bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computed tomographic features of inflammatory myofibroblastic tumour of the stomach in adult patients: An analysis of five multicentre cases with literature review
Authors: Lee Ji Eun , Choi Seo‐Youn , Lee Hae Kyung , Yi Boem Ha , Lee Min Hee , Lee Sunyoung , Lee So Jung , Lee Jisun , Jeong Woo Kyoung 
Published: August 2018

AbstractIntroductionThe aim of this study was to describe the clinical and computed tomography (CT) features of gastric inflammatory myofibroblastic tumour (IMT) in adult patients and provide a review of the literature.MethodsFive adult patients with surgically resected and pathologically confirmed gastric IMT were included in the study from four tertiary referral centres. Clinical history was assessed for determination of patient demographics and symptoms at presentation. All patients underwent contrast‐enhanced abdominal CT, and two radiologists assessed the CT features by consensus. Also, abdominal CT findings from previous case reports of nine adult patients with gastric IMT were reviewed and summarised.ResultsOf five gastric IMTs, four (80%) appeared as a well‐defined subepithelial mass and only one (20%) appeared as an irregular wall thickening. All of five gastric IMTs showed strong enhancement. When we analysed the CT features of nine cases from previously published literatures combined with our five cases, predominant imaging feature of gastric IMT was a well‐defined subepithelial mass with strong enhancement. Perigastric infiltration or direct invasion of the neighbouring organs was rarely seen.ConclusionGastric IMT in adult patients appeared either as a well‐defined subepithelial mass or irregular wall thickening, with mostly strong enhancement. Although rare, these imaging feature may be helpful for diagnosis of gastric IMT.
Prolonged vasopressor support during hip‐fracture surgery is a risk factor for enhanced mortality
Authors: Kristiansson Johan , Olsen Fredrik , Hagberg Eva , Dutkiewicz Robert , Nellgård Bengt 
Published: August 2018

BackgroundHip fracture is a common injury in the elderly population and is associated with high morbidity and mortality. Intraoperative hypotension is commonly noted, and is often treated with vasopressors (VP), however, to what extent is unknown. We set out to examine retrospectively how many hip fracture‐patients received VP perioperatively and further to investigate if VP treatment is connected to increased mortality.MethodData on VP treatment were captured from medical and anaesthesia journals, and if so, data were investigated to find potential confounders. Patients were divided into (a) no VP, (b) VP by injection, (c) VP by infusion <3 hours, and (d) VP by infusion ≥3 hours to achieve stratification.ResultsNine hundred and ninety‐seven patients were included. About 80.4% received VP treatment. The 30‐day mortality rates in subgroups were 3.6%, 5.4%, 6.4% and 19.1% respectively. The 90‐day mortality rates were 6.7%, 10.3%, 11.6% and 30.3% respectively. Finally, the same patient groups had 365‐day mortality rates of 12.8%, 20.0%, 23.3% and 44.9% respectively. We found a significant increase in mortality (30‐90‐365 days) in patients receiving VP infusion ≥3 hours, after adjusting for confounding factors. There was no increased mortality in patients treated by injection and by infusion <3 hours after adjustment for confounding factors vs untreated patients.ConclusionVasopressor treatment is common during hip fracture surgery. Patients treated with VP infusion ≥3 hours have increased mortality, while patients treated with injections or infusion <3 hours have not. We suggest that the prolonged use of VP treatment is linked to increased mortality.
Professional firefighter and trained volunteer first‐responding units in emergency medical service
Authors: Tamminen Joonas I. , Hoppu Sanna E. , Kämäräinen Antti J. J. 
Published: August 2018

