bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous pneumothorax in the elderly: a sign of a malignancy?
Authors: Kolbas Ilker , Evman Serdar , Tezel Cagatay , Citak Sevinc , Kanbur Metin Serda , Alpay Levent , Kiral Hakan , Baysungur Volkan 
Published: February 2019

Background Spontaneous pneumothorax usually occurs as a result of rupture of a subpleural bleb or emphysematous bulla. Spontaneous pneumothorax, which is more common in younger age groups, might be the first sign of pulmonary malignancy, especially when it manifests in older patients. Methods Data of all patients who were treated for spontaneous pneumothorax in our clinic between June 2013 and June 2017 were examined retrospectively. The demographic characteristics, diagnostic methods, pathologic subtypes, and treatment protocols applied in patients diagnosed with malignancy during the treatment period were investigated. Results Out of 1187 patients, 9 (0.8%) had incidental pulmonary malignancies. Metastatic lung cancer was detected in 2 of 9 patients, while primary lung cancer was detected in the other 7. Six patients were operated on and the other 3 were referred for oncologic treatment for various reasons. Conclusions We suggest that cases of spontaneous pneumothorax in advanced age should be evaluated in a more detailed fashion, and further investigations should be carried out with suspicion of an underlying pulmonary malignancy.
Appointment utilization as a trigger for palliative care introduction: A retrospective cohort study
Authors: Nenova Zlatana , Hotchkiss John 
Published: February 2019

Background: Chronic kidney disease palliative care guidelines would benefit from more diverse and objectively defined health status measures. Aim: The aim is to identify high-risk patients from administrative data and facilitate timely and uniform palliative care involvement. Design: It is a retrospective cohort study. Setting/participants: In total, 45,368 Veterans, with chronic kidney disease Stage 3, 4, or 5, were monitored for up to 6 years and categorized into three groups, based on whether they died, started dialysis, or avoided both outcomes. Results: Patient’s appointment utilization was a significant predictor for both outcomes. It separated individuals into low, medium, and high appointment utilizers. Among the low appointment utilizers, the risk of death did not change significantly, while the risk of dialysis increased. Medium appointment utilizers had a stable risk of death and a decreasing risk of dialysis. Significant appointment utilization (above 31 visits during the baseline year) helped high-risk patients avoid both outcomes of interest—death and dialysis. Conclusion: Our model could justify the creation of a novel palliative care introduction trigger, as patients with medium demand for care may benefit from additional palliative care evaluation. The trigger could facilitate the uniformization of conservative treatment preparations. It could prompt messages to a managing physician when a patient crosses the threshold between low and medium appointment utilization. It may also aid in system-level policy development. Furthermore, our results highlight the benefit of significant appointment utilization among high-risk patients.
Microbubble contrast-enhanced ultrasound in the vascular evaluation after pancreas transplantation: a single-center experience
Authors: Berstad Audun E , Brabrand Knut , Horneland Rune , Syversveen Trygve , Haugaa Håkon , Jenssen Trond G , Foss Aksel 
Published: February 2019

Background Arterial and venous thrombosis are feared complications of pancreas transplantation (PTx). Microbubble contrast-enhanced ultrasound (CEUS) is a non-invasive imaging technique that can augment diagnostic capabilities of transplant organ perfusion. Purpose To document the state to which CEUS can improve the vascular evaluation of PTx compared to conventional Doppler ultrasound (US) directly after surgery. Material and Methods A total of 129 consecutive PTx in 128 adult patients were eligible for inclusion. The duodenal segment of the graft was anastomosed to the native duodenum. Within 12 h postoperatively, graft circulation was monitored by Doppler US in 116 PTx performed in 116 patients (69 men, 47 women; mean age =41 years). CEUS was performed with a sulfur hexafluoride-containing contrast agent (SonoVue) intravenously if the examiner was not able to confirm normal graft circulation. Image quality was documented by two independent observers on a 4-point scale: 1 = excellent; 2 = minor diagnostic limitations; 3 = major diagnostic limitations; and 4 = non-diagnostic. Results In the early postoperative phase, 79 (68%) of 116 PTx were examined with Doppler US only. Of these, 52 were of excellent quality (grade 1), 22 of good quality (grade 2), and five were of grade 3 or 4 quality. Thirty-seven (32%) examinations were supplemented by CEUS. CEUS significantly improved examination quality compared to Doppler US alone (median visualization score 1.5 vs. 2.5, respectively; P < 0.0001). Conclusion CEUS can significantly improve vascular evaluation of PTx compared to Doppler US alone in the early postoperative phase.
A case series of anaphylaxis to chlorhexidine-impregnated central venous catheters in cardiac surgical patients
Authors: Baird Peter A , Cokis Chris J 
Published: February 2019

