bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accurate Depth of Radiofrequency-Induced Lesions in Renal Sympathetic Denervation Based on a Fine Histological Sectioning Approach in a Porcine Model
Authors: Sakaoka Atsushi , Terao Hisako , Nakamura Shintaro , Hagiwara Hitomi , Furukawa Toshihito , Matsumura Kiyoshi , Sakakura Kenichi 
Published: February 2018

Background—
Ablation lesion depth caused by radiofrequency-based renal denervation (RDN) was limited to <4 mm in previous animal studies, suggesting that radiofrequency-RDN cannot ablate a substantial percentage of renal sympathetic nerves. We aimed to define the true lesion depth achieved with radiofrequency-RDN using a fine sectioning method and to investigate biophysical parameters that could predict lesion depth.

Methods and Results—
Radiofrequency was delivered to 87 sites in 14 renal arteries from 9 farm pigs at various ablation settings: 2, 4, 6, and 9 W for 60 seconds and 6 W for 120 seconds. Electric impedance and electrode temperature were recorded during ablation. At 7 days, 2470 histological sections were obtained from the treated arteries. Maximum lesion depth increased at 2 to 6 W, peaking at 6.53 (95% confidence interval, 4.27–8.78) mm under the 6 W/60 s condition. It was not augmented by greater power (9 W) or longer duration (120 seconds). There were statistically significant tendencies at 6 and 9 W, with higher injury scores in the media, nerves, arterioles, and fat. Maximum lesion depth was positively correlated with impedance reduction and peak electrode temperature (Pearson correlation coefficients were 0.59 and 0.53, respectively).

Conclusions—
Lesion depth was 6.5 mm for radiofrequency-RDN at 6 W/60 s. The impedance reduction and peak electrode temperature during ablation were closely associated with lesion depth. Hence, these biophysical parameters could provide prompt feedback during radiofrequency-RDN procedures in the clinical setting.
Repeated Administrations of Cardiac Progenitor Cells Are Superior to a Single Administration of an Equivalent Cumulative Dose
Authors: Tang Xian‐Liang , Nakamura Shunichi , Li Qianhong , Wysoczynski Marcin , Gumpert Anna M. , Wu Wen‐Jian , Hunt Greg , Stowers Heather , Ou Qinghui , Bolli Roberto 
Published: February 2018

Background

We have recently found that 3 repeated doses (12×10
6
each) of c‐kit

POS

cardiac progenitor cells (
CPC
s) were markedly more effective than a single dose of 12×10
6
cells in alleviating postinfarction left ventricular dysfunction and remodeling. However, since the single‐dose group received only one third of the total number of
CPC
s given to the multiple‐dose group, it is unknown whether the superior therapeutic efficacy was caused by repeated treatments per se or by administration of a higher total number of
CPC
s. This issue has major clinical implications because multiple cell injections in patients pose significant challenges, which would be obviated by using 1 large injection. Accordingly, we determined whether the beneficial effects of 3 repeated
CPC
doses can be recapitulated by 1 large dose containing the same total number of cells.

Methods and Results

Rats with a 30‐day‐old myocardial infarction received 3 echo‐guided intraventricular infusions, 35 days apart, of vehicle‐vehicle‐vehicle, 36×10
6
CPC
s‐vehicle‐vehicle, or 3 equal doses of 12×10
6
CPC
s. Infusion of a single, large dose of
CPC
s (36×10
6
cells) produced an initial improvement in left ventricular function, but no further improvement was observed after the second and third infusions (both vehicle). In contrast, each of the 3 doses of
CPC
s (12×10
6
) caused a progressive improvement in left ventricular function, the cumulative magnitude of which was greater than with a single dose. Unlike the single dose, repeated doses reduced collagen content and immune cell infiltration.

Conclusions

Three repeated doses of
CPC
s are superior to 1 dose even though the total number of cells infused is the same, possibly because of greater antifibrotic and anti‐inflammatory actions.
Characterizing the Atmospheric Conditions Leading to Large Error Growth in Volcanic Ash Cloud Forecasts
Authors: Dacre H. F. , Harvey N. J. 
Published: February 2018

