bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain
Authors: Lumbreras Blanca , Salinas Josee María , Gonzalez-Alvarez Isabel 
Published: September 2019

ObjectivesTo calculate each patient’s cumulative radiation exposure and the recurrent tests during a 12-year study period, according to sex and age, in routine practice.DesignRetrospective cohort study.SettingA general hospital with a catchment population of 224 751 people, in the Southeast of Spain.ParticipantsPopulation belonged to the catchment area of that hospital in 2007. We collected all consecutive diagnostic imaging tests undergone by this population until 31 December 2018. We excluded: imaging tests that did not involve radiation exposure.Main outcome measuresThe cumulative effective dose and the recurrent imaging tests by sex and age at entry of study.ResultsOf the 224 751 people, 154 520 (68.8%) underwent an imaging test. The population had 1 335 752 imaging tests during the period of study: 1 110 077 (83.0%) plain radiography; 156 848 (11.8%) CT; 63 157 (4.8%) fluoroscopy and 5670 (0.4%) interventional radiography. 25.4% of the patients who had a CT, underwent five or more CTs (5.4% in the 0–20 years age group). The median total cumulative effective dose was 2.10 mSv (maximum 3980.30) and 16.30 mSv (maximum 1419.30 mSv) if we considered only doses associated with CT. Women received more effective dose than men (median 2.38 vs median 1.90, p<0.001). A total of 7142 (4.6%) patients received more than 50 mSv, with differences in men and women (p<0.001) and 2.5% of the patients in the 0–20 years age group, if we considered only doses associated with CT.ConclusionsNearly 5% of patients received doses higher than 50 mSv during the 12-year period of study and 2.5% of the patients in the 0–20 years age group, if we considered only doses associated with CT. The rate of recurrent examinations was high, especially in older patients, but also relevant in the 0–20 years age group.
Implantable cardioverter defibrillator deactivation and advance care planning: a focus group study
Authors: Stoevelaar Rik , Brinkman-Stoppelenburg Arianne , van Driel Anne Geert , van Bruchem-Visser Rozemarijn L , Theuns Dominic AMJ , Bhagwandien Rohit E , Van der Heide Agnes , Rietjens Judith AC 
Published: September 2019

ObjectiveImplantable cardioverter defibrillators can treat life-threatening arrhythmias, but may negatively influence the last phase of life if not deactivated. Advance care planning conversations can prepare patients for future decision-making about implantable cardioverter defibrillator deactivation. This study aimed at gaining insight in the experiences of patients with advance care planning conversations about implantable cardioverter defibrillator deactivation.MethodsIn this qualitative study, we held five focus groups with 41 patients in total. Focus groups were audio-recorded and transcribed. Transcripts were analysed thematically, using the constant comparative method, whereby themes emerging from the data are compared with previously emerged themes.ResultsMost patients could imagine deciding to have their implantable cardioverter defibrillator deactivated, for instance because the benefits of an active device no longer outweigh the harm of unwanted shocks, when having another life-limiting illness, or when relatives would think this would be in their best interest. Some patients expressed a need for advance care planning conversations with a healthcare professional about deactivation, but few had had these. Others did not, saying they solely focused on living. Some patients were hesitant to record their preferences about deactivation in advance care directives, because they were unsure whether their current preferences would reflect future preferences.ConclusionsAlthough patients expressed a need for more information, advance care planning conversations about implantable cardioverter defibrillator deactivation seemed to be uncommon. Deactivation should be more frequently addressed by healthcare professionals, tailored to the disease stage of the patient and readiness to discuss this topic.
Effect of probiotic containing Lactobacillus plantarum on growth performance, nutrient digestibility, and fecal microbiota in weaning pigs
Authors: Yang Y. , Park J.H. , Kim I.H. 
Published: September 2019