BackgroundAlthough widely dispatched to out‐of‐hospital cardiac arrests, the performance of prehospital first‐responding units in other medical emergencies is unknown.MethodsIn this retrospective, descriptive study, the general performance of 44 first‐responding units in Pirkanmaa County, Finland, were examined. A subgroup analysis compared the first‐responding units made up of professional firefighters and trained volunteers.ResultsFirst‐responding units were dispatched to patients during 1622 missions between 1 January 2013 and 31 December 2013. The median time to reach the scene was 9 minutes in any mission. Overall, first responders evaluated 1015 patients and provided treatment or assisted ambulance personnel in 793 (78%) cases. The most common treatment modalities were assistance, such as carrying (22%) and the administration of supplemental oxygen (19%). There were 83 resuscitation attempts during the time period. In 42 of these, first‐responding units initiated basic life support a median of 4 minutes prior to the arrival of ambulance personnel. Return of spontaneous circulation was achieved in 20% of cases. The subgroup analysis showed that trained volunteers administered oxygen more liberally than professional firefighters in stroke and chest pain mission (stroke: professional 9/236 cases [4%] vs layperson 26/181 cases [14%], P < 0.001; chest pain: professional 16/78 cases [21%] vs layperson 77/159 cases [48%], P < 0.001).ConclusionFirst‐responding units provided initial treatment or assistance to ambulance personnel in approximately half of the missions. Implementation of professional‐ and layperson‐staffed first‐responding units in emergency medical service system seems to be feasible.
Genetic variants in fat‐ and short‐tailed sheep from high‐throughput RNA‐sequencing data
Authors: Ma L. , Li Z. , Cai Y. , Xu H. , Yang R. , Lan X. 
Published: August 2018

SummaryThe identification of genetic variations underlying desired phenotypes is one of the main challenges of current livestock genetic research. High‐throughput transcriptome sequencing has been recognized as an efficient way to unravel the rich genetic variants across various species. The Lanzhou Fat‐Tail sheep is an endangered sheep breed in China with a notable feature of an exaggerated fat tail that also independently occurs in other sheep breeds. However, the genetic mechanism underlying this particular trait has not been fully elucidated yet. In this study, we used RNA‐seq on tissue samples (longissimus dorsi muscle, perinephric fat and tail fat) from three sheep breeds with either fat or thin tails and characterized the genetic variation in Lanzhou Fat‐Tail sheep with the ultimate goal of identifying the causal genes and genetic networks responsible for the fat tail in this rare sheep breed. In total, 7 122 920 SNPs and 901 518 indels were detected in the nine individual sheep investigated, of which 606 952 SNPs (8.5%) and 77 633 indels (8.6%) overlapped with QTL associated with fat traits in sheep. Furthermore, we detected 26 613 specific SNPs in Lanzhou Fat‐Tail sheep and 44 SNPs located in the same genomic position reported in another sheep breed with fat tails. Interestingly, 33 SNPs are selectively distributed on a chromosome 3 region (39.58–40.91 Mb) that was reported as a strong candidate genomic region for fat deposition in tails of sheep. Our research has also suggested that three genes (CREB1, WDR92 and ETAA1) may be associated with fat tail development. In summary, the resultant genetic variants data in this study provide a valuable resource for marker‐assisted selection of the trait in Lanzhou Fat‐Tail sheep populations.
Management of feeding decisions in hospitalised adults with severe oropharyngeal dysphagia
Authors: McHutchison Louise , Miles Anna , Spriggs David , Jayathissa Sisira 
Published: August 2018

ObjectiveFor patients with dysphagia, decisions must be made for provision of nutrition and hydration. This retrospective audit explored feeding decisions for patients with severe oropharyngeal dysphagia.MethodsFifty adult inpatients were identified across a 15‐month period as requiring a feeding decision due to severe persisting oropharyngeal dysphagia. For each patient, all admissions (previous and subsequent admissions up to and including six months postrecruitment) where dysphagia or dysphagia‐related complications were reported in the discharge summary were audited.ResultsA total of 103 admissions were identified with palliation in 22%. Enteral tube feeding (ETF) was initiated in 19% of admissions; and 63% of enteral tube placements failed. Nil‐by‐mouth with ETF was the final feeding decision in only 8% of admissions, while 43% of admissions led to documented oral feeding despite risk. Dysphagia was documented in only 44% of discharge summaries, with a feeding decision documented in only 34%.ConclusionVariation in management and poor documentation in this cohort suggest the need for a Risk Feeding Clinical Guideline.
Development of a pelvic exenteration service at a tertiary referral centre
Authors: Dickfos Marilla , Tan Stephanie B. M. , Stevenson Andrew R. L. , Harris Craig A. , Esler Rachel , Peters Matthew , Taylor David G. 
Published: August 2018