ABSTRACTVolcanic ash poses an ongoing risk to safety in the airspace worldwide. The accuracy with which volcanic ash dispersion can be forecast depends on the conditions of the atmosphere into which it is emitted. In this study, meteorological ensemble forecasts are used to drive a volcanic ash transport and dispersion model for the 2010 Eyjafjallajökull eruption in Iceland. From analysis of these simulations, the authors determine why the skill of deterministic-meteorological forecasts decreases with increasing ash residence time and identify the atmospheric conditions in which this drop in skill occurs most rapidly. Large forecast errors are more likely when ash particles encounter regions of large horizontal flow separation in the atmosphere. Nearby ash particle trajectories can rapidly diverge, leading to a reduction in the forecast accuracy of deterministic forecasts that do not represent variability in wind fields at the synoptic scale. The flow‐separation diagnostic identifies where and why large ensemble spread may occur. This diagnostic can be used to alert forecasters to situations in which the ensemble mean is not representative of the individual ensemble‐member volcanic ash distributions. Knowledge of potential ensemble outliers can be used to assess confidence in the forecast and to avoid potentially dangerous situations in which forecasts fail to predict harmful levels of volcanic ash.
Outpatient Procedural Sedation of Patients With Autism Spectrum Disorders for Magnetic Resonance Imaging of the Brain Using Propofol
Authors: Kamat Pradip P. , Karaga Marie K. , Wisniewski Benjamin L. , McCracken Courtney E. , Simon Harold K. , Sidhu Reet , Grunwell Jocelyn R. 
Published: February 2018

Objective: To quantify the number of personnel, time to induce and complete sedation using propofol for outpatient magnetic resonance imaging (MRI) of the brain, and the frequency of serious adverse events (SAEs) in children with autism spectrum disorder (ASD) compared with children without ASD. Results: Baseline characteristics were the same between both groups. Overall sedation success was 99%. Although most children were sedated with ≤3 providers, 10% with ASD needed ≥4 providers (P = .005). The duration of sedation was less for the ASD group compared with the non-ASD group (49 minutes vs 56 minutes, P = .005). There was no difference in SAE frequency between groups (ASD 14% vs non-ASD 16%, P = .57). Conclusion: Children with ASD can be sedated for brain MRI using propofol with no increased frequency of SAEs compared with children without ASD. Sedation teams should anticipate that 10% of children with ASD may need additional personnel before propofol induction.
Bleeding Risks in Patients on Percutaneous Ventricular Assist Devices Receiving Two Different Dextrose Concentrations of Heparinized Purge Solution: A Case Series
Authors: Dietrich Jenna N. , Kazmi Hasan 
Published: February 2018

Background: The Impella manufacturer has changed its recommendation for the diluent of the heparinized purge solution from 20% dextrose (D20) to 5% dextrose (D5). This reduced viscosity may result in increased purge solution infusion rates and unfractionated heparin (UFH) exposure. Increased UFH exposure could potentially cause increased bleeding events and may necessitate reduction in UFH concentration in the purge solution. Our objective was to evaluate anticoagulation for patients on Impella pumps receiving heparinized purge solution with D20 or D5 diluents. Methods: This retrospective cohort analysis evaluated patients requiring Impella support outside of the cardiac catheterization lab. The primary outcome evaluated the number of patients with at least one supratherapeutic activated partial thromboplastin time (aPTT) while receiving heparinized purge solution alone without systemic UFH. Secondary outcomes included heparin concentration changes made to the purge solution, bleeding, and thrombotic events. Results: Twelve patients received Impella support for an average of 37 hours (range, 10.8-89.6). Four patients received D20 and 8 patients received D5 purge solution. Five patients had at least one supratherapeutic aPTT while receiving heparinized purge solution alone without additional systemic UFH. All 5 patients were in the D5 group. Of these 5 patients, 3 required purge heparin concentration decreases and 3 had bleeding events. No patients had pump thrombosis. Conclusion: D5 purge solution with heparin 50 units/mL may increase the risk of supratherapeutic aPTTs, leading to increased bleeding. Decreasing heparin to 25 units/mL as a standard in purge solution may decrease these risks; however, protection against thrombosis remains unknown.
Building consensus on user participation in social work: A conversation analysis
Authors: Leung Terry TF , Lam Barry CL 
Published: February 2018