We report a case series of anaphylaxis to chlorhexidine-coated central venous catheters (CVCs) when used in cardiac surgical patients in our institution. Our experience, together with increasing reports of anaphylaxis to chlorhexidine-coated CVCs from other sources indicates that chlorhexidine-coated CVCs are not without additional risk. Attempts to lower rates of catheter-related bloodstream infection has led to the widespread adoption of chlorhexidine-coated CVCs in the perioperative and critical care setting, including for routine cardiac surgery. However, closer scrutiny indicates that there is lack of strong evidence demonstrating a meaningful reduction in rates of sepsis or serious morbidity, especially with CVC dwell times of less than seven days. Given the lack of clear benefit, we recommend non-coated CVCs for routine cardiac surgery, with even consideration for chlorhexidine-coated CVCs when specifically indicated for patients at high risk of CVC infection.
A Regional, Cost-Effective, Collaborative Model for Critical Care Fellows’ Ultrasonography Education
Authors: Patrawalla Paru , Narasimhan Mangala , Eisen Lewis , Shiloh Ariel L. , Koenig Seth , Mayo Paul 
Published: February 2019

Objective: Training in critical care ultrasonography is an essential tool in critical care medicine and recommended for fellowship programs in pulmonary and critical care medicine. Major barriers to implementing competency-based training in individual fellowship programs include a lack of expert faculty, time, and funding. Our objective was to investigate whether regional collaboration to deliver an introductory critical care ultrasonography course for fellows might overcome these barriers while achieving international training standards. Methods: This was a retrospective review of course evaluation and learner assessment data from a 3-day ultrasonography course between 2012 and 2017. All critical care fellows (n = 545) attending the course completed pre- and postcourse surveys and postcourse knowledge and technical skills tests. Evaluation of educational outcomes was performed based on the Kirkpatrick model. Results: Fellows reported minimal prior formal training in ultrasonography, and ultrasound-guided vascular access was the most common area of prior training. The course was a blended model of didactic lectures coordinated with real-time demonstration scanning using live models, hands-on training on human models and task trainers, and interpretation of ultrasonography images with a wide range of pathology. Course content included basic echocardiography and general critical care ultrasonography (lung, pleural, vascular diagnostic, vascular access, and abdominal ultrasonography). At the conclusion of the course, fellows demonstrated high levels of knowledge and skill competence on a previously validated assessment tool and significantly improved confidence in all content areas. Barriers to training at individual programs were overcome through faculty cooperation, faculty development, and cost sharing. Success of this model is supported by the sustained growth of this course. Conclusions: A regional collaborative model for training fellows in ultrasonography is a feasible, efficient, and flexible model for delivering curricula, where expertise at individual programs is not routinely available.
Evolution and clinical relevance of common iliac artery seal zone after endovascular aortic aneurysm repair
Authors: Taneva Gergana T , García Alejandro González , Arribas Díaz Ana Begoña , Yebra Yasmina Baquero , Donas Konstantinos P , Martínez César Aparicio 
Published: February 2019

