bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Echocardiographic Parameters of Right Ventricular Remodeling and Myocardial Performance With Modified Task Force Criteria in Adolescents With Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Pieles Guido E. , Grosse-Wortmann Lars , Hader Majeda , Fatah Meena , Chungsomprasong Paweena , Slorach Cameron , Hui Wei , Fan Chun-Po Steve , Manlhiot Cedric , Mertens Luc , Hamilton Robert , Friedberg Mark K. 
Published: April 2019

Background:
The usefulness of echocardiographic indices, including those already used by modified Task Force Criteria (mTFC), and others such as strain imaging, to identify arrhythmogenic right ventricular cardiomyopathy (ARVC) in adolescence is not well established.

Methods:
Echocardiograms from 120 adolescents investigated for ARVC (13±4 years) were retrospectively analyzed. According to the mTFC, patients were classified into definite (n=38), borderline (n=39), or possible (n=43) ARVC. Results were compared with 35 healthy controls. mTFC echocardiographic parameters were analyzed, as well as comprehensive right ventricular (RV) and left ventricular assessment of function including parameters not included in mTFC such as pulsed-wave tissue Doppler and RV 2-dimensional speckle strain.

Results:

mTFC parameters indexed for body surface area were significantly more abnormal in patients with possible, borderline, or definite ARVC compared with controls for parasternal long-axis view of the RV outflow tract. RV end-diastolic diameters were significantly larger in patients versus controls, a difference that increased with likelihood of ARVC. Left ventricular ejection fraction, tricuspid annular peak systolic excursion, and systolic and diastolic pulsed-wave tissue Doppler imaging indices were similar to controls for all groups. Average and segmental RV peak longitudinal systolic strain was significantly lower in patients with definite ARVC (−21±4%) and disease subgroups versus controls (−25±3%). Multivariable risk analysis showed that reduced RV strain was significantly associated with ARVC diagnosis and its likelihood (multivariable odds ratio [95% CI]=1.23 [1.1–1.37];
P
<0.001) as was increased end-diastolic diameter at the apical third of the RV (multivariable odds ratio [95% CI]=1.51 [1.33–1.72];
P
<0.001).

Conclusions:
mTFC echocardiographic criteria are significantly different between patients and controls and between the different diagnostic groups. However, in our cohort, current echocardiographic mTFC are not met by the majority of adolescent ARVC patients, particularly when indexed to body surface area. Measurement of RV apical dimensions and strain may increase the diagnostic yield of echocardiography for ARVC.
Formation and Changes of Uluses in the Mongol Empire
Authors: Kim Hodong 
Published: April 2019

AbstractUlus is a key concept for understanding the Mongol Empire; the Mongols called the empire they had created the ‘Mongol Ulus’ or the ‘Yeke (= Great) Mongol Ulus.’ It was a single huge ulus containing within itself a large number of multilayered smaller uluses. The sizes of these uluses differed. The three large western uluses of Chaghadai, Jochi, and Hülegü were so large that they looked like independent empires, and in fact they were politically quite autonomous from the Qa’an Ulus in the east. However, their enormous size or political independence notwithstanding, to the Mongols of that time they were after all individual uluses comprising part of the Yeke Mongol Ulus. The notion of ulus appears to have been an important basis that enabled the Mongols to retain a sense of unity within their empire.
What Is Possible and What Is Not? The Development of a Legal Framework for Drug Pricing Mechanisms in the EU
Authors: Ernst Gisela 
Published: April 2019

Abstract
As a result of the constantly increasing number of innovative but exceedingly high priced medicines, many Member States have implemented price-regulating mechanisms to ensure the financial viability of their healthcare systems. However, the European Court of Justice applies strict criteria to these measures – some of them have already been suspended for the purposes of the free movement of goods. The European Union (EU) allowed the development of an ever-stricter case law on one hand, without changing the legal frame on the other hand. Considering the importance and the binding nature of the Court’s judgements, this leaves great uncertainty for national legislators about which measures to remedy the pricing problem are legally possible and which are not. In order to provide clarity, this article seeks to analyse the development of the case law and to define the legal scope for pharmaceutical pricing mechanisms in the EU.
A Probabilistic Radar Forward Model for Branched Planar Ice Crystals
Authors: Schrom Robert S. , Kumjian Matthew R. 
Published: April 2019