Summary In order to understand how mutual understanding was achieved in discursive interactions between the welfare service users and service practitioners, conversation analysis was conducted in four discussion panels set up for building consensus on the appropriate structure for user participation in service management. Conversations in eight panel discussion meetings were audio-taped for analysing the talks-in-interaction therein. Drawing on the conversation analysis, the article uncovers the dynamics of consensus building among participants from different epistemic communities. Findings The study identifies the extent of divergence in views among stakeholders, which could have been obscured by the pressure to acquiesce in platform of face-to-face coordination. In the contest for truth between the welfare service users and service practitioners, personal experience has not been accepted as legitimate resource for supporting truth claims. Having limited argument resources on issues of service management, the welfare service users perceived argumentation in panel discussion a threatening venture that they chose to avoid. Avoidance was also a strategy that panel participants employed to maintain mundane interactions in the face of looming dissents. The article argues that the Habermasian communicative ethics are not panacea to the problem of coordination between the welfare service users and service practitioners. An agonistic model of democracy is called for to shift the objective of communication from gauging consensus to encouraging articulation of disagreements in the intricate user participation project. Application The article provides a new direction for developing the user participation imperative to address necessary pluralities among stakeholders of welfare services.
Association Between Dementia Severity and Recommended Lifestyle Changes: A Retrospective Cohort Study
Authors: Thoits Timothy , Dutkiewicz Alison , Raguckas Sarah , Lawrence Michael , Parker Jessica , Keeley Jacob , Andersen Nicholas , VanDyken Martha , Hatfield-Eldred Maegan 
Published: February 2018

Objective: Early diagnosis of dementia leads to early treatment which is beneficial to patients and the community. We reviewed initial evaluations from the Spectrum Health Medical Group Neurocognitive Clinic (SHMGNC) to evaluate dementia stage at the time of diagnosis. Methods: We retrospectively reviewed 110 randomly chosen initial evaluations from September 2008 to December 2015 at the SHMGNC. Patients underwent a neurological examination, Montreal Cognitive Assessment, and a battery of neuropsychological testing. Results: Of all, 78.9% had moderate or severe dementia at diagnosis. The SHMGNC recommended lifestyle changes (medication assistance, financial assistance, driving restrictions, and institutional care) in 75.8% of patients with dementia. The severity of dementia was associated with the number of lifestyle changes recommended. Cohabitation with a caregiver did not lead to an early diagnosis of dementia. Conclusions: Patients are not undergoing evaluation at the onset of the dementia process. Diagnosis is delayed. Home-based, patient-centered care may improve early screening and detection of dementia.
Effect of 12 weeks of once-daily tiotropium/olodaterol on exercise endurance during constant work-rate cycling and endurance shuttle walking in chronic obstructive pulmonary disease
Authors: Maltais François , O’Donnell Denis , Gáldiz Iturri Juan Bautista , Kirsten Anne-Marie , Singh Dave , Hamilton Alan , Tetzlaff Kay , Zhao Yihua , Casaburi Richard 
Published: February 2018

Background: The TORRACTO® study evaluated the effects of tiotropium/olodaterol versus placebo on endurance time during constant work-rate cycling and constant speed shuttle walking in patients with chronic obstructive pulmonary disease (COPD) after 12 weeks of treatment. Methods: The effects of once-daily tiotropium/olodaterol (2.5/5 and 5/5 μg) on endurance time during constant work-rate cycle ergometry (CWRCE) after 6 and 12 weeks of treatment were compared with placebo in patients with COPD in a randomized, double-blind, placebo-controlled, parallel-group clinical trial. Endurance time during the endurance shuttle walk test (ESWT) after 6 and 12 weeks of treatment was also evaluated in a subset of patients. Results: A total of 404 patients received treatment, with 165 participating in the ESWT substudy. A statistically significant improvement in endurance time during CWRCE was observed after 12 weeks (primary endpoint) with tiotropium/olodaterol 5/5 µg [14% ( p = 0.02)] but not with tiotropium/olodaterol 2.5/5 µg [9% ( p = 0.14)] versus placebo. In the ESWT substudy, a trend to improvement in endurance time during ESWT after 12 weeks (key secondary endpoint) was observed with tiotropium/olodaterol 5/5 µg [21% ( p = 0.055)] and tiotropium/olodaterol 2.5/5 µg [21% ( p = 0.056)] versus placebo. Conclusion: Tiotropium/olodaterol 5/5 µg improved endurance time during cycle ergometry versus placebo, with a strong tendency to also improve walking endurance time. [ ClinicalTrials.gov identifier: NCT01525615.]
Imaging and classification of osteochondritis dissecans of the capitellum: X-ray, magnetic resonance imaging or computed tomography?
Authors: van den Ende Kimberly I. M. , Keijsers Renée , van den Bekerom Michel P. J. , Eygendaal Denise 
Published: February 2018