BackgroundOver one‐third of primary rectal cancers are locally advanced at diagnosis, and local recurrence of rectal cancer occurs at a rate of 3–10% following primary curative resection. Extended resectional surgery, including pelvic exenteration, is the only proven therapy with curative potential in the treatment of these cancers along with many other pelvic malignancies. A microscopically clear resection margin (R0 resection) is the predominant prognostic factor affecting overall and disease‐free survival. The extent and complexity of surgery required to achieve an R0 resection is associated with significant risk of morbidity and mortality. The aim of this paper is to show that pelvic exenterations can be performed with acceptable oncological and safe perioperative results in an appropriately resourced specialist centre.MethodsData was collected retrospectively for 61 consecutive patients treated between June 2012 and February 2017. This included patient demographics, tumour characteristics, operative, clinical and histological data, length of hospital stay, morbidity and mortality data.ResultsA total of 61 patients underwent surgery. Median age was 57 years (range 27–78 years). Median length of stay was 41 days (range 6–288 days). Median operative time was 624 min (range 239–1035 min); 30‐day mortality was 3.3% (n = 2). Resection rates were 91.5% – R0, 6.8% – R1 and 1.7% – R2 resections. Histologically, 86.9% – adenocarcinomas, 3.3% – squamous cell carcinomas and 9.8% – represented by leiomyosarcoma, melanoma, myxoid chondrosarcoma, non‐neoplastic processes and undifferentiated carcinoma.ConclusionOur experience confirms that radical resectional pelvic surgery can be safely performed with acceptable results during the establishment phase of a dedicated tertiary service.
Our connection procedure for an EEA™ XL stapler and anvil head using EEA OrVil™ for laparoscopic total or proximal gastrectomy
Authors: Rino Yasushi , Yukawa Norio , Kano Kazuki , Sato Tsutomu , Yamada Takanobu , Aoyama Toru , Maezawa Yukio , Oshima Takashi , Shiozawa Manabu , Morinaga Soichiro , Cho Haruhiko , Yoshikawa Takaki , Masuda Munetaka 
Published: August 2018

AbstractIntroductionWe describe an easy technique to connect the anvil and center rod of the EEA™ OrVil™.Materials and Surgical TechniqueThe bulb tip of EEA OrVil was orally inserted slowly until the valve tip reached the esophageal stump. The surgeon inserted forceps while grasping the anvil from the right abdomen trocar. The circular stapler (EEA XL) was inserted via the cut‐off stump of the lifted jejunum or remnant stomach through the intraumbilical incision. Then, the circular stapler was held with the shaft convex. When the automated stapler and center rod were confirmed to be completely aligned, the anvil and the main unit were connected, and the device was fired.DiscussionAlthough we only reversed the direction of the circular stapler’s shaft, this method improved the ease of the operation.
Monitoring, Corporate Performance and Institutional Directors
Authors: Pucheta‐Martínez María Consuelo , García‐Meca Emma 
Published: August 2018

AbstractOur main objective is to study the effect of institutional directors on firm performance, distinguishing directors according to whether they maintain business relationships (pressure‐sensitive) or not (pressure‐resistant). Our results show that in weak regulatory and low investor protection environments, institutional directors have a negative impact on corporate performance. Our evidence shows that this negative effect is mainly driven by the role of pressure‐resistant directors and not for those directors representing mainly banks and other financial institutions with a long‐term investment horizon. These findings have implications for numerous parties, such as institutional investors, regulators, potential new board members and other corporate governance reform proponents, who frequently examine board characteristics to assess the effectiveness of boards in value‐creation policies.
Therapeutic drug monitoring of small molecule kinase inhibitors in oncology in a real‐world cohort study: does age matter?
Authors: Crombag Marie‐Rose B.S. , van Doremalen Jacobine G.C. , Janssen Julie M. , Rosing Hilde , Schellens Jan H.M. , Beijnen Jos H. , Steeghs Neeltje , Huitema Alwin D.R. 
Published: August 2018

AbstractAimPharmacokinetics of small molecule kinase inhibitors (KIs) used in cancer treatment may alter with increasing age, but results are conflicting. This study aims to compare exposure to KIs between older and younger patients (≥70 and <70 years) in clinical practice.MethodsKI plasma concentrations of routinely treated patients were measured using validated assays. Calculated trough concentrations were compared in both age groups. For KIs with a clinically meaningful target concentration (erlotinib, imatinib, pazopanib, sunitinib and vemurafenib), influence of older age on target attainment was assessed.ResultsWe analysed 616 samples from 454 patients (median age: 61; range 20–93 years), treated with dabrafenib (n = 105), erlotinib (n = 49), imatinib (n = 165), pazopanib (n = 63), sunitinib (n = 87), trametinib (n = 95) and vemurafenib (n = 52). Older age did not significantly influence exposure to erlotinib, imatinib, pazopanib, sunitinib, trametinib and vemurafenib. Elderly patients had significantly higher dabrafenib trough concentrations than younger patients (P = 0.02; 62 ng ml−1 (coefficient of variation [CV] 41%), vs. 53 ng ml−1 (CV 46%), respectively). For KIs with a predefined target concentration, 68% of older and 61% of younger patients reached target.ConclusionsIn this real‐world study, exposure to most included KIs was comparable in older and younger patients, except for dabrafenib, which showed higher exposure in older patients. In the absence of an absolute target for this KI, clinical relevance remains unclear. For all other included KIs, our data suggest no clinically relevant influence of older age on KI exposure.
Loop diuretics decrease the renal elimination rate and increase the plasma levels of trimethylamine‐N‐oxide
Authors: Latkovskis G. , Makarova E. , Mazule M. , Bondare L. , Hartmane D. , Cirule H. , Grinberga S. , Erglis A. , Liepinsh E. , Dambrova M. 
Published: August 2018