AbstractPolarimetric radar measurements provide information about ice particle growth and offer the potential to evaluate and better constrain ice microphysical models. To achieve these goals, one must map the ice particle physical properties (e.g., those predicted by a microphysical model) to electromagnetic scattering properties using a radar forward model. Simplified methods of calculating these scattering properties using homogeneous, reduced-density spheroids produce large errors in the polarimetric radar measurements, particularly for low-aspect-ratio branched planar crystals. To overcome these errors, an empirical method is introduced to more faithfully represent branched planar crystal scattering using scattering calculations for a large number of detailed shapes. Additionally, estimates of the uncertainty in the scattering properties, owing to ambiguity in the crystal shape given a set of bulk physical properties, are also incorporated in the forward model. To demonstrate the utility of the forward model developed herein, the radar variables are simulated from microphysical model output for an Arctic cloud case. The simulated radar variables from the empirical forward model are more consistent with the observations compared to those from the homogeneous, reduced-density-spheroid model, and have relatively low uncertainty.
Animals and Alternatives: Societal Expectations and Scientific Need
Authors: Goldberg Alan M. 
Published: April 2019

As Russell and Burch suggested more than 40 years ago, the most humane science is the best science. The path ahead is clear: pain and distress must be eliminated in animal experiments or reduced to an absolute minimum, and, as scientists, we must use the most humane approaches in our research. To accomplish the best science, we must train those who come after us in the principles and practice of humane science. “Each of them necessitated the community's rejection of one time-honored scientific theory in favor of another incompatible with it. Each produced a consequent shift in the problems available for scientific scrutiny and in the standards by which the profession determined what should count as an admissible problem or as a legitimate problem-solution. And each transformed the scientific imagination in ways that we shall ultimately need to describe as a transformation of the world within which scientific work was done. Such changes, together with the controversies that almost always accompany them, are the defining characteristics of scientific revolutions.” (Thomas Kuhn, 1922–1996, on scientific revolutions) “Change is scientific, progress is ethical; change is indubitable, whereas progress is a matter of controversy.” (Bertrand Russell, 1872–1970)
Learning curve for multidisciplinary team setup in veno-venous extracorporeal membrane oxygenation for acute respiratory failure
Authors: Yeo Hye Ju , Cho Woo Hyun , Kim Dohyung 
Published: April 2019

Background: Quality control is essential for a successful extracorporeal membrane oxygenation program. We investigated the learning curve for outcome improvement and focused on factors associated with failure of extracorporeal membrane oxygenation treatment. Methods: Between August 2011 and May 2017, 150 patients were supported with veno-venous extracorporeal membrane oxygenation for acute respiratory failure. The learning curve was examined using cumulative sum analysis. We defined successful extracorporeal membrane oxygenation treatment as intensive care unit discharge, acceptable failure rate as 40%, and unacceptable failure rate as 60%. We chronologically divided patients into three periods with 50 consecutive patients each and retrospectively compared the clinical outcomes by period. Results: Overall, weaning and survival to discharge rates were 72.7% and 56%, respectively. Cumulative sum analysis indicated that the extracorporeal membrane oxygenation team achieved nearly acceptable performance after 56 cases and consistently acceptable performance after 104 cases. Clinical outcomes were improved by period: weaning rate (58% vs. 80% vs. 80%, p = 0.017); intensive care unit discharge rate (42% vs. 60% vs. 78%, p = 0.001); survival to discharge rate (40% vs. 58% vs. 70%, p = 0.010); and 1 year survival rate (40% vs. 56% vs. 70%, p = 0.010). In multivariate analysis, infection (odds ratio: 4.54, 95% confidence interval: 1.83-11.27, p = 0.001), immune compromise (odds ratio: 5.78, 95% confidence interval: 1.66-20.14, p = 0.006), extracorporeal membrane oxygenation team period (odds ratio: 2.12, 95% confidence interval: 1.14-3.92, p = 0.017), and age (odds ratio: 1.09, 95% confidence interval: 1.05-1.14, p < 0.001) were associated with extracorporeal membrane oxygenation failure. Conclusion: More than 100 cases of extracorporeal membrane oxygenation experience were necessary for acceptable performance and stabilization of outcomes.
Long-term pulmonary function and quality of life in adults after extracorporeal membrane oxygenation for respiratory failure
Authors: von Bahr Viktor , Kalzén Håkan , Frenckner Björn , Hultman Jan , Frisén K Gunilla , Lidegran Marika K , Diaz Sandra , Malfertheiner Maximilian V , Millar Jonathan E , Dobrosavljevic Tanja , Eksborg Staffan , Holzgraefe Bernhard 
Published: April 2019

