bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pseudo-Occlusion of the Internal Carotid Artery Predicts Poor Outcome After Reperfusion Therapy
Authors: Chen Zhicai , Zhang Meixia , Shi Feina , Gong Xiaoxian , Liebeskind David , Ding Xinfa , Liu Chang , Zhang Ruiting , Lou Min 
Published: April 2018

Background and Purpose—
This study aimed to evaluate the occurrence rate of the internal carotid artery pseudo-occlusion (ICA-PO) on 4-dimensional–computed tomography angiography and to investigate its relationship with clinical outcome after reperfusion therapy.

Methods—
In this case–control study, we retrospectively reviewed our prospectively collected database for consecutive acute ischemic stroke patients who received reperfusion therapy between June 2009 and February 2017. ICA-PO was defined when the arterial segment was not opacified on peak arterial phase yet was subsequently patent after artery peak phase on 4-dimensional–computed tomography angiography. Poor outcome was defined as 3-month modified Rankin Scale of 4 to 6. Binary logistic regression was used to investigate the relationship of ICA-PO with poor outcome and the rate of reperfusion, respectively.

Results—

A total of 143 patients with isolated middle cerebral artery occlusion were included and 30 (21.0%) had ICA-PO. Patients with ICA-PO were more likely to have poor outcome (80.0% versus 37.2%;
P
<0.001) and a lower rate of reperfusion (45.8% versus 69.0%;
P
=0.033) than those without. Binary logistic regression revealed that ICA-PO was independently associated with poor outcome (odds ratio, 7.957; 95% confidence interval, 1.655–34.869;
P
=0.009) and reperfusion at 24 hours (odds ratio, 0.150; 95% confidence interval, 0.045–0.500;
P
=0.002) after adjustment. Among patients with no reperfusion, all ICA-PO patients obtained poor outcome, whereas only 45.2% non-PO patients underwent poor outcome (
P
=0.001).

Conclusions—
Four dimensional-computed tomography angiography is a useful noninvasive technique to identify ICA-PO. Patients with ICA-PO are prone to undergo poor outcome from reperfusion therapy, especially when reperfusion is not achieved.
Evidence for Qin Law in the Qianling County Archive: A Preliminary Survey (遷陵縣檔案中秦法的證據：初步的研究)
Authors: Yates (葉山) Robin D.S. 
Published: April 2018

This paper reviews the various types of Qin legislation found in the documents published so far that were excavated from Well no. 1, Liye, Hunan Province. They provide insight into the actual functioning and application of the law in the context of local administration in China’s first imperial dynasty.
本文回顧了已發表的湖南省里耶 1 號井出土文獻中的各類秦法。它們可以讓人們了解在中國第一帝國時期的地方行政管理中，法律實際上是如何運行和應用的。
The effect of air exposure on leucocyte and cytokine activation in an in-vitro model of cardiotomy suction
Authors: Toomasian Cory J. , Aiello Salvatore R. , Drumright Benjamin L. , Major Terry C. , Bartlett Robert H. , Toomasian John M. 
Published: April 2018

Introduction: Cardiopulmonary bypass (CPB) is known to cause a systemic inflammatory and immune response. Objective: An in-vitro model of cardiotomy suction was designed to quantify the effects of incrementally increased air-blood exposure on leucocyte marker CD11b and cytokine activation in two common anticoagulants, heparin and citrate. Methods: Fresh human blood was exposed to increasing amounts of air flow for ten minutes. Leucocyte and cytokine levels were measured prior to and after ten minutes of air flow. Cytokine levels were also measured after air exposure when incubated for 24 hours at 37oC. Results: Leucocyte activation, measured by CD11b, was elevated between baseline and air flow rates up to 50 mL/min. After 10 minutes of air exposure, no measured cytokine levels were elevated. After 24 hours of incubation, cytokine levels of TNFα, IL-10, IL-6, and IL-8 were elevated. However, only IL-8 was significantly elevated in citrated blood, but not in heparinized blood, when compared to baseline samples that were also incubated for 24 hours. Conclusion: This study investigates CD11b levels in response to an air stimulus in blood that was anticoagulated with citrate or heparin. Exposure to an air stimulus activates leucocytes. Activation of CD11b was less when using heparin as an anticoagulant compared to citrate. Cytokine activation occurs with air stimulation, but levels do not immediately rise, indicating that time is required to generate free cytokines.
Comparison of two pediatric cases requiring the use of bivalirudin during cardiopulmonary bypass
Authors: Bryant Molly E. , Regan William L. , Fynn-Thompson Francis , Hoganson David , Nasr Viviane G. , Zaleski Katherine , Faella Katie , Matte Gregory S. 
Published: April 2018