Background Diagnosing capitellar osteochondritis dissecans (OCD) can be difficult, causing delay in treating young athletes. The main aim of this retrospective diagnostic study was to determine which radiological technique is preferred to identify and classify elbow OCD. Methods We identified young patients who underwent elbow arthroscopy because of symptomatic OCD. We included all patients who had pre-operative radiographs, a computed tomography (CT) scan and magnetic resonance imaging (MRI) available. We assessed whether the osteochondral lesion could be identified using the various imaging modalities. All lesions were classified according to previous classifications for X-ray, CT and MRI, respectively. These results were compared with findings at arthroscopy. Results Twenty-five patients had pre-operative radiographs as well as CT scans and MRI. In six patients, the lesion was not visible on standard X-ray. In 20 patients, one or two loose bodies were found during surgery, consistent with an unstable lesion. Pre-operatively, this was seen on 11 X-rays, 13 MRIs and 18 CT scans. Conclusions Capitellar OCD lesions are not always visible on standard X-rays. A CT appears to be the preferred imaging technique to confirm diagnosis of OCD. Loose bodies are often missed, especially on standard X-rays and MRIs.
High Rate of Return to Yoga for Athletes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome
Authors: Frank Rachel M. , Ukwuani Gift , Allison Bradley , Clapp Ian , Nho Shane J. 
Published: February 2018

Background: Femoroacetabular impingement syndrome (FAIS) is most commonly diagnosed in patients who perform activities that require repetitive hip flexion and rotational loading. Yoga is an activity growing in popularity that involves these motions. The purpose of this study was to evaluate patients’ ability to return to yoga after hip arthroscopy for FAIS. Hypothesis: There would be a high rate of return to yoga after hip arthroscopy. Study Design: Retrospective analysis. Level of Evidence: Level 4. Methods: Consecutive patients with FAIS who had identified themselves as participating in yoga and had undergone hip arthroscopy for the treatment of FAIS between 2012 and 2015 were reviewed. Demographic data were collected and assessed for all patients, as well as preoperative physical examination, imaging, and patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, and visual analog scale (VAS) for pain. Postoperatively, examination and PRO data were collected at a minimum 1 year after surgery, including a yoga-specific questionnaire. Results: A total of 42 patients (90% female; mean age, 35 ± 9 years; mean body mass index, 23.1 ± 3.2 kg/m2) were included. Thirty patients (71%) had to discontinue their yoga routine preoperatively because of hip-related symptoms at a mean 9.5 ± 8.2 months before surgery. After surgery, 39 patients (93%) were able to return to yoga at a mean 5.3 ± 2.2 months after surgery. Two of the 3 patients who did not return to yoga noted loss of interest as their reason for stopping, while 1 patient was unable to return because of persistent hip pain. Nineteen patients (45%) returned to a higher level of yoga practice, 17 patients (40%) returned to the same level, and 3 patients (7%) returned to a lower level. There was no difference in the number of hours spent practicing yoga per week pre- and postoperatively (2.7 ± 1.9 vs 2.5 ± 1.3 hours; P = 0.44). All patients demonstrated significant improvement in all PROs as well as pain scores after surgery (HOS-ADL, 67.4 ± 18.3 to 93.1 ± 6.9 [ P < 0.001]; HOS-SS, 45.6 ± 24.7 to 81.5 ± 18.8 [ P < 0.001]; mHHS, 62.3 ± 11.3 to 86.8 ± 12.3 [ P < 0.0001]; VAS pain, 6.3 ± 2.2 to 0.90 ± 1.1 [ P < 0.001]). Conclusion: Patients participating in yoga return to yoga 93% of the time and at a mean 5.3 ± 2.2 months after hip arthroscopy for FAIS. Clinical Relevance: Information regarding surgical outcomes is critical in counseling patients, particularly female athletes, on their expectations with respect to returning to yoga after hip arthroscopy for FAIS.
Evidence of Early Emergence of the Primary Dentition in a Northern Plains American Indian Population
Authors: Dawson D.V. , Blanchette D.R. , Douglass J.M. , Tinanoff N. , Kramer K.W.O. , Warren J.J. , Phipps K.R. , Starr D.E. , Marshall T.A. , Mabry T.R. , Pagan-Rivera K. , Banas J.A. , Drake D.R. 
Published: February 2018