Background: There is a significant long-term burden on survivors after acute respiratory distress syndrome, even 5 years after discharge. This is not well investigated in patients treated with extracorporeal membrane oxygenation. The objective of this study was to describe very-long-term (⩾3 years) disability in lung function and morphology, quality of life, mood disorders, walking capacity, and return to work status in extracorporeal membrane oxygenation survivors. Methods: Single-center retrospective cohort study on long-term survivors treated with extracorporeal membrane oxygenation for respiratory failure between 1995 and 2010 at a tertiary referral center in Sweden. Eligible patients were approached, and those who consented were interviewed and investigated during a day at the hospital. Results: A total of 38 patients were investigated with a median follow-up time of 9.0 years. Quality of life was reduced in several Short form 36 (SF-36) subscales and all domains of the St George’s Respiratory Questionnaire, similar to previous studies in conventionally managed acute respiratory distress syndrome survivors. A reduced diffusion capacity of carbon monoxide was seen in 47% of patients, and some degree of residual lung parenchymal pathology was seen in 82%. Parenchymal pathology correlated with reductions in quality of life and diffusion capacity. Symptoms of anxiety and depression were seen in 22% and 14%, respectively. Conclusion: A significant long-term burden remains even 3–17 years after extracorporeal membrane oxygenation treatment, similar to conventionally managed acute respiratory distress syndrome survivors. Future prospective studies are needed to elucidate risk factors for these sequelae.
Hemoglobin trigger and approach to red blood cell transfusions during veno-venous extracorporeal membrane oxygenation: the international TRAIN-ECMO survey
Authors: Martucci Gennaro , Grasselli Giacomo , Tanaka Kenichi , Tuzzolino Fabio , Panarello Giovanna , Schmidt Matthieu , Bellani Giacomo , Arcadipane Antonio 
Published: April 2019

Introduction: Optimal red blood cell transfusion practice during veno-venous extracorporeal membrane oxygenation (VV ECMO) is still under debate. This survey aimed to assess the Hb trigger (also comparing with other critically ill patients) and major physiologic determinants considered for transfusions during veno-venous extracorporeal membrane oxygenation. Methods: Voluntary Web-based survey, endorsed by the European Society of Intensive Care Medicine, conducted among VV ECMO pratictioners worldwide. Results: A total of 447 respondents worldwide answered the questionnaire: 277 (61.9%) from Europe, 99 (22.1%) from North America, 36 (8.2%) from Asia and Oceania, and 35 (7.8%) from Central and South America. Among the respondents, 59.2% managed less than 12 venous extracorporeal membrane oxygenation runs/year, 19.4% between 12 and 24 runs/year, and 21.4% more than 24 runs/year. Of the respondents, 54.4% do not use a predefined Hb trigger in veno-venous extracorporeal membrane oxygenation, and, while the rate of adoption of a defined trigger varied worldwide, the effective value of Hb did not differ significantly among macro-regions. In patients on veno-venous extracorporeal membrane oxygenation, the Hb trigger to initiate red blood cell transfusion, was higher than in other critically ill patients: 9.1 ± 1.8 g/dL versus 8.3 ± 1.7 g/dL, p < 0.01. The Hb trigger was lower in centers with more than 24 venous extracorporeal membrane oxygenation runs/year (8.4 mg/dL (95% CI: 7.7-8.9)); (8.9 mg/dL (95% CI: 8.2-9.7)) in centers with between 12 and 24 venous extracorporeal membrane oxygenation runs/year; and (9.6 mg/dL (95% CI: 9.1-10.0)) in centers with fewer than 12 venous extracorporeal membrane oxygenation runs/year (p < 0.01). Several and variable adjunctive parameters are considered in cases of uncertainty for transfusion: the principal are hemodynamic status, SvO2, lactates, and fluid balance. Conclusion: Although the use of a predefined Hb trigger is still under-adopted among centers with low or median extracorporeal membrane oxygenation case volume, the majority of respondents use a higher Hb trigger for veno-venous extracorporeal membrane oxygenation patients compared with other critically ill patients. Higher volume centers tolerate lower Hb levels.
Management of accidental hypothermia: an established extracorporeal membrane oxygenation centre experience
Authors: Balik Martin , Porizka Michal , Matousek Vojtech , Brestovansky Petr , Svobodova Eva , Flaksa Marek , Rulisek Jan , Mlejnsky Frantisek , Hodkova Gabriela , Grus Tomas , Vobruba Vaclav , Belohlavek Jan 
Published: April 2019

