bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Femoral Artery Ultrasound Measurements in Predicting Restenosis following Endovascular Intervention
Authors: Wang Grace J. , Shaw Pamela A. , Mohler Emile R. , Durinka Joel B. , Layne Andrew J. , Etherington Mark S. , Sehgal Chandra M. , Fairman Ronald M. , Ky Bonnie 
Published: March 2018

Background Although endovascular interventions for peripheral artery disease (PAD) have become increasingly common, they are associated with a significant rate of restenosis. An improved understanding of the risk factors for restenosis is needed to guide the management of patients with PAD. Methods We performed a cross-sectional analysis of 101 patients with PAD, to determine the association between clinical predictors, novel imaging measures of vascular function of the femoral artery [intima-media thickness, diameter, and intima-media cross-sectional area, change in diameter (delta diameter), average expansion and average contraction], and risk of reintervention. Univariable and multivariable associations between clinical and imaging measures and the need for reintervention were assessed using logistic regression. The predictive accuracy of the selected regression model and added predictive value of imaging measures were assessed using the area under the Receiver operating characteristic curve (AUC). The added predictive value of ultrasound was assessed by comparing AUC of the selected model with clinical parameters alone with that of the same model with additional ultrasound parameters. Results Of the 101 patients with PAD, 20 underwent recent multiple reinterventions. Vessel diameter was statistically significantly smaller in the group who underwent multiple reinterventions, p = 0.0170. Univariate logistic regression revealed that smoking status, hypertension, hypercholesterolemia, and chronic renal insufficiency were clinical parameters that met the statistical cut point of p ≤ 0.20. In the multivariable model, chronic renal insufficiency status (odds ratio (OR) = 8.27, 1.17–58.25), hypertension (OR = 0.145, 0.020–1.062), and femoral artery diameter (OR = 0.375, 0.136–1.031) remained important predictors for reintervention. The AUC for the clinical multivariable logistic regression model was 0.7481 while that for the model additionally including the ultrasound parameters was 0.8325 ( p = 0.044). Conclusions Including ultrasound parameters in the risk prediction model for restenosis improved the ability to predict restenosis in this group of patients with known PAD. Further study is needed to define its utility in preoperative assessment and risk stratification before revascularization.
Duplex Ultrasound Diagnosis and Follow-Up of Nutcracker Syndrome
Authors: Matthews Cheryl , Wilson Darlene , Demasi Richard , Nelms Courtney , Tuvell Nancy 
Published: March 2018

Introduction Nutcracker syndrome (NCS), also referred to as left renal vein entrapment, is characterized by left renal vein compression between the superior mesenteric artery and aorta. Treatment usually involves renal vein percutaneous angioplasty with or without stent placement. Patients frequently present to the vascular laboratory with vague complaints including various symptoms such as pelvic pain and hematuria. Duplex ultrasound (DU) can play a vital role in the initial diagnosis as well as serial follow-up post-intervention. Case Report Two female patients presented to our laboratory with symptoms ranging from left flank pain, lower quadrant pain, pelvic pain, and microscopic hematuria. Patient 1 was referred by her urologist. Patient 2 was referred after the computed tomography (CT) scan for left side pain indicated possible NCS. Inferior vena cava (IVC) duplex exams were performed with a Phillips iU22 using a C5-1 MHz curved transducer. DU revealed increased velocities in the left renal veins of each patient. Also, the renal veins appeared to be externally compressed. Subsequent venograms with intravascular ultrasound (IVUS) confirmed left renal vein stenosis in both patients. Left renal vein stents were placed in the patients. The stents were evaluated using DU within 1 week of intervention yielding excellent results. Discussion DU was useful in the diagnosis of both patients. If left untreated, NCS can cause damage to the left kidney leaving patients in pain for the rest of their lives. Several diagnostic modalities should be considered for diagnosis of this disease including IVC and renal DU, CT scan, magnetic resonance imaging, and venogram with IVUS. Conclusion NCS patients often present with vague symptoms and diagnosis can be difficult. When NCS is clinically suspected, DU is an excellent primary diagnostic method with which to identify renal vein compression. Following intervention, DU can successfully ensure patency of the renal vein stent with serial follow-up exams.
Accreditation is Perceived to Improve the Quality of Vascular Testing Facilities
Authors: Brinza Ellen K. , Zhu Linda J. , Lilly Michael , Manning Warren J. , Needleman Laurence , Gornik Heather L. 
Published: March 2018