Introduction: Comparison of two pediatric cases at our institution that utilized bivalirudin for anticoagulation on cardiopulmonary bypass (CPB); a bilateral lung transplant (BLT) and a ventricular assist device (VAD) implantation. Methods: The same bivalirudin protocol was utilized in both cases with an initial bolus of 1 mg/kg administered by the anesthesia team, a 50 mg bolus in the pump prime at the time of the initial patient bolus and an initial infusion rate of 2.5 mg/kg/h, with titration as needed during CPB to maintain kaolin-activated clotting time (K-ACT) values >400 s. Results: The BLT experienced high K-ACT levels (>720 s) for the majority of the case despite decreasing the bivalirudin infusion rate to 0.5 mg/kg/h. The VAD implantation case required the bivalirudin infusion rate to be increased to 5.0 mg/kg/h throughout the case due to low K-ACTs. Conclusion: The literature strongly supports a specific infusion rate1–7 (2.5 mg/kg/h) for bivalirudin anticoagulation during extracorporeal circulation. Clinicians must consider the loss of clotting factors and the administration of blood products while adjusting the bivalirudin infusion during bypass. We have now elected to maintain an infusion rate of ≥0.5 mg/kg/h for bivalirudin anticoagulation at our center, based on institutional experience, though consideration for a higher infusion rate for an added margin of safety should be considered. It is imperative to have a well-developed protocol for the management of these cardiopulmonary bypass patients and we offer our one-page timeline of events to help guide other pediatric centers looking to use bivalirudin anticoagulation.
Assessment of bowel and anal sphincter function after neoadjuvant chemoradiotherapy in locally advanced rectal cancer
Authors: Rosa Consuelo , Di Tommaso Monica , Caravatta Luciana , Vinciguerra Annamaria , Augurio Antonietta , Perrotti Francesca , Allajbej Albina , Regoli Marco , Zecca Isaia AL , Di Nicola Marta , Genovesi Domenico 
Published: April 2018

Purpose: To report long-term effects on anorectal function and bowel disorders and late toxicity rate of preoperative chemoradiotherapy in patients with locally advanced rectal cancer. Methods: Between 2000 and 2016, 201 patients treated with different neoadjuvant schedules of chemotherapy and radiotherapy doses were retrospectively analyzed. The Memorial Sloan–Kettering Cancer Center score was used for the evaluation of anal sphincter function. Results: The median follow-up time was 68 months (interquartile range 35–113 months). Radical resection was performed in 188 (93.5%) patients with a pathologic complete response rate of 26.4%. Overall sphincter function resulted excellent in 105 (52.2%) patients, good in 13 (6.5%), fair in 10 (5.0%), and poor (incontinence) in 40 (19.9%), with a persistent stoma rate of 16.4%. A further evaluation on 194 patients showed an improvement of sphincter function after 2 years in 11.9% of them. Seventy-three patients presenting stoma or poor sphincter function were re-evaluated for quality of life (QoL) indexes. Twenty-one (29%), 19 (26%), and 24 (33%) of them declared some variations concerning well-being, fatigue, and ability to perform daily activities. The 5-year overall survival, disease-free survival, and local recurrence rates were 88.0% ± 2.6%, 86.3% ± 2.5%, and 94.6% ± 1.9%, respectively. Conclusions: In our study, neoadjuvant chemoradiotherapy was associated with good results in terms of sphincter function, late toxicities, and QoL indexes. A routine use of assessment scales could contribute to a better selection of patients with increased risk of developing functional disorders who could benefit from neoadjuvant therapy.
Transverse Fractures of the Spinous Process of the 7th Cervical Vertebra in RDT Patients: An AI Related Disease?
Authors: Marumo F. , Nomura T. , Nishikawa H. 
Published: April 2018

Transverse fractures of the spinous process of the 7th cervical vertebra were noted in 2 patients and of the 1st thoracic vertebra in 1 patient on maintenance hemodialysis. Two patients with aluminum (AI)- and/or iron-related bone disease complained of bone pain, relieved by deferoxamine therapy. In all three cases, the bone fractures had occurred suddenly while the patients were going about their daily work. These observations indicate that AI- or iron-related bone disease with secondary hyperparathyroidism can induce bone fracture by only slight stress in patients maintained on hemodialysis.
Plasma-Exchange in Myasthenia Gravis: A Study in 20 Patients
Authors: Taiuti R. , Avanzi G. , Paoletti P. , Marconi G. 
Published: April 2018