The purposes of this study were to describe primary tooth emergence in an American Indian (AI) population during the first 36 mo of life to compare 1) patterns of emergence between male and female children and 2) tooth emergence between these AI children and other U.S. ethnic groups. Data were derived from a birth cohort of 239 AI children from a Northern Plains tribe participating in a longitudinal study of early childhood caries, with examination data at target ages of 8, 12, 16, 22, 28, and 36 mo of age (±1 mo). Patterns of emergence in AI children were characterized and sex comparisons accomplished with interval-censored survival methodology. Numbers of erupted teeth in AI children at each age were compared via Kruskal-Wallis tests against those in children of the same age, as drawn from a cross-sectional study of dental caries patterns in Arizona; these comparisons were based on the dental examinations of 547 White non-Hispanic and 677 Hispanic children. Characterization of time to achievement of various milestones—including emergence of the anterior teeth, the first molars, and the complete primary dentition—provided no evidence of sex differences among AI children. AI children had significantly more teeth present at 8 mo (median, 3) than either White non-Hispanic ( P < 0.0063) or Hispanic ( P < 0.0001) children (median, 2 each). This was also true at 12 mo ( P < 0.001; medians, 8 vs. 6 and 7, respectively) and 16 mo ( P < 0.001; medians, 12 vs. 11 each). Less pronounced differences were seen at 22 mo ( P < 0.0001). White non-Hispanic and Hispanic children did not differ at any time considered ( P > 0.05). These results provide evidence of earlier tooth emergence in AI children than in the other 2 ethnicities. Although the underlying etiology of the severity of early childhood caries in AI children is likely to be multifactorial, earlier tooth emergence may be a contributing factor. Knowledge Transfer Statement: The findings of this study have practical implications for practitioners providing childhood oral health care to ethnic groups with early tooth emergence. It may be important to provide parents with information on toothbrushing, dentist visits, and other practices supportive of good oral health as early as possible to protect their children’s primary dentition.
Drip and ship versus direct to endovascular thrombectomy: The impact of treatment times on transport decision-making
Authors: Holodinsky Jessalyn K , Patel Alka B , Thornton John , Kamal Noreen , Jewett Lauren R , Kelly Peter J , Murphy Sean , Collins Ronan , Walsh Thomas , Cronin Simon , Power Sarah , Brennan Paul , O’hare Alan , McCabe Dominick JH , Moynihan Barry , Looby Seamus , Wyse Gerald , McCormack Joan , Marsden Paul , Harbison Joseph , Hill Michael D , Williams David 
Published: February 2018

Introduction In ischaemic stroke care, fast reperfusion is essential for disability free survival. It is unknown if bypassing thrombolysis centres in favour of endovascular thrombectomy (mothership) outweighs transport to the nearest thrombolysis centre for alteplase and then transfer for endovascular thrombectomy (drip-and-ship). We use conditional probability modelling to determine the impact of treatment times on transport decision-making for acute ischaemic stroke. Materials and methods Probability of good outcome was modelled using a previously published framework, data from the Irish National Stroke Register, and an endovascular thrombectomy registry at a tertiary referral centre in Ireland. Ireland was divided into 139 regions, transport times between each region and hospital were estimated using Google’s Distance Matrix Application Program Interface. Results were mapped using ArcGIS 10.3. Results Using current treatment times, drip-and-ship rarely predicts best outcomes. However, if door to needle times are reduced to 30 min, drip-and-ship becomes more favourable; even more so if turnaround time (time from thrombolysis to departure for the endovascular thrombectomy centre) is also reduced. Reducing door to groin puncture times predicts better outcomes with the mothership model. Discussion This is the first case study modelling pre-hospital transport for ischaemic stroke utilising real treatment times in a defined geographic area. A moderate improvement in treatment times results in significant predicted changes to the optimisation of a national acute stroke patient transport strategy. Conclusions Modelling patient transport for system-level planning is sensitive to treatment times at both thrombolysis and thrombectomy centres and has important implications for the future planning of thrombectomy services.
Hypoxia-inducible KDM3A addiction in multiple myeloma
Authors: Ikeda Sho , Kitadate Akihiro , Abe Fumito , Takahashi Naoto , Tagawa Hiroyuki 
Published: February 2018

Key Points
Under hypoxia, KDM3A, but not IRF4, leads myeloma cells to acquire an antiapoptotic phenotype. KDM3A regulates a long noncoding RNA, MALAT1, leading to upregulation of glycolytic genes under hypoxia.