Objective Data in literature suggest iliac artery dilatation and endograft retraction as complications after endovascular aneurysm repair. However, mainly older generation endografts were included. Therefore, we sought to evaluate the distal sealing zone chronological changes after endovascular aneurysm repair with newer generation stent-grafts. Methods Clinical and radiological data of patients with abdominal aortic aneurysms treated with endovascular aneurysm repair between January 2010 and December 2013 were reviewed. Measurements were made using volumetric reconstructions in the first and last available computed tomography angiography. Endpoints of the study were the presence of iliac dilatation and retraction of the endograft. Association with distal oversizing and sealing length was analyzed. Results Consecutive patients with a total of 52 common iliac arteries were included in the study (mean age 74.9 ± 6.8 years, four women (7.7%)). The mean follow-up was 3.1 years. The mean iliac diameter increased from 15.5 to 17.1 mm ( p < .001) in the first control computed tomography angiography and to 18.7 mm ( p < .001) in the last available computed tomography angiography. No endograft (Endurant by Medtronic (24/52; 46%), Excluder de Gore (23/52; 44%), Zenith by Cook (5/52; 9%)) was associated with dilatation ( p = .066) or iliac retraction ( p = .591). Two type Ib endoleaks were found (3.8%) and successfully treated with distal graft extension. An iliac branch retraction of ≥5 mm was identified in seven cases (13%). Iliac arteries treated with limbs of ≥24 mm in diameter dilated significantly more than the rest of limbs (5.37 mm versus 3.12 mm; p = .022). In the last available imaging, iliac dilatation was ≥20% in 28 cases (53.8%) and had exceeded the diameter of the implanted endograft in 20 cases (38.4%). Iliac dilatation (OR 15.11 per mm, p = .025) was identified as a risk factor for retraction ≥5 mm. Conclusion Iliac dilatation and endograft limb retraction are common findings after endovascular aneurysm repair despite the use of new generation endografts. Optimizing the iliac sealing length and meticulous computed tomography angiography surveillance are recommended especially in case of use ≥24 mm iliac stent-grafts to prevent possible complications.
Echocardiographic diagnosis of congenital coronary artery abnormalities in a continuous series of adolescent football players
Authors: Gerling Stephan , Loose Oliver , Zant Robert , Michel Holger , Melter Michael , Gündisch Christian , Krutsch Volker , Krutsch Werner 
Published: February 2019

Background Sudden cardiac death (SCD) in children and adolescents is rare. Several studies have reported a higher risk of SCD during athletic competition. High risk congenital coronary artery abnormalities are the second leading cause of SCD in young athletes in the USA. Echocardiographic assessment of coronary arteries has not been routinely used in screening programmes for junior athletes so far. Design Prospective cohort study in 1045 consecutive adolescent elite football players. Methods All athletes underwent a standardized cardiovascular screening protocol with a medical history, a physical examination, 12-lead resting electrocardiogram and a complete transthoracic 2D-echocardiography. Results Two athletes (0.19%) showed a high-risk coronary artery abnormality (CAA) with a right coronary artery originating abnormal from the aorta and coursing inter-arterial. Low-risk CAAs were found in 16 athletes (1.53%). There was an ectasia of the left coronary artery (+3.9z and +4.3z) and a fistula from the left coronary artery in two cases (0.19%), respectively. In 1.05% ( n = 11) we found a high take-off (2.3–6.8 mm) and in one case (0.096%) there was a tangential take-off of the right main coronary artery. Variants of coronary arterial anatomy were identified in 335 of 1045 athletes (32.06%). Conclusion Basic pre-participation screening tests including 12-lead or exercise electrocardiogram do not safely identify high-risk CAAs. In adolescent athletes an expert cardiologist is able to describe the origin and the proximal course of the coronary arteries and identify major abnormalities in most of the cases by transthoracic 2D-echocardiography.
Central nervous system–restricted familial hemophagocytic lymphohistiocytosis responds to hematopoietic cell transplantation
Authors: Li Hojun , Benson Leslie A. , Henderson Lauren A. , Solomon Isaac H. , Kennedy Alyssa L. , Soldatos Ariane , Bielekova Bibiana , Murphy Jennifer , Davies Kimberly J. , Lehmann Leslie E. , Lee Michelle A. , Alexandrescu Sanda , Degar Barbara A. , Gorman Mark P. , Duncan Christine N. 
Published: February 2019

Key Points
Familial HLH can present as chronic isolated neuroinflammation. CNS-isolated HLH responds to hematopoietic cell transplantation.
Effects of chloride content of intravenous crystalloid solutions in critically ill adult patients: a meta-analysis with trial sequential analysis of randomized trials
Authors: Xue Ming , Zhang Xiwen , Liu Feng , Chang Wei , Xie Jianfeng , Xu Jingyuan , Yang Yi , Qiu Haibo 
Published: February 2019

Abstract
Background
Intravenous crystalloid solutions are administered commonly for critically ill patients. We performed this meta-analysis of randomized trials with trial sequential analysis (TSA) to evaluate effects of chloride content of intravenous crystalloid solutions on clinical outcomes among critically ill adult patients.