Objective Accreditation for noninvasive vascular testing facilities has been available since 1990, but is not mandatory. We sought to determine the perceived value of accreditation among the staff of vascular laboratories accredited by the Intersocietal Accreditation Commission (IAC). Methods A multi-item electronic survey was sent to medical and technical staff and administrative contacts within the IAC database. Respondents were asked to rate statements about the impact of accreditation on their facility. Data for vascular testing facilities are presented. Results Of the 7,289 surveys sent, there were 882 (12.1%) respondents. Respondents were primarily responsible for the facility's accreditation application (75.0%), with the majority being technologists (82.0%), followed by physicians (11.3%). Most respondents were from hospital-based facilities (51.1%) and from facilities accredited for >3 years (79.6%). The majority, 94.3% of respondents, felt that maintaining accreditation of their facility was important (3.5% neutral, 2.2% not important). The greatest perceived benefits were in standardization of study acquisition and reporting, adherence to guidelines, and report completeness. Conclusions The majority of respondents from IAC-accredited vascular testing facilities viewed accreditation favorably. The favorable perception of accreditation by its users supports the value of accreditation for vascular testing facilities.
Comparison of Freehand 3D and 4D Ultrasound to Measure Thrombus Volume in Patients with Acute Deep Vein Thrombosis
Authors: Zhao Limin , Patel Richa , Sikdar Siddhartha , Prior Steven J. 
Published: March 2018

Objectives Current imaging techniques have limited ability to quantify thrombus burden in patients with acute deep vein thrombosis (DVT). There is limited ability to objectively measure clot progression or clot resolution over time and with treatment. These critical measures are important determinants of optimal treatment and therapeutic success for thrombolysis or thrombectomy treatment of DVT. In this study, we evaluated the feasibility and reliability of a method of quantifying thrombus volume using freehand three-dimensional (3D) ultrasonography and compared it to a commercially available four-dimensional (4D) transducer for acquiring and analyzing 3D ultrasound images to measure thrombus volume. Methods We studied 10 consecutive patients with a first episode of acute DVT to compare the performance of freehand 3D with 4D transducer imaging (group 1). In addition, we studied five patients with thrombus length >3.8 cm to evaluate the performance of freehand 3D imaging in larger clots (group 2). Scanning was performed with routine grayscale, color-flow, and power-Doppler imaging; followed by freehand 3D and 4D transducer volumetric imaging. Postprocessing was performed using the Stradwin software to measure thrombus volume after each scan. Results The age of patients was 54 ± 13 years (mean ± SD), 73.3% of DVTs were in the upper extremity, and 60% of the patients received anticoagulation. The mean thrombus volume in group 1 measured by freehand 3D and 4D probes was 0.49 ± 0.40 cm3 and 0.52 ± 0.46 cm3, respectively, and there was no significant difference between the measurements ( t = −1.57, p = 0.15). Regression analysis demonstrated good agreement between the two imaging modalities ( R2 = 0.99, regression slope = 1.13, p < 0.001). The freehand 3D technique was also successfully used to quantify thrombus volume (4.71 ± 3.28 cm3) in five patients with DVT >3.8 cm in length (group 2). Conclusions The described freehand 3D imaging protocol reliably measures thrombus volume in patients with acute DVT when compared with the commercially available 4D transducer. The freehand 3D method has the additional benefit of measuring thrombus volume in DVTs >3.8 cm in length. The method is convenient and can be used in clinical practice.
Ultrasound-Based Automated Carotid Lumen Diameter/Stenosis Measurement and its Validation System
Authors: Araki Tadashi , Kumar Asheed M. , Krishna Kumar P. , Gupta Ajay , Saba Luca , Rajan Jeny , Lavra Francesco , Sharma Aditya M. , Shafique Shoaib , Nicolaides Andrew , Laird John R. , Suri Jasjit S. 
Published: March 2018