A total of 150 weaning pigs (7.53 ± 1.23 kg) were randomly assigned to three treatments consisting of basal diet, and the basal diet supplemented with 300 and 600 mg kg−1 of probiotics, respectively, in a 42 d trial. The incremental levels of probiotics linearly increased average daily gain during week 1 and through the overall experimental period (P < 0.05). The average daily feed intake, body weight, and the apparent total tract digestibility of dry matter, nitrogen, and gross energy also increased (P < 0.05) with the increased level of probiotics. A significant reduction in Escherichia coli counts (P = 0.0037) and increase (P = 0.0016) in Lactobacillus counts were observed on day 42.
MicroRNAs Affect Complement Regulator Expression and Mitochondrial Activity to Modulate Cell Resistance to Complement-Dependent Cytotoxicity
Authors: Hillman Yaron , Mardamshina Mariya , Pasmanik-Chor Metsada , Ziporen Lea , Geiger Tamar , Shomron Noam , Fishelson Zvi 
Published: September 2019

AbstractMicroRNAs (miR) are small RNA molecules that shape the cell transcriptome and proteome through regulation of mRNA stability and translation. Here, we examined their function as determinants of cell resistance to complement-dependent cytotoxicity (CDC). To achieve this goal, we compared the expression of microRNAs between complement-resistant and -sensitive K562 leukemia, Raji lymphoma, and HCT-116 colorectal carcinoma cells. Global microRNA array analysis identified miR-150, miR-328, and miR-616 as regulators of CDC resistance. Inhibition of miR-150 reduced resistance, whereas inhibition of miR-328 or miR-616 enhanced cell resistance. Treatment of K562 cells with a sublytic dose of complement was shown to rapidly increase miR-150, miR-328, and miR-616 expression. Protein targets of these microRNAs were analyzed in K562 cells by mass spectrometry–based proteomics. Expression of the complement membrane regulatory proteins CD46 and CD59 was significantly enhanced after inhibition of miR-328 and miR-616. Enrichment of proteins of mitochondria, known target organelles in CDC, was observed after miR-150, miR-328, and miR-616 inhibition. In conclusion, miR-150, miR-328, and miR-616 regulate cell resistance to CDC by modifying the expression of the membrane complement regulators CD46 and CD59 and the response of the mitochondria to complement lytic attack. These microRNAs may be considered targets for intervention in complement-associated diseases and in anticancer, complement-based therapy.
Effect of Dumbbell Exercise on Arteriovenous Fistula in Patients Undergoing Maintenance Haemodialysis: A Prospective Randomized Controlled Trial
Authors: Mo Yawen , Song Li , Sun Chunyan , Huang Jingya , Zhou Lifang , Zheng Shuqian , Zhuang Tingting , Chen Yuanhan , Liu Shuangxin , Liang Xinling , Fu Xia 
Published: September 2019

<b><i>Background:</i></b> Arteriovenous fistulas (AVF) have been the main vascular accesses for haemodialysis patients, but the maintenance after maturation poses serious challenges. Arm exercises promote the maturation of AVFs. However, few studies have evaluated the effect of arm exercise on matured AVF and addressed the intervention for late fistula failure. <b><i>Objectives:</i></b> The study was conducted to explore the effect of dumbbell exercise on mature AVF. <b><i>Methods:</i></b> 86 participants undergoing haemodialysis with AVFs were randomized into the control group and experimental group. The experimental group held 6-pound dumbbells on non-dialysis days for 3 months, while the control group squeezed rubber balls. <b><i>Results:</i></b> For blood flow of draining vein (DV; primary outcome), the between-group effects, interaction effect and time effect showed significant differences. A significant increase in blood flow of DV was observed in the dumbbell group at the 3rd month (mean difference, 359.50 [111.90–829.05] mL/min; <i>p</i> = 0.001). The difference in blood flow of AVF proximal artery, blood flow of brachial artery, the diameter of DV and the incidence of adverse events at 3 months (secondary outcomes) between the 2 groups was insignificant. <b><i>Conclusion:</i></b> Prolonged training with arm exercises is essential for patients with AVFs though the fistula has matured. The designed dumbbell exercise is an economical, effective intervention to maintain the function of AVF, especially for patients with potential reduction of access blood flow and no percutaneous transluminal angioplasty indication.
Secondary Management for Recurrent Ureteropelvic Junction Obstruction after Pyeloplasty: A Comparison of Re-Do Robot-Assisted Laparoscopic Pyeloplasty and Conventional Laparoscopic Pyeloplasty
Authors: Zhang Yucong , Ouyang Wei , Xu Hao , Luan Yang , Yang Jun , Lu Yuchao , Hu Jia , Liu Zheng , Yu Xiao , Guan Wei , Hu Zhiquan , Ye Zhangqun , Wang Shaogang , Li Heng 
Published: September 2019