Twenty patients with myasthenia gravis (MG) of generalized 2A and 2B types according to the Ossermann classification were treated with a course of nine plasma exchanges (PE) every two days. Before starting of the course, at the fourth exchange, and at the end of the course, the muscle balance was assessed following a special protocol. Other functions, such as respiratory function, stapedial reflex, phonation, and electro-oculographic activity were assessed and a Desmedt test was done. Three patients showed complete remission of symptoms, 8 showed good improvement and 6 mild improvement. Three showed no improvement. In total 85% of patients gained from PE. The onset of improvement was rapid in all patients but in some it lasted only a short time while in others it persisted for several weeks and even months, without the need for immunosuppressive therapy.
Anaphylatoxins C3a and C5a Adsorption on Acrylonitrile Membrane of Hollow-fiber and Plate Dialyzer – an in Vivo Study
Authors: Kandus A. , Ponikvar R. , Drinovec J. , Kladnik S. , Ivanovich P. 
Published: April 2018

We studied the adsorption of anaphylatoxins C3a and C5a on acrylonitrile (AN69) hollow-fiber (AN69HF) and plate (AN69P) dialyzers in 8 patients during 4-hour hemodialyses (HD). Blood passed first through a cuprophan dialyzer and then through AN69 dialyzers that were not in contact with dialysis fluid. Plasma C3a and C5a were measured in samples taken from the afferent and efferent blood lines of the acrylonitrile dialyzers at 15, 60 and 240 min. Plasma C3a concentrations decreased significantly in blood that had passed through AN69 dialyzers. This decrease, indicating membrane adsorption, was maximal (by 65% in AN69HF and by 59% in AN69P) at 15 min and minimal (by 53% in AN69HF and by 18% in AN69P) at 240 min. The decrease in plasma C5a concentrations was smaller and significant throughout HD only with AN69HF. The amount of C3a adsorbed was at least 45,000 μg in AN69HF and 18,000 μg in AN69P. These findings demonstrate that acrylonitrile dialyzers adsorb more C3a and C5a than they produce. This membrane adsorption may explain why the increase of plasma C3a and C5a is inhibited during HD.
Kinetics of Pulmonary Leukocyte Sequestration in Man during Hemodialysis with Different Membrane-Types
Authors: Kolb G. , Höffken H. , Müller T. , Havemann K. , Joseph K. , Lange H. 
Published: April 2018

Although it has been suggested that pulmonary sequestration of leukocytes could account for membrane-dependent white blood cell depletion in HD, direct evidence in patients is still lacking. Therefore a study was initiated to test whether and how leukocytes distribute in the lung circulation during HD with different membranes. Thirteen patients suffering from chronic renal failure underwent lung scintigraphy during HD with cuprophane (n = 3), hemophane (n = 8) and polysulfone (n = 2) lowflux capillary dialyzers. Isolated autologous leukocytes were labelled with 99m-Technetium and reinfused before starting HD. Distribution of leukocyte related activity was registered by lung scintigraphy. In comparison to normal lung scintigraphy performed without HD, an impressive redistribution peak was demonstrated 10-20 min after the start of HD with cuprophane and also to a lesser extent with hemophane. When HD was performed with polysulfone the decrease in activity was delayed but no real redistribution was obtained. In accordance with other phenomena, such as peripheral leukopenia and changes in granulocyte oxidative metabolism, pulmonary sequestration of leukocytes takes place in man in the initial phase of HD and appears to be strongly dependent on the type of membrane. (Int J Artif Organs 1990; 13: 729-36)
Using tickets in employment standards inspections: Deterrence as effective enforcement in Ontario, Canada?
Authors: Casey Rebecca , Tucker Eric , Vosko Leah F , Noack Andrea M 
Published: April 2018

