRT 2W-MRI) has an equivalent accuracy to gadolinium-enhanced T 1 weighted MRI (Gd-MRI) in the assessment of vs size and; (3) imaging with HRT 2W-MRI rather than Gd-MRI could offer financial savings.

Methods:
Two neuroradiologists independently performed measurements of 50 vs imaged with HRT 2W-MRI and Gd-MRI. Differences in mean tumour measurements between HRT 2W-MRI and Gd-MRI were determined, as were intra- and interobserver concordance. Level of agreement was measured using Bland–Altman plots. Consultant neuroradiologists within 30 adult neurosurgical units in the UK were contacted via email and asked to provide the MRI protocol used for the surveillance of non-operated vs in their institution. The financial difference between scanning with HRT 2W-MRI and Gd-MRI was determined within Leeds Teaching Hospitals NHS Trust.

Results:
There was no statistically significant difference in the mean diameter of vs size, measured on HRT 2W-MRI and Gd-MRI (p = 0.28 & p = 0.74 for observers 1 and 2 respectively). Inter- and intraobserver concordance were excellent (Interclass correlation coefficient = 0.99, Interclass correlation coefficient ≥ 0.98 respectively). Differences between the two sequences were within limits of agreement. 26 of 30 UK neuroscience centres (87 % response rate) provided imaging protocols. 16 of the 26 (62%) centres use Gd-MRI for the surveillance of vs. HRT 2-MRI is £36.91 cheaper per patient than Gd-MRI.

Conclusion:
Variation exits across UK centres in the imaging surveillance of non-operated vs. HRT 2W-MRI and Gd-MRI have equivalent accuracy when measuring vs. Imaging with HRT 2W-MRI rather than Gd-MRI offers potential financial savings.

Advances in knowledge:
This study highlights the potential health and economic benefits of a national standardized imaging protocol for the surveillance of non-operated vs.
The Utilitarian Stigma of Environmental Protection
Authors: Wawrzyniak Jan R. 
Published: January 2019

In this paper I want to point out the multifaceted impact of utilitarianism as well as pragmatism, applied as the unified philosophy of environmental protection. Special attention is paid to the utilitarian aspect of Marxism, and a continuous (1988-2018), comprehensive case study from Poland – in the context of European economic realities – serves as an example of social receptionof the utilitarian paradigm in contemporary environmental protection policy.
Conserved structure of the NPR1 gene distal promoter isolated from a chili pepper (Capsicum annuum L.) in West Sumatera
Authors: Jamsari Jamsari , Oktavioni Maythesya , Nova Bastian , Candra Ifan Aulia , Asben Alfi , Syukriani Lily 
Published: January 2019

Background: The non-expressor of pathogenesis related gene 1 (NPR1) protein is one of the key regulators in the systemic acquired resistance plant defence system. The cis-acting elements of its distal promoter gene are characterized by salicylic acid inducing elements such as the W-box, RAV1AAT and ASF1, accompanied with enhancer and silencer elements. This study was aimed to isolate and characterize the distal promoter sequence of the NPR1 gene (PD_CbNPR1) from the chili pepper (Capsicum annuum L.) genotype Berangkai, a local genotype known to produce large yields, but is susceptible to viral infection. Elucidating its sequence structure will open a broad range of possibilities to engineer the NPR1 gene expression which is important to improve chili pepper resistant. Methods: PCR-based cloning combined with a primer walking strategy was applied in this study. The BioEdit tool was used to edit the sequence and verify sequence integrity, while homology analysis was conducted with BLASTn searching. Identification of a cis-acting element was detected by PLACE. Results: Isolation of the complete distal promoter sequence of PD_CbNPR1 produced a fragment 5,950 bp in size. BLASTn search analysis indicated that PD_CbNPR1 sequence is highly conserved (99% homology) showing only a single nucleotide polymorphism (SNP) (base substitution) compared with its reference sequence. Analysis using PLACE tools successfully identified nine cis-acting elements containing a W-box, WLE1, RAV1AAT, TATA-box, CAAT-box, GARE and GT1 with multi repeats and diverse motives, as well as enhancer and silencer elements, which is characterized by a CCAAT-box and GAGAAATT pattern, respectively. Conclusion: The distal promoter of the NPR1 gene is highly conserved, showing only one SNP caused by one base substitution event.
Tranexamic acid toxicity in human periarticular tissues
Authors: McLean M. , McCall K. , Smith I. D. M. , Blyth M. , Kitson S. M. , Crowe L. A. N. , Leach W. J. , Rooney B. P. , Spencer S. J. , Mullen M. , Campton J. L. , McInnes I. B. , Akbar M. , Millar N. L. 
Published: January 2019