<b><i>Objective:</i></b> To describe and analyze our experience with secondary robot-assisted laparoscopic pyeloplasty (RALP) and conventional laparoscopic pyeloplasty (LP) in treating recurrent ureteropelvic junction obstruction (UPJO) after primary pyeloplasty. <b><i>Methods:</i></b> Patients who underwent secondary RALP or LP for recurrent UPJO were retrospectively analyzed. Baseline characteristics, detailed history of previous pyeloplasty, operative profile and follow-up data were collected and analyzed. <b><i>Results:</i></b> Among 29 patients presented with recurrent UPJO, 15 patients underwent secondary RALP. Both groups (RALP or LP) were comparable in baseline characteristics and detailed history of previous pyeloplasty. The mean operative time, suturing time, and hospitalization time of patients in RALP group were significantly less than those in LP group. The mean operative time of RALP group was 2.1 h, while the mean operative time of LP group was 3.23 h. The average suturing time of LP (62.43 min) is about 3 times that of RALP (21.47 min). The overall mean follow-up data was 23 months. The success rate of the RALP group and LP group was 87.7 and 85.7% respectively. <b><i>Conclusion:</i></b> Compared to LP, RALP may be a better choice for the treatment of recurrent UPJO. Further high-quality clinical studies are needed to confirm the superior nature of RALP.
Targeted Ablation of Ventricular Tachycardia Guided by Wavefront Discontinuities During Sinus Rhythm
Authors: Aziz Zaid , Shatz Dalise , Raiman Michael , Upadhyay Gaurav A , Beaser Andrew D. , Besser Stephanie A. , Shatz Nathaniel A. , Fu Zihuan , Jiang Ruhong , Nishimura Takuro , Liao Hongtao , Nayak Hemal M. , Tung Roderick 
Published: September 2019

Background:
Accurate and expedited identification of scar regions most prone to reentry is needed to guide ventricular tachycardia (VT) ablation. We aimed to prospectively assess outcomes of VT ablation guided primarily by the targeting of deceleration zones (DZ) identified by propagational analysis of ventricular activation during sinus rhythm.

Methods:
Patients with scar-related VT were prospectively enrolled in the University of Chicago VT Ablation Registry between 2016 and 2018. Isochronal late activation maps annotated to the latest local electrogram deflection were created with high-density multielectrode mapping catheters. Targeted ablation of DZ (>3 isochrones within 1cm radius) was performed, prioritizing later activated regions with maximal isochronal crowding. When possible, activation mapping of VT was performed, and successful ablation sites were compared with DZ locations for mechanistic correlation. Patients were prospectively followed for VT recurrence and mortality.

Results:
One hundred twenty patients (median age 65 years [59-71], 15% female, 50% nonischemic, median ejection fraction 31%) underwent 144 ablation procedures for scar-related VT. 57% of patients had previous ablation and epicardial access was employed in 59% of cases. High-density mapping during baseline rhythm was performed (2518 points [1615-3752] endocardial, 5049±2580 points epicardial) and identified an average of 2±1 DZ, which colocalized to successful termination sites in 95% of cases. The median total radiofrequency application duration was 29 min (21-38 min) to target DZ, representing ablation of 18% of the low-voltage area. At 12±10 months, 70% freedom from VT recurrence (80% in ischemic cardiomyopathy and 63% in nonischemic cardiomyopathy) was achieved. The overall survival rate was 87%.