Objective Degree of carotid stenosis is an important predictor to assess risk of stroke. Systolic velocity-based methods for lumen diameter and stenosis measurement are subjective. Image-based methods face a challenge because of low gradients in media and intima walls. Methods This article presents AtheroEdge™ 2.0, a two-stage process for automated carotid lumen diameter measurement that combats the above challenges. Stage one uses spectral analysis based on the hypothesis that far-wall adventitia is brightest. Stage two uses lumen pixel region identification based on the assumption that blood flow has constant density. Using global and local processing, lumen boundaries are detected. This clinical system outputs lumen diameter along with stenosis severity index (SSI). Results Our database consists of institutional review board–approved 202 patients (males/females: 155/47) left and right common carotid artery images (404 images, Toshiba scanner). Two trained neuro radiologists performed manual lumen border tracings using ImgTracer™ software. The coefficient of correlation between automated and two manual readings was 0.91 and 0.92. Dice similarity and Jaccard index were 95.82%, 95.72% and 92.10%, 91.92%, respectively. The mean diameter error between automated and two manual readings was 0.27 ± 0.26 and 0.26 ± 0.28 mm, respectively. Precision of merit was 98.05% and 99.03% with respect to two readings. SSI showed 97% accuracy. Conclusions The image-based automated carotid lumen diameter and stenosis measurement system is fast, accurate, and reliable.
Visceral fat mass as a novel risk factor for predicting gestational diabetes in obese pregnant women
Authors: Balani J , Hyer SL , Shehata H , Mohareb F 
Published: March 2018

Objective To develop a model to predict gestational diabetes mellitus incorporating classical and a novel risk factor, visceral fat mass. Methods Three hundred two obese non-diabetic pregnant women underwent body composition analysis at booking by bioimpedance analysis. Of this cohort, 72 (24%) developed gestational diabetes mellitus. Principal component analysis was initially performed to identify possible clustering of the gestational diabetes mellitus and non-GDM groups. A machine learning algorithm was then applied to develop a GDM predictive model utilising random forest and decision tree modelling. Results The predictive model was trained on 227 samples and validated using an independent testing subset of 75 samples where the model achieved a validation prediction accuracy of 77.53%. According to the decision tree developed, visceral fat mass emerged as the most important variable in determining the risk of gestational diabetes mellitus. Conclusions We present a model incorporating visceral fat mass, which is a novel risk factor in predicting gestational diabetes mellitus in obese pregnant women.
Prevalence of feline immunodeficiency virus and feline leukaemia virus infection in Malaysia: a retrospective study
Authors: Sivagurunathan Amilan , Atwa Asem M , Lobetti Remo 
Published: March 2018

Objectives Feline ownership is popular and represents the largest segment of the pet population in Malaysia. Most feline owners own, on average, 2–3 cats, with some having >10 cats per household. Feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) are two clinically important viral infections in cats. Documenting the prevalence of these diseases in the feline population is important for both veterinarians and the public. Methods This was a retrospective study, using data collected from the domestic cat population seen at a 24 h private veterinary hospital in Malaysia, to determine the prevalence of FIV and FeLV in an urban area and risk factors associated with these infections. Between 2010 and 2016, 2230 blood samples were collected and tested for FIV antibodies and FeLV antigen using commercially available ELISA test kits. Results In total, 10.0% (n = 224; 95% confidence interval [CI] 8.80–11.26) were seropositive for FIV; 12.0% (n = 267; 95% CI 10.62–13.32) were seropositive for FeLV; and 2.6% (n = 58; 95% CI 2.01–3.17) were seropositive for both. Conclusions and relevance The prevalence of FIV is lower and FeLV higher than previously documented for this region. Because of the immunosuppressive potential of both viruses, client education and use of appropriate control strategies such as routine screening, vaccination and eradication should be considered.
Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery
Authors: D’Lauro Christopher , Johnson Brian R. , McGinty Gerald , Allred C. Dain , Campbell Darren E. , Jackson Jonathan C. 
Published: March 2018