Introduction: Data on management of severe accidental hypothermia published from an established high-volume extracorporeal membrane oxygenation centre are scarce. Methods: A total of 28 patients with intravesical temperature lower than 28°C on admission were either treated with veno-arterial extracorporeal membrane oxygenation or rewarmed conservatively. Results: A total of 10 patients rewarmed on veno-arterial extracorporeal membrane oxygenation (age: 37 ± 12.6 years) and 18 conservatively (age: 55.2 ± 11.2 years) were collected over a course of 5 years. The dominant cause was alcohol intoxication with exposure to cold (39%), 12 patients were resuscitated prior to admission. The admission temperature in the extracorporeal membrane oxygenation group (23.8 ± 2.6°C) was lower than in the non–extracorporeal membrane oxygenation group (26.0 ± 1.5°C, p = 0.01). The peripheral percutaneous veno-arterial extracorporeal membrane oxygenation was always cannulated in malignant arrhythmias causing refractory cardiac arrest. The typical extracorporeal membrane oxygenation blood flow was 3-4 L/minute and sweep gas flow 2 L/minute, the median extracorporeal membrane oxygenation duration was 48.3 (28.1-86.7) hours. The median rates of rewarming did not differ (0.41 (0.35-0.7)°C/hour in extracorporeal membrane oxygenation and 0.77 (0.54-0.98)°C/hour in non–extracorporeal membrane oxygenation, p = 0.46) as well as the admission arterial lactate, pH and potassium. Their development was not different between the groups except for higher pH between the third and ninth hour of rewarming in the extracorporeal membrane oxygenation group. The hospital mortality was 10% in the extracorporeal membrane oxygenation group and 11.1% in the non–extracorporeal membrane oxygenation group with the median last Glasgow Coma Scale 15 and Cerebral Performance Score 1. Conclusion: Veno-arterial extracorporeal membrane oxygenation for severe hypothermia shows promising outcome data collected in an extracorporeal membrane oxygenation/extracorporeal cardiopulmonary resuscitation centre located in a European urban area. Except for presence of refractory cardiac arrest, the established hypothermia-related prognostic indicators did not differ between patients in need for extracorporeal membrane oxygenation and those rewarmed without extracorporeal membrane oxygenation.
Mesenchymal stem cells may ameliorate inflammation in an ex vivo model of extracorporeal membrane oxygenation
Authors: von Bahr Viktor , Millar Jonathan E , Malfertheiner Maximillian V , Ki Katrina K , Passmore Margaret R , Bartnikowski Nicole , Redd Meredith A , Cavaye Michael , Suen Jacky Y , McAuley Danny F , Fraser John F 
Published: April 2019