Objectives Tranexamic acid (TXA) is an anti-fibrinolytic medication commonly used to reduce perioperative bleeding. Increasingly, topical administration as an intra-articular injection or perioperative wash is being administered during surgery. Adult soft tissues have a poor regenerative capacity and therefore damage to these tissues can be harmful to the patient. This study investigated the effects of TXA on human periarticular tissues and primary cell cultures using clinically relevant concentrations. Methods Tendon, synovium, and cartilage obtained from routine orthopaedic surgeries were used for ex vivo and in vitro studies using various concentrations of TXA. The in vitro effect of TXA on primary cultured tenocytes, fibroblast-like synoviocytes, and chondrocytes was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell viability assays, fluorescent microscopy, and multi-protein apoptotic arrays for cell death. Results There was a significant (p < 0.01) increase in cell death within all tissue explants treated with 100 mg/ml TXA. MTT assays revealed a significant (p < 0.05) decrease in cell viability in all tissues following treatment with 50 mg/ml or 100 mg/ml of TXA within four hours. There was a significant (p < 0.05) increase in cell apoptosis after one hour of exposure to TXA (100 mg/ml) in all tissues. Conclusion The current study demonstrates that TXA caused significant periarticular tissue toxicity ex vivo and in vitro at commonly used clinical concentrations. Cite this article: M. McLean, K. McCall, I. D. M. Smith, M. Blyth, S. M. Kitson, L. A. N. Crowe, W. J. Leach, B. P. Rooney, S. J. Spencer, M. Mullen, J. L. Campton, I. B. McInnes, M. Akbar, N. L. Millar. Tranexamic acid toxicity in human periarticular tissues. Bone Joint Res 2019;8:11–18. DOI: 10.1302/2046-3758.81.BJR-2018-0181.R1.
Computer Aided Volume Measurement Using Osirix, A Free 3D-Rendering Software, In Preplanned Correction Of Enophthalmos With Diced Cartilage Graft
Authors: Kreshanti Prasetyanugraheni , Bangun Kristaninta 
Published: January 2019

Autologous costal diced cartilage graft is an option for replenishment of the volume deficit in residual enophthalmos following orbito-zygomatic trauma. However, in published journals referring this treatment option, quantitative volume measurement of the graft needed has not been established. Two patients with orbito-zygomatic fractures resulted from motorcycle accidents, presented with dystopia, entrapment of the eyeball, diplopia, and depressed malar eminence on the affected side. CT scans demonstrated orbital-floor disruption and herniation of the intra-orbital content into the maxillary sinus. Using OsiriX®, a free and open source medical imaging software, we calculated the volume discrepancy of the affected orbit. On coronal slices, the segmentation of the bony orbital region of interest of each single slice was performed and grouped to compute the volume. At surgery, diced cartilage grafts were inserted to the orbital cavity according to the calculated volume, to promote forwards shift of the eye globe position after releasing the entrapment and replacing the orbital floor. In both patients, good position of the eye globe was achieved. The aesthetic appearance was perceived as quite acceptable to the patients and other viewers. Transient diplopia settled within 3 months. We considered OsiriX® as a reliable tool for accurate quantitative measurement of diced cartilage graft volume in enophthalmos correction.
Modified Two-Flap Palatoplasty With Leaving Lateral Periosteum and Application of Honey Pack : A Preliminary Study
Authors: Bangun Kristaninta , Sudjatmiko Gentur , Mahandaru Danu 
Published: January 2019

According to our experience in Ciptomangunkusumo hospital, most cleft palate patients has wide gap. It makes the epithelialization of the lateral defect takes longer time ( 3- 4 weeks). In this study, the authors propose a modified technique to the two-flap palatoplasty by not elevating the lateral part of the periosteum with the flap, and then apply honey packs to cover the lateral defects. The technique modification and additional honey-soaked dressing are expected to hasten the epithelialization rate. Twelve consecutive patients with non-syndromic cleft palate (with or without cleft lip) are included in the study. They undergo the modified two-flap palatoplasty with the lateral periosteum left behind, covering the palatal bone and the utilization of Honey pack. The rate of epithelialization is then observed every 2 days after operation until full healing is achieved. Complete epithelialization was attained within 5 days in one patient ( 2,8 mm/day), within 7 days in 8 patients (2-2,5mm/day), and within 9 days in 3 patients (2,2-2,7mm/day). There were no surgical complications, such as hemorrhage or wound infection. The fistula of the palate was not found until the defect closed. Our technique hasten the rate of epithelialization. It may prevent the maxillary growth disturbances in the future because faster healing reduces scar formation and wound contraction.
Microsurgery Recontruction in Plastic Surgery Division FKUI-RSCM, From 2009 - 2010
Authors: Atmodiwirjo Parintosa , Adhistana Prasasta 
Published: January 2019

Microvascular surgery is the ability to repair very small blood vessels. Once the technique is mastered it becomes possible to revascularize and replant incomplete or complete digital amputations, and to design free tissue transfer procedures for the reconstruction of a large variety of damaged parts. This study included 17 cases of microsurgery in the last 1 years admitted to Division of Plastic and Reconstructive Surgery RSCM between February 2009 to February 2010. All patient were subjected to through clinical examination and appropriate laboratory and radiological investigations. Trauma is the most common etiology of soft tissue defect (10 cases, 58,8%), followed by tumor and infection (5 and 2 cases respectively). Defect is located 35,3% on the head/neck, 23,6% on the knee/lower leg, 23,6% on ankle/foot, and 17,6% on upper extremity. In this study we performed 9 anterolateral thigh (ALT), 6 radial forearm, 1 chimera flap, and 1 fibula flap. Flaps were vital in 13 cases, compromised in 4 cases, with 2 of them salvaged and survived. Vitality rate of ALT flap was 88,9% (7 vital, 1 non vital, 1 salvaged), 83,8% in RFFF (4 vital, 1 non vital, 1 salvaged) and 100% in fibular flap. The use of microvascular techniques has revolutionized reconstruction method and expanded the range of options for reconstructing a large anatomic defects in patients. If compare with advance center, the success of micro-surgery in our division is still under them. Expected to be approached with increasing operator experience and number of cases was undertaken.