AbstractIt is widely agreed that there is a crisis in labour/employment standards enforcement. A key issue is the role of deterrence measures that penalise violations. Employment standards enforcement in Ontario, like in most jurisdictions, is based mainly on a compliance framework promoting voluntary resolution of complaints and, if that fails, ordering restitution. Deterrence measures that penalise violations are rarely invoked. However, the Ontario government has recently increased the role of proactive inspections and tickets, a low-level deterrence measure which imposes fines of CAD295 plus victim surcharges. In examining the effectiveness of the use of tickets in inspections, we begin by looking at this development in the broader context of employment standards enforcement and its historical trajectory. Then, using administrative data from the Ministry of Labour, we examine when and why tickets are issued in the course of workplace inspections. After demonstrating that even when ticketable violations are detected, tickets are issued only rarely, we explore factors associated with an increased likelihood of an inspector issuing a ticket. Finally, we consider how the overall deterrent effect of workplace inspections is influenced by the use or non-use of deterrence tools.
The Role of Biomarkers in Research on Caregivers for Cancer Patients: A Scoping Review
Authors: Park Jumin , Ross Alyson , Klagholz Stephen D. , Bevans Margaret F. 
Published: April 2018

Background: Biomarkers can be used as prognostic, predictive, or monitoring indicators of an associated outcome. The purpose of this review was to provide a comprehensive summary of the research examining the use of biomarkers as surrogate end points for clinical outcomes in family caregivers for cancer patients, identify gaps, and make recommendations for future research. Methods: A scoping review, a process of mapping the existing literature, was conducted. Studies comparing biomarkers across caregivers and controls and/or examining relationships between biomarkers and psychological health were reviewed. Results: The studies ( N = 18) of caregivers for cancer patients who were identified used biomarkers to predict outcomes ( n = 13) and to monitor the efficacy of interventions ( n = 6). Biomarkers were divided into two categories based on physiological systems involved: (1) neuroendocrine function (sympathetic–adrenal–medullary axis activity, hypothalamic–pituitary–adrenal axis activity) and (2) immune function. Predictive biomarkers were sensitive to differences between caregivers and controls. The biomarkers were used to evaluate outcomes frequently associated with stress, depression, and anxiety. Cortisol was the biomarker most commonly measured to monitor the efficacy of interventions. Discussion: Biomarkers are most commonly incorporated into caregiver studies to predict group membership and psychological health. Neuroendocrine biomarkers, specifically cortisol, are most frequently assessed. Future research should include biomarkers of other physiologic functions (e.g., cardiovascular function, cognitive dysfunction, and cell aging) and those that serve as multisystem indicators. Expanding the scientific study of biomarkers will contribute to our understanding of the mechanisms through which stress may influence caregiver health.
Population impact of the 2017 ACC/AHA guidelines compared with the 2013 ESH/ESC guidelines for hypertension management
Authors: Vaucher Julien , Marques-Vidal Pedro , Waeber Gérard , Vollenweider Peter 
Published: April 2018

Background The 2017 ACC/AHA guidelines on hypertension management recommend the introduction of antihypertensive treatment for patients with new stage 1 hypertension thresholds (130–139/80–89 mm Hg) and with a cardiovascular disease or related condition. We compared the Swiss population and economic impact of antihypertensive treatment of the 2017 ACC/AHA guidelines with the 2013 European guidelines. Methods Analyses were based on 4438 participants (aged 45–85 years; 2448 women) of the CoLaus|PsyCoLaus study recruited between 2014-2017. Participants eligible for antihypertensive treatment according to the 2017 ACC/AHA and 2013 European guidelines were sex and age standardised using the Swiss population for 2016. In addition, we estimated the population-wide annual costs of antihypertensive treatment. Results Individuals eligible for antihypertensive treatment were 40.3% (95% confidence interval 38.5–42.1) and 31.3% (29.7–32.9) according to the 2017 ACC/AHA and 2013 European guidelines, respectively. That difference would translate into approximately 250,000 additional individuals eligible for antihypertensive treatment, corresponding to an additional annual cost of 72.5 million CHF (63.0 million EUR). Conclusion The 2017 ACC/AHA guidelines on the management of hypertension substantially increase the number of individuals eligible for antihypertensive treatment compared to the 2013 European guidelines. While implementation of the 2017 ACC/AHA guidelines is expected to lead to cost reduction by preventing cardiovascular diseases, that reduction might be mitigated by the costs incurred by antihypertensive treatments in a larger proportion of the population.
Postmarketing Modifications of Drug Labels for Cancer Drugs Approved by the US Food and Drug Administration Between 2006 and 2016 With and Without Supporting Randomized Controlled Trials
Authors: Shepshelovich Daniel , Tibau Ariadna , Goldvaser Hadar , Molto Consolación , Ocana Alberto , Seruga Bostjan , Amir Eitan 
Published: April 2018