Introduction: Mesenchymal stem cells exhibit immunomodulatory properties which are currently being investigated as a novel treatment option for Acute Respiratory Distress Syndrome. However, the feasibility and efficacy of mesenchymal stem cell therapy in the setting of extracorporeal membrane oxygenation is poorly understood. This study aimed to characterise markers of innate immune activation in response to mesenchymal stem cells during an ex vivo simulation of extracorporeal membrane oxygenation. Methods: Ex vivo extracorporeal membrane oxygenation simulations (n = 10) were conducted using a commercial extracorporeal circuit with a CO2-enhanced fresh gas supply and donor human whole blood. Heparinised circuits (n = 4) were injected with 40 × 106-induced pluripotent stem cell–derived human mesenchymal stem cells, while the remainder (n = 6) acted as controls. Simulations were maintained, under physiological conditions, for 240 minutes. Circuits were sampled at 15, 30, 60, 120 and 240 minutes and assessed for levels of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tumour necrosis factor-α, transforming growth factor-β1, myeloperoxidase and α-Defensin-1. In addition, haemoglobin, platelet and leukocyte counts were performed. Results: There was a trend towards reduced levels of pro-inflammatory cytokines in mesenchymal stem cell–treated circuits and a significant increase in transforming growth factor-β1. Blood cells and markers of neutrophil activation were reduced in mesenchymal stem cell circuits during the length of the simulation. As previously reported, the addition of mesenchymal stem cells resulted in a reduction of flow and increased trans-oxygenator pressures in comparison to controls. Conclusions: The addition of mesenchymal stem cells during extracorporeal membrane oxygenation may cause an increase in transforming growth factor-β1. This is despite their ability to adhere to the membrane oxygenator. Further studies are required to confirm these findings.
Good end-of-life care in nursing home according to the family carers’ perspective: A systematic review of qualitative findings
Authors: Gonella Silvia , Basso Ines , De Marinis Maria Grazia , Campagna Sara , Di Giulio Paola 
Published: April 2019

Background: Nursing homes are becoming a common site where delivering end-of-life care for older adults. They often represent the junction between the curative and the palliative phase. Aim: To identify the elements that nursing home residents’ family carers perceive as good end-of-life care and develop a conceptual model of good end-of-life care according to the family perspective. Design: Systematic review (PROSPERO no. 95581) with meta-aggregation method. Data Sources: Five electronic databases were searched from inception between April and May 2018. Published qualitative studies (and mixed-method designs) of end-of-life care experience of nursing home family carers whose relative was dead or at the end-of-life were included. No language or temporal limits were applied. Results: In all, 18 studies met inclusion criteria. A ‘life crisis’ often resulted in a changed need of care, and the transition towards palliative care was sustained by a ‘patient-centered environment’. Family carers described good end-of-life care as providing resident basic care and spiritual support; recognizing and treating symptoms; assuring continuity in care; respecting resident’s end-of-life wishes; offering environmental, emotional and psychosocial support; keeping family informed; promoting family understanding; and establishing a partnership with family carers by involving and guiding them in a shared decision-making. These elements improved the quality of end-of-life of both residents and their family, thus suggesting a common ground between good end-of-life care and palliative care. Conclusion: The findings provide a family-driven framework to guide a sensitive and compassionate transition towards palliative care in nursing home.
The brain protective effect of dexmedetomidine during surgery for paediatric patients with congenital heart disease
Authors: Gong Jin , Zhang Rufang , Shen Li , Xie Yewei , Li Xiaobing 
Published: April 2019

Objective To study the brain protective effect of dexmedetomidine (DEX) during surgery in paediatric patients with congenital heart disease (CHD). Methods This randomized single-blind controlled study enrolled paediatric patients aged 0–3 years with CHD who underwent surgery and randomized them into two groups: one group received DEX and the control group received 0.9% NaCl during anaesthesia. Demographic data, heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded. Levels of neuron specific enolase (NES) and S-100β protein were determined using enzyme-linked immunosorbent assays. Results The study enrolled 80 paediatric patients with CHD. Compared with the control group, HR, MAP and CVP were significantly lower in the DEX group at all time-points except for T0. At all time-points except for T0, the levels of jugular venous oxygen saturation in the DEX group were significantly higher compared with the control group. At all time-points except for T0, the levels of arterial venous difference and cerebral extraction of oxygen were significantly lower in the DEX group compared with the control group. Levels of NES and S-100β protein in the DEX group were significantly lower compared with the control group at all time-points except for T0. Conclusion DEX treatment during surgery for CHD improved oxygen metabolism in brain tissues and reduced the levels of NES and S-100β protein.