Conclusions:
A novel voltage-independent high-density mapping display can identify the functional substrate for VT during sinus rhythm and guide targeted ablation, obviating the need for extensive radiofrequency delivery. Regions with isochronal crowding during the baseline rhythm were predictive of VT termination sites, providing mechanistic evidence that deceleration zones are highly arrhythmogenic, functioning as niduses for reentry.
Urinary 11-nor-9-carboxy-tetrahydrocannabinol elimination in adolescent and young adult cannabis users during one month of sustained and biochemically-verified abstinence
Authors: Schuster Randi Melissa , Potter Kevin , Vandrey Ryan , Hareli Maya , Gilman Jodi , Schoenfeld David , Evins A Eden 
Published: September 2019

Background: Despite adolescents and young adults being the most frequent users of cannabis, all information on cannabis drug testing interpretation is based on data from adults. Aims: This study aimed to define the time course of urinary 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH) excretion among 70 adolescent and young adult cannabis users during 1 month of biochemically-verified cannabis abstinence. Methods: Urine specimens were collected at non-abstinent baseline and after 2, 3, 8, 15, 21 and 28 days of abstinence. Specimens were tested for THCCOOH with a ‘rapid’ immunoassay drug test and a confirmatory assay using liquid chromatography-tandem mass spectrometry, with a 5 ng/mL limit of quantitation. Elimination rate was tested using a population pharmacokinetics model. Results/outcomes: Participants had an average of 26 days of abstinence (SD = 6). Initial creatinine-adjusted THCCOOH concentration (CN-THCCOOH) was 148 ng/mg (SD = 157). Half-life was 2 days (SD = 5), with a 10-day window of detection (estimated range: 4–80 days). At the final timepoint and among those with > 25 days of abstinence ( n = 62), 40% ( n = 25) had THCCOOH concentrations > 5 ng/mL (i.e. detectable on confirmatory assay) and 19% ( n = 12) were ‘positive’ per federal drug testing guidelines (i.e. values greater than 50 ng/mL on the screening immunoassay and 15 ng/mL on the confirmatory assay). More frequent past month cannabis use was associated with higher baseline CN-THCCOOH concentrations, but not with rate of elimination. Nested five-fold cross-validation suggested high model reliability and predictive validity. Conclusions/interpretation: Findings underscore that, as with adults, detectable cannabinoid metabolites do not necessarily indicate recent use in adolescents and young adults. Algorithms that account for THCCOOH levels, assessed longitudinally and time between specimen collections are best equipped to confirm abstinence. Clinical Trial Registration: NCT03276221; https://clinicaltrials.gov/ct2/show/NCT03276221?term=Randi+Schuster&rank=1
Strategic Ambiguity with Probabilistic Voting
Authors: Asako Yasushi 
Published: September 2019

Political parties and candidates usually prefer making ambiguous promises. This study identifies the conditions under which candidates choose ambiguous promises in equilibrium, given convex utility functions of voters. The results show that in a deterministic model, no equilibrium exists when voters have convex utility functions. However, in a probabilistic voting model, candidates make ambiguous promises in equilibrium when (i) voters have convex utility functions, and (ii) the distribution of voters’ most preferred policies is polarized. JEL Classification: D71, D72
Obesity and 1-Year Mortality in Adults After Sepsis: A Systematic Review
Authors: Robinson Jamie , Swift-Scanlan Theresa , Salyer Jeanne 
Published: September 2019

Purpose: In recent years, researchers have noted an “obesity paradox,” where individuals with obesity survive sepsis at higher rates than their nonobese counterparts. This systematic review summarizes the literature on studies examining the association between obesity and 1-year mortality among patients admitted with sepsis, severe sepsis, or septic shock. Materials and Methods: Using a comprehensive search strategy, a systematic review was conducted to identify studies examining the association of obesity and sepsis mortality. PubMed, Cumulative Index of Nursing and Allied Health Literature, and Elton B. Stephens Company host databases were searched for the terms sepsis, obesity, mortality, and adult. Results: The initial search identified 189 studies, 9 of which met inclusion criteria. Of these, four provided evidence that obese or very obese patients with sepsis have lower mortality than nonobese patients. Methodologic differences in the remaining five studies, which reported conflicting results, limit generalizability. Conclusion: This systematic review on the association of obesity and sepsis mortality found three studies that demonstrated lower sepsis mortality among obese patients in the first 30 days and one showing that this protective effect extends up to 1 year. Given the increased number of patients surviving sepsis, it is important to consider long-term mortality and further describe the variables associated with increased survival.
The “central vein sign” in patients with diagnostic “red flags” for multiple sclerosis: A prospective multicenter 3T study
Authors: Maggi Pietro , Absinta Martina , Sati Pascal , Perrotta Gaetano , Massacesi Luca , Dachy Bernard , Pot Caroline , Meuli Reto , Reich Daniel S , Filippi Massimo , Pasquier Renaud Du , Théaudin Marie 
Published: September 2019