PurposeModifications in cancer drug indications, dosing, and related toxicities after Food and Drug Administration approval are common. It is unclear whether drug approval without a supporting randomized controlled trial (RCT) influences the probability of such modifications.MethodsWe searched the Drugs@FDA Web site for new drug indications for solid tumors approved between January 2006 and December 2016. Study characteristics, regulatory pathways, and label modifications from approval to October 2017 were collected from drug labels. Label modifications were considered to be major if defined as such in the drug label. Indications approved with and without supporting RCTs were compared using logistic regression. The Benjamini-Hochberg false discovery rate method was used to adjust for multiplicity.ResultsWe identified 59 individual drugs for 109 solid tumor indications. Of these, 17 indications (15.6%) were not supported by an RCT, with no change over time. Indications not supported by RCTs were more likely to require companion diagnostic tests (odds ratio [OR], 3.90; P = .02), to include surrogate end points as primary outcomes (OR, 7.88; P < .001), and to receive breakthrough therapy designation (OR, 7.62; P = .006) or accelerated approval (OR, 17.67; P < .001). Indications not supported by RCTs were associated with significantly higher odds of postapproval modifications in common adverse events (71% v 29%; OR, 5.78; P = .002). A nonsignificantly higher odds of postapproval major modifications in warnings and precautions was also observed (88% v 62%; OR, 4.61; P = .051). Postapproval major modifications in indication and usage, dosing and administration, boxed warnings, and contraindications were comparable in the two groups.ConclusionCancer drug indications not supported initially by RCTs are associated with more postmarketing safety-related label modifications. Health care professionals should be vigilant for unrecognized adverse effects when prescribing drugs approved without a supporting RCT.
Oncology Guidelines Usage in a Low- and Middle-Income Country
Authors: Ismaila Nofisat , Salako Omolola , Mutiu Jimoh , Adebayo Oladeji 
Published: April 2018

Purpose There is a paucity of data about current usage of oncology guidelines in low- and middle-income countries (LMICs), specifically in terms of the availability and quality of those guidelines. Our objective was to determine usage of oncology guidelines and the barriers and facilitators to their usage among radiation oncologists in LMICs. Methods An online cross-sectional survey was conducted among practicing radiation oncologists in Nigeria via e-mail and the social media database of the Association of Radiation and Clinical Oncologists of Nigeria. In addition, paper questionnaires were administered at regional clinical meetings. Results The survey response rate was 53.4% in a sample of 101 radiation oncologists from the database. Sixty-nine percent of respondents were consultants and 30% were residents. Approximately 43% had < 5 years’ experience. All of the respondents were involved in administering chemotherapy during the treatment of patients with cancer, whereas approximately half were involved in diagnosing cancer. Ninety-three percent reported using guidelines in treating patients, the top two guidelines being those from the National Comprehensive Cancer Network (90%) and the American Society of Clinical Oncology (50%). The two major barriers to guideline usage were that facilities were inadequate for proper guideline implementation and that the information in guidelines were too complex to understand. Potential facilitators included providing adequate facilities, developing local guidelines, and increasing awareness of guideline usage. Conclusion Our study shows that clinicians involved in the treatment of patients with cancer in LMICs are aware of cancer treatment guidelines. However, implementation of these guidelines hinders their usage because the facilities are inadequate, guidelines are not applicable to the local setting, and the information in the guidelines is too complex.
Regulator of calcineurin-2 is a centriolar protein with a role in cilia length control
Authors: Stevenson Nicola L. , Bergen Dylan J. M. , Xu Amadeus , Wyatt Emily , Henry Freya , McCaughey Janine , Vuolo Laura , Hammond Chrissy L. , Stephens David J. 
Published: April 2018

ABSTRACT
Almost every cell in the human body extends a primary cilium. Defective cilia function leads to a set of disorders known as ciliopathies, which are characterised by debilitating developmental defects that affect many tissues. Here, we report a new role for regulator of calcineurin 2 (RCAN2) in primary cilia function. It localises to centrioles and the basal body and is required to maintain normal cilia length. RCAN2 was identified as the most strongly upregulated gene from a comparative RNAseq analysis of cells in which expression of the Golgi matrix protein giantin had been abolished by gene editing. In contrast to previous work where we showed that depletion of giantin by RNAi results in defects in ciliogenesis and in cilia length control, giantin knockout cells generate normal cilia after serum withdrawal. Furthermore, giantin knockout zebrafish show increased expression of RCAN2. Importantly, suppression of RCAN2 expression in giantin knockout cells results in the same defects in the control of cilia length that are seen upon RNAi of giantin itself. Together, these data define RCAN2 as a regulator of cilia function that can compensate for the loss of giantin function.