AimsTrimethylamine‐N‐oxide (TMAO) is a novel cardiovascular risk marker. We explored the association of commonly used cardiovascular medications with TMAO levels in patients and validated the identified associations in mice.MethodsDetailed history of drug treatment was recorded in 300 patients with cardiovascular disease without diabetes in an observational, cross‐sectional study. Animal study was performed in CD1 mice.ResultsMedian plasma TMAO (interquartile range) level was 2.144 (1.570–3.104) μmol l–1. Among nine cardiovascular drug groups, the use of loop diuretics (0.510 ± 0.296 in users vs. 0.336 ± 0.272 in nonusers, P = 0.008) and mineralocorticoid receptor antagonists (0.482 ± 0.293 in users vs. 0.334 ± 0.272 in nonusers, P = 0.007) was associated with increased log‐TMAO. Acute concomitant administration of furosemide or torasemide with TMAO in mice significantly influenced TMAO pharmacokinetic profile and almost doubled the plasma TMAO area under the curve. Furosemide decreased the TMAO excretion rate by 1.9‐fold during the first 30 min after administration and increased TMAO concentrations in kidney, heart and liver, suggesting the interaction of furosemide and TMAO with efflux transporters. The concentrations of TMAO in blood plasma after the administration of the organic anion transporter inhibitor probenecid were not different from those of the control group, suggesting an effect not mediated by organic anion transporters.ConclusionsLoop diuretics increased plasma TMAO concentration by decreasing its urinary excretion rate. Loop diuretic use should be considered a potential confounder in TMAO studies.
CPAP in patients with obstructive sleep apnea and type 2 diabetes mellitus: Systematic review and meta‐analysis
Authors: Labarca Gonzalo , Reyes Tomas , Jorquera Jorge , Dreyse Jorge , Drake Lauren 
Published: August 2018

AbstractIntroductionObstructive sleep apnea hypopnea syndrome (OSAHS) is a prevalent condition across the world; it co‐exists with others metabolic diseases, such as central obesity, dyslipidemia, and arterial hypertension. These associations increase the cardiovascular risk and mortality. Observational studies have reported a strength association between OSA and type 2 Diabetes Mellitus (T2DM) and continuous positive airway pressure (CPAP) is recommended for moderate to severe OSAHS.ObjectiveTo summarize the evidence of CPAP in T2DM patients with OSAHS.MethodsA compressive search in Medline, Cochrane, Ovids, Epistemonikos, and DARE was performed. Two reviewers evaluated included studies, extracted data, carried out quality assessment and summarized the result. Pooled data was evaluated by meta‐analysis and summaries of results and evidence grading were performed through the GRADE method.ResultsSix randomized controlled trials (RCTs), including a total of 581 participants. Treatment with CPAP showed no effectiveness regarding changing glycated hemoglobin (HbA1c) levels at 12 or 24 weeks after treatment; (Mean difference= −0.10; Confidence interval −0.25 to 0.04) (GRADE: MODERATE). Subgroup analysis by adherence to CPAP (> 4 hours or < 4 hours) confirmed these results. Other indirect outcomes, such as change in fasting glucose levels, were similar in CPAP population and placebo.DiscussionThis systematic review and meta‐analysis evaluates the evidence regarding the efficacy of CPAP in patients with T2DM and OSAHS. In conclusion, CPAP does not improve glycemic control measure as HbA1c.
Safety of exertional desaturation in idiopathic pulmonary fibrosis: An electrocardiography study
Authors: Vainshelboim Baruch , Dobin Genady , Myers Jonathan , Oliveira Jose , Unterman Avraham , Izhakian Shimon , Reuven Kramer Mordechai 
Published: August 2018