Background: The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective. Objectives: To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases. Methods: In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory “red flags” (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed. Results: Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value. Conclusion: The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
Feasibility of Integrating Panel-Based Pharmacogenomics Testing for Chemotherapy and Supportive Care in Patients With Colorectal Cancer
Authors: Kasi Pashtoon Murtaza , Koep Tyler , Schnettler Erica , Shahjehan Faisal , Kamatham Vaishnavi , Baldeo Candice , Hughes Caren L. 
Published: September 2019

Introduction: Pharmacogenomics is about selecting the “right drug in the right amount for the right patient.” In metastatic colorectal cancer, germline pharmacogenomics testing presents a unique opportunity to improve outcomes, since the genes dihydropyrimidine dehydrogenase and UDP-glucuronosyltransferase metabolizing the chemotherapy drugs, 5-fluorouracil, and irinotecan are already well known. In a retrospective analysis of the landmark TRIBE clinical trial [(TRIBE - TRIplet plus BEvacizumab multicenter, phase III trial by the Italian Cooperative GONO (Gruppo Oncologico Nord Ovest) group (NCT00719797)], the proportion of patients with serious adverse events was higher in those with dihydropyrimidine dehydrogenase/UDP-glucuronosyltransferase aberrations and was dose dependent. We aimed to report on the feasibility and the results of incorporating pharmacogenomics testing into clinical practice. Methods: As a quality improvement initiative and a center of individualized medicine grant, we integrated the use of OneOme RightMed comprehensive test, which reports on 27 genes related to pharmacogenomics and over 300 medications of interest. We limited initial testing to patients with colorectal cancer. Pharmacists provided dosage recommendations based on test results in real-time. Results: At our cancer center, 155 patients underwent pharmacogenomics testing from November 2017 to January 2019. Results were available within 3 to 5 days of testing for most patients and were integrated into treatment decision-making. Of 155 sampled participants, a total of 89 (57.4%) participants had an UGT1A1 variant genotype, NM_000463.2: c.-53_-52[8] *1/*28, n = 74 (47.7%); *28/*28, n = 15 (9.7%). Additionally, 4 (2.6%) participants were heterozygous for dihydropyrimidine dehydrogenase. Two (1.3%) individuals were heterozygous for both UDP-glucuronosyltransferase and dihydropyrimidine dehydrogenase genes. All (100%) the patients had at least 1 actionable aberration related to supportive care medications ( CYP-family) of all the possible medications listed on their pharmacogenomics report. Conclusion: Preemptive comprehensive pharmacogenomics testing can be integrated into clinical practice in real-time for patients with cancer given faster turnaround and low cost. Pharmacist-driven, patient-specific medication management consults add further value given the number of genes/drugs. This sets the stage for a prospective randomized clinical trial to demonstrate the amount of benefit this can result in these patients.
Physical Activity in Severe Dementia Is Associated With Agitation Rather Than Cognitive Function
Authors: Ishimaru Daiki , Tanaka Hiroyuki , Nagata Yuma , Takabatake Shinichi , Nishikawa Takashi 
Published: September 2019

Background: The authors examined associations between physical activity, cognitive function, activities of daily living, and behavioral and psychological dementia symptoms (BPSD) in severe and moderate dementia. Methods: A cross-sectional study was conducted to assess severe and moderate dementia groups according to the Clinical Dementia Rating. An actigraphy measured physical activity. Other measures included Mini-Mental State Examination, Cognitive Test for Severe Dementia, Hyogo Activities of Daily Living Scale, and Neuropsychiatric Inventory-Nursing Home. Results: Sixty-three participants were assessed (mean age = 89.3 ± 6.4). Physical activity was not associated with cognitive function among participants with severe dementia, although there was a trend-level association with cognitive function among those with moderate dementia. Physical activity was significantly associated with BPSD, specifically agitation/aggression symptoms, for participants with severe dementia, and there was a trend-level association with anxiety for participants with moderate dementia. Conclusions: Physical activity appears to be associated with BPSD among individuals in the advanced stages of dementia.