bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambulance Clinical Triage for Acute Stroke Treatment
Authors: Zhao Henry , Pesavento Lauren , Coote Skye , Rodrigues Edrich , Salvaris Patrick , Smith Karen , Bernard Stephen , Stephenson Michael , Churilov Leonid , Yassi Nawaf , Davis Stephen M. , Campbell Bruce C.V. 
Published: March 2018

Background and Purpose—
Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability.

Methods—
The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen. ACT-FAST examination steps were retrospectively validated, and then prospectively validated by paramedics transporting culturally and linguistically diverse patients with suspected stroke in the emergency department, for the identification of internal carotid or proximal middle cerebral artery occlusion. The diagnostic performance of the full ACT-FAST algorithm was then validated for patients accepted for thrombectomy.

Results—
In retrospective (n=565) and prospective paramedic (n=104) validation, ACT-FAST displayed higher overall accuracy and specificity, when compared with existing LVO triage scales. Agreement of ACT-FAST between paramedics and doctors was excellent (κ=0.91; 95% confidence interval, 0.79–1.0). The full ACT-FAST algorithm (n=60) assessed by paramedics showed high overall accuracy (91.7%), sensitivity (85.7%), specificity (93.5%), and positive predictive value (80%) for recognition of endovascular-eligible LVO.

Conclusions—
The 3-step ACT-FAST algorithm shows higher specificity and reliability than existing scales for clinical LVO recognition, despite requiring just 2 examination steps. The inclusion of an eligibility step allowed recognition of endovascular-eligible patients with high accuracy. Using a sequential algorithmic approach eliminates scoring confusion and reduces assessment time. Future studies will test whether field application of ACT-FAST by paramedics to bypass suspected patients with LVO directly to endovascular-capable centers can reduce delays to endovascular thrombectomy.
Τὸ πνεῦµα in 1 Corinthians 5:5: A Reconsideration of Patristic Exegesis
Authors: Suh Michael K. W. 
Published: March 2018

Abstract
This article questions the assumption that there was a standard patristic interpretation regarding the identity of “spirit” in 1 Corinthians 5:5 (ἵνα τὸ πνεῦµα σωθῇ ἐν τῇ ἡµέρᾳ τοῦ κυρίου). Recent scholarship on 1 Corinthians 5 either fails to provide a fair representation of the available data or ignores the patristic exegesis altogether. The present essay addresses this deficiency in current scholarship by presenting the varieties of ways that early Christians read and interpreted “spirit” in 1 Cor 5:5.
Manichaean Imagery of Christ as God’s Right Hand
Authors: van Oort Johannes 
Published: March 2018

Abstract
The article examines the conspicuous references to God’s ‘Right Hand’ in Manichaeism by analysing texts from both Western and Eastern sources. The analysed texts prove that the eye-catching imagery (directly or indirectly) refers to Christ. Perhaps this imagery of Christ as God’s Right Hand also had its place in Manichaean art. The article aims to function as background for a subsequent study of Augustine’s portrayal of Christ as manus or dextera Dei in his Confessions.
Das Martyrion des Babylas und die polemischen Schriften des Johannes Chrysostomos
Authors: Rohmann Dirk 
Published: March 2018

Abstract
While the early life of John Chrysostom remains largely obscure to us, scholars have been able to reconstruct the chronology of sermons given by John in Antioch. There is, however, less clarity on the date of John’s polemical treatises such as De Babyla contra Iulianum et Gentiles and the Demonstratio. Taking into account archaeological and literary evidence on the translation of the remains of the martyr Babylas, descriptions of space and buildings as well as historical allusions and intertextual references in these and other works, the present paper argues that both treatises were written and composed as a unity in late 386 or early 387, when the remains of Babylas were translated to their final resting place. Both treatises show that John came up with a number of polemical motifs only after he was appointed as a priest and thus illustrate the heated atmosphere in Antioch of 386/7.
The European Union, the Arctic, and International Law
Authors: Alcaide-Fernández Joaquín 
Published: March 2018

Abstract
The European