AbstractIntroductionExertional desaturation is a cardinal manifestation of idiopathic pulmonary fibrosis (IPF) which raises concerns for serious complications.ObjectivesTo evaluate the safety of clinically significant desaturation (CSD) during exercise and to assess whether abnormal electrocardiographic (ECG) changes are associated with mortality and hospitalizations in patients with IPF.MethodsThirty‐four IPF patients (68 ± 8 years, 35% women) underwent maximal cycle cardiopulmonary exercise testing (CPET) using 12‐lead ECG and pulse oximetry (SpO2) and were followed up to 40 months. CSD was considered as SpO2 <95% or decline from baseline ≥5%. The level of agreement between abnormal ECG changes and CSD was evaluated. Risks for mortality and hospitalizations were assessed in relation to abnormal ECG changes.ResultsAll patients completed CPET without adverse events or life‐threating ECG changes. Comparing rest to exercise conditions, the prevalence of mild ventricular arrhythmia rose from 3% to 18% (P = .025) and CSD rose from 21% to 79% (P < .001). There was no agreement between the prevalence of arrhythmia and CSD during exercise (kappa = −.065, χ2 = .72, P = .40). A trend for lower prevalence was observed in ST‐T segment deviation during exercise. Resting and exercise ECG abnormalities were not associated with mortality or hospitalizations during the follow‐up.ConclusionsCSD during CPET was not associated with ventricular arrhythmias, ischemia, or complications in patients with IPF. These findings suggest that CPET is generally a safe procedure for IPF, although carefully monitoring for signs and symptoms including ECG is strongly recommended. Additional research is warranted to confirm these results.
Views, experience and adherence among pregnant women with gestational diabetes participating in a weight loss study (WELLBABE)
Authors: McParlin C. , Hodson K. , Barnes A. C. , Taylor R. , Robson S. C. , Araujo‐Soares V. 
Published: August 2018

AbstractAimsTo investigate the views and experience of pregnant women newly diagnosed with gestational diabetes mellitus participating in a 1200 kcal/day diet to achieve moderate weight loss (the WELLBABE study), and to explore barriers to and facilitators of adherence.MethodsTwelve participants engaged in semi‐structured interviews after completion of the 4‐week diet. An interview schedule was devised using open‐ended questions guided by the Theoretical Domains Framework. Transcript responses were analysed thematically.ResultsParticipants were anxious about their diagnosis of gestational diabetes, but concerns related to dieting in pregnancy were allayed by reassurance from the research team. Participants expected health benefits, improved knowledge and support from enrolling on the study. The participants’ primary motivator to diet adherence was their baby's wellbeing. Other facilitatory factors included improving their own health and reducing any future risk of diabetes. Trying to provide reliable results and receiving extra care also facilitated adherence. Partners, friends and family were an important source of social support and no barrier caused by concern about weight loss in pregnancy was encountered. Observed and experienced physical changes and feedback from the research team positively reinforced adherence. The main barrier was that learning new skills was initially time‐consuming.ConclusionsWeight loss was acceptable to women with gestational diabetes provided with clear information about likely benefit. A randomized controlled trial of this intervention is now required, employing clear information and feedback of glycaemic benefit to facilitate efficacy.
Capacity Development re‐examined through the lens of Indonesia's learning experiences with international donors
Authors: Shimoda Yukimi 
Published: August 2018

AbstractCapacity Development (CD) is a long‐term endogenous process. Despite an abundant literature, CD and the length of time required for its realisation are still abstract in practice. The examination of the process of fostering CD contributes to understanding the time required and the role of external actors, such as international donors, in supporting CD. This article aims to reveal part of the process of fostering CD and the time required, and to consider the role of international donors. This qualitative study focuses on Wakatobi district in Southeast Sulawesi province, Indonesia. The data reveal how bottom‐up local development approaches have developed through national and external donor programmes and projects. This study confirms the long endogenous learning process that CD involves. The case of Wakatobi district shows the continual efforts to institutionalize and functionalize bottom‐up local development. The acquired knowledge and skills have gradually developed the core capacities of Wakatobi, with beneficial effects on other districts and society more broadly. The fostering of CD, which resists social transformation, will take longer than donors expect. Continual learning is key and constant for the growth of CD. Donors should consider the provision of training, which makes continual, endless learning possible.