Background: Return-to-play protocols describe stepwise, graduated recoveries for safe return from concussion; however, studies that comprehensively track return-to-play time are expensive to administer and heavily sampled from elite male contact-sport athletes. Purpose: To retrospectively assess probable recovery time for collegiate patients to return to play after concussion, especially for understudied populations, such as women and nonelite athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Medical staff at a military academy logged a total of 512 concussion medical records over 38 months. Of these, 414 records included complete return-to-play protocols with return-to-play time, sex, athletic status, cause, and other data. Results: Overall mean return to play was 29.4 days. Sex and athletic status both affected return-to-play time. Men showed significantly shorter return to play than women, taking 24.7 days (SEM, 1.5 days) versus 35.5 days (SEM, 2.7 days) ( P < .001). Intercollegiate athletes also reported quicker return-to-play times than nonintercollegiate athletes: 25.4 days (SEM, 2.6 days) versus 34.7 days (SEM, 1.6 days) ( P = .002). These variables did not significantly interact. Conclusion: Mean recovery time across all groups (29.4 days) showed considerably longer return to play than the most commonly cited concussion recovery time window (7-10 days) for collegiate athletes. Understudied groups, such as women and nonelite athletes, demonstrated notably longer recovery times. The diversity of this sample population was associated with longer return-to-play times; it is unclear how other population-specific factors may have contributed. These inclusive return-to-play windows may indicate longer recovery times outside the population of elite athletes.
Filgrastim enhances T-cell clearance by antithymocyte globulin exposure after unrelated cord blood transplantation
Authors: de Koning Coco , Gabelich Julie-Anne , Langenhorst Jurgen , Admiraal Rick , Kuball Jurgen , Boelens Jaap Jan , Nierkens Stefan 
Published: March 2018

Key PointsResidual ATG exposure delays CD4+ T-cell reconstitution more severely after CBT than after BMT. Filgrastim (G-CSF), given early after CBT, enhances ATG-mediated T-cell clearance in patients with residual ATG exposure.
MECOM-associated syndrome: a heterogeneous inherited bone marrow failure syndrome with amegakaryocytic thrombocytopenia
Authors: Germeshausen Manuela , Ancliff Phil , Estrada Jaime , Metzler Markus , Ponstingl Eva , Rütschle Horst , Schwabe Dirk , Scott Richard H. , Unal Sule , Wawer Angela , Zeller Bernward , Ballmaier Matthias 
Published: March 2018

Key PointsGerm line mutations in MECOM cause a heterogeneous bone marrow failure syndrome with congenital hypomegakaryocytic thrombocytopenia. MECOM-associated syndrome includes various organ malformations with variable penetrance, including radioulnar synostosis.
Drug repurposing in malignant pleural mesothelioma: a breath of fresh air?
Authors: Boyer Arnaud , Pasquier Eddy , Tomasini Pascale , Ciccolini Joseph , Greillier Laurent , Andre Nicolas , Barlesi Fabrice , Mascaux Celine 
Published: March 2018

Drug repurposing is the use of known drugs for new indications. Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. So far, few treatments have been approved in this disease. However, its incidence is expected to increase significantly, particularly in developing countries. Consequently, drug repurposing appears as an attractive strategy for drug development in MPM, since the known pharmacology and safety profile based on previous approvals of repurposed drugs allows for faster time-to-market for patients and lower treatment cost. This is critical in low- and middle-income countries where access to expensive drugs is limited. This review assesses the published preclinical and clinical data about drug repurposing in MPM.In this review, we identified 11 therapeutic classes that could be repositioned in mesothelioma. Most of these treatments have been evaluatedin vitro, half have been evaluatedin vivoin animal models of MPM and only three (i.e.valproate, thalidomide and zoledronic acid) have been investigated in clinical trials, with limited benefits so far. Efforts could be coordinated to pursue further investigations and test promising drugs identified in preclinical experiments in appropriately designed clinical trials.
The potentially beneficial central nervous system activity profile of ivacaftor and its metabolites
Authors: Schneider Elena K. , McQuade Rachel M. , Carbone Vincenzo C. , Reyes-Ortega Felisa , Wilson John W. , Button Brenda , Saito Ayame , Poole Daniel P. , Hoyer Daniel , Li Jian , Velkov Tony 
Published: March 2018