Methods
Electronic databases were searched up to June 1, 2018, for randomized trials of use of balanced crystalloids versus 0.9% saline solutions in critically ill adult patients. The outcome variables included mortality, renal outcomes, serum content alterations and organ function. Subgroup analysis was conducted according to patient settings, types or volume of crystalloid fluid, or among sepsis versus non-sepsis, TBI versus non-TBI or subpopulations by the categories of baseline kidney function. Random errors were evaluated by trial sequential analysis.

Results
Eight studies with 19,301 patients were analyzed. A trend of in-hospital survival benefit with no statistical difference could be observed with balanced crystalloids compared with 0.9% saline (RR 0.92, 95% CI 0.85–1.0, p = 0.06). The use of balanced crystalloid solutions was associated with longer RRT-free days (SMD 0.09, 95% CI 0.06–0.12, p < 0.001), less risk of increase in serum concentrations of chloride (SMD − 1.23, 95% CI − 1.59 to − 0.87, p < 0.001) and sodium (SMD − 1.28, 95% CI − 1.65 to − 0.92, p < 0.001), less risk of decline in serum base deficit (SMD − 0.58, 95% CI − 0.98 to − 0.18, p = 0.004), longer ventilator-free days (SMD 0.08, 95% CI 0.05–0.11, p < 0.001) and vasopressor-free days (SMD 0.04, 95% CI 0.00–0.07, p = 0.02). Subgroup analysis showed that balanced crystalloid solutions were associated with a reduced in-hospital mortality rate among septic patients (RR 0.86, 95% CI 0.75–0.98; p = 0.02) and non-traumatic brain injury patients (RR 0.90, 95% CI 0.82–0.99, p = 0.02), while the TSA results indicated a larger sample size is still in need.

Conclusions
Limited evidence supported statistical survival benefit with balanced crystalloid solutions, while it benefited in reducing organ support duration and fluctuations in serum electrolyte and base excess and was associated with decreased in-hospital mortality in subpopulation with sepsis and non-TBI. Large-scale rigorous randomized trials with better designs are needed to provide robust evidence for clinical management.
Trial registration The protocol for this meta-analysis was registered on PROSPERO: International prospective register of systematic reviews (CRD42018102661), https://www.crd.york.ac.uk/prospero/#recordDetails
Preservation of allograft bone using a glycerol solution: a compilation of original preclinical research
Authors: Samsell Brian , Softic Davorka , Qin Xiaofei , McLean Julie , Sohoni Payal , Gonzales Katrina , Moore Mark A. 
Published: February 2019

Abstract

Background
Bone allografts are used in many orthopedic procedures to provide structural stability as well as an osteoconductive matrix for bone ingrowth and fusion. Traditionally, bone allografts have been preserved by either freezing or freeze-drying. Each of these preservation methods has some disadvantages: Frozen grafts require special shipping and storage conditions, and freeze-drying requires special lyophilization equipment and procedures that may impact biomechanical integrity. This report describes an alternate type of preservation using glycerol, which allows storage of fully-hydrated tissues at ambient temperature avoiding the potential complications from freeze-drying.

Methods
In the in vitro three-point bend test, cortical bone was processed and frozen, freeze-dried, or treated with glycerol-based preservation (GBP). Load was applied to each graft at a rate of 2.71 mm/min. The flexural strain, flexural strength, and flexural modulus were then calculated. In the in vitro axial compression test, iliac crest wedges, fibular segments, and Cloward dowels were processed and either freeze-dried or GBP treated. The compressive strength of the grafts were tested at time zero and after real time aging of 1, 4, and 5 years. In the in vivo rat calvarial defect assessment, freeze-dried, frozen, and GBP bone implants were compared after being implanted into a critical sized defect. Samples underwent histological and biomechanical evaluation.

Results
Bone grafts subjected to GBP were found to be at least biomechanically equivalent to frozen bone while also being significantly less brittle than freeze-dried bone. GBP-preserved bone demonstrated significantly greater compressive strength than freeze-dried at multiple time points. Preclinical research performed in calvaric defect models found that GBP-preserved bone had similar osteoconductivity and biocompatibility to frozen and freeze-dried samples.