Ivacaftor–lumacaftor and ivacaftor are two new breakthrough cystic fibrosis transmembrane conductance modulators.The interactions of ivacaftor and its two metabolites hydroxymethylivacaftor (iva-M1) and ivacaftorcarboxylate (iva-M6) with neurotransmitter receptors were investigated in radioligand binding assays.Ivacaftor displayed significant affinity to the 5-hydroxytryptamine (5-HT; serotonin) 5-HT2Creceptor (pKi=6.06±0.03), β3-adrenergic receptor (pKi=5.71±0.07), δ-opioid receptor (pKi=5.59±0.06) and the dopamine transporter (pKi=5.50±0.20); iva-M1 displayed significant affinity to the 5-HT2Creceptor (pKi=5.81±0.04) and the muscarinic M3 receptor (pKi=5.70±0.10); iva-M6 displayed significant affinity to the 5-HT2Areceptor (pKi=7.33±0.05). Thein vivocentral nervous system activity of ivacaftor (40 mg·kg−1intraperitoneally for 21 days) was assessed in a chronic mouse model of depression. In the forced swim test, the ivacaftor-treated group displayed decreased immobility (52.8±7.6 s), similarly to fluoxetine (33.8±11.0 s), and increased climbing/swimming activity (181.5±9.2 s). In the open field test, ivacaftor produced higher locomotor activity than the fluoxetine group, measured both as mean number of paw touches (ivacaftor 81.1±9.6versusfluoxetine 57.9±9.5) and total distance travelled (ivacaftor 120.6±16.8 cmversusfluoxetine 84.5±16.0 cm) in 600 s. Treatment of 23 cystic fibrosis patients with ivacaftor–lumacaftor resulted in significant improvements in quality of life (including anxiety) in all five domains of the AweScoreCF questionnaire (p=0.092–0.096).Our findings suggest ivacaftor displays potential clinical anxiolytic and stimulating properties, and may have beneficial effects on mood.
Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial
Authors: Jafar Tazeen H. , Tan Ngiap Chuan , Allen John C. , Finkelstein Eric A. , Goh Paul , Moey Peter , Quah Joanne Hui Min , Hwang Siew Wai , Bahadin Juliana , Thiagarajah Anandan Gerard , Chan Jason , Kang Gary , Koong Agnes 
Published: March 2018

Abstract
Background
Hypertension is a serious public health problem in Singapore and is associated with significant morbidity and mortality from cardiovascular disease (CVD) with considerable implications for health-care resources. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering blood pressure (BP) among adults with uncontrolled hypertension in Singapore primary-care clinics.

Methods/design
The study is a cluster randomized trial in eight polyclinics in Singapore: four deliver a structured MCI and four deliver usual care. The components of the MCI are: (1) an algorithm-driven antihypertensive treatment for all hypertensive individuals using single-pill combination (SPC) and lipid-lowering medication for high-risk hypertensive individuals, (2) a motivational conversation for high-risk hypertensive individuals, (3) telephone-based follow-ups of all hypertensive individuals by polyclinic nurses, and (4) discounts on SPC antihypertensive medications.
The trial will be conducted with 1000 individuals aged ≥ 40 years with uncontrolled hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg, based on the mean of the last two of three measurements) in eight polyclinics in Singapore. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability adjusted life years (DALY) averted and quality adjusted life years (QALY) saved will be computed.

Discussion
The demonstration of an effective and cost-effective hypertension control program that is implementable in busy polyclinics would provide compelling evidence for upscaling the program across all primary-care centers in Singapore, and possibly other regional countries with a similar health-care structure.

Trial registration
Clinicaltrials.gov, NCT02972619. Registered on 23 November 2016.