Conclusion
Preclinical research demonstrated that glycerol–preservation of bone yields a material that maintains biomechanical strength while eliminating the need for extensive rehydration or thaw periods if used clinically. Additionally, in vivo evidence suggests no negative impact of glycerol-preservation on the ability of bone grafts to successfully participate in new bone formation and fusion.
The effect of integrated care on self-management and emergency department attendance
Authors: Scheiner Nikki , Cohen Sarah , Davis Ruth , Gale Tim , Agyare Amanda 
Published: February 2019

Aims and methodThe Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017–2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency. The terms emergency department and Accident and Emergency are used interchangeably, reflecting the practice in policy documents. A subsequent article will report on the impact of the Commissioning for Quality and Innovation in Hertfordshire.ResultsAnalysis of the interventions indicated a highly significant (P < 0.0001) mean reduction in attendances. Lower gains were made in patients whose primary presentations were alcohol-related. A failure to effect change in two patients led to a significant revision of their respective care plans, resulting in a subsequent reduction in their attendances.Clinical implicationsAn integrated approach to patients with complex presentations was associated with high levels of both patient and referrer satisfaction. It is hypothesised that dismantling the barriers between physical and mental health may lead to similar successes in frequent attenders in other in-patient and community medical and psychiatric services.Declaration of interestNone.
Generating intravital super-resolution movies with conventional microscopy reveals actin dynamics that construct pioneer axons
Authors: Zhang Yide , Nichols Evan L. , Zellmer Abigail M. , Guldner Ian H. , Kankel Cody , Zhang Siyuan , Howard Scott S. , Smith Cody J. 
Published: February 2019

ABSTRACT
Super-resolution microscopy is broadening our in-depth understanding of cellular structure. However, super-resolution approaches are limited, for numerous reasons, from utilization in longer-term intravital imaging. We devised a combinatorial imaging technique that combines deconvolution with stepwise optical saturation microscopy (DeSOS) to circumvent this issue and image cells in their native physiological environment. Other than a traditional confocal or two-photon microscope, this approach requires no additional hardware. Here, we provide an open-access application to obtain DeSOS images from conventional microscope images obtained at low excitation powers. We show that DeSOS can be used in time-lapse imaging to generate super-resolution movies in zebrafish. DeSOS was also validated in live mice. These movies uncover that actin structures dynamically remodel to produce a single pioneer axon in a ‘top-down’ scaffolding event. Further, we identify an F-actin population – stable base clusters – that orchestrate that scaffolding event. We then identify that activation of Rac1 in pioneer axons destabilizes stable base clusters and disrupts pioneer axon formation. The ease of acquisition and processing with this approach provides a universal technique for biologists to answer questions in living animals.
Spo13 prevents premature cohesin cleavage during meiosis
Authors: Galander Stefan , Barton Rachael E. , Kelly David A. , Marston Adèle L. 
Published: February 2019

Background:Meiosis produces gametes through two successive nuclear divisions, meiosis I and meiosis II. In contrast to mitosis and meiosis II, where sister chromatids are segregated, during meiosis I, homologous chromosomes are segregated. This requires the monopolar attachment of sister kinetochores and the loss of cohesion from chromosome arms, but not centromeres, during meiosis I. The establishment of both sister kinetochore mono-orientation and cohesin protection rely on the budding yeast meiosis I-specific Spo13 protein, the functional homolog of fission yeast Moa1 and mouse MEIKIN.Methods:Here we investigate the effects of loss ofSPO13on cohesion during meiosis I using a live-cell imaging approach.Results:Unlike wild type, cells lackingSPO13fail to maintain the meiosis-specific cohesin subunit, Rec8, at centromeres and segregate sister chromatids to opposite poles during anaphase I. We show that the cohesin-destabilizing factor, Wpl1, is not primarily responsible for the loss of cohesion during meiosis I. Instead, premature loss of centromeric cohesin during anaphase I inspo13Δcells relies on separase-dependent cohesin cleavage. Further, cohesin loss inspo13Δanaphase I cells is blocked by forcibly tethering the regulatory subunit of protein phosphatase 2A, Rts1, to Rec8.Conclusions:Our findings indicate that separase-dependent cleavage of phosphorylated Rec8 causes premature cohesin loss inspo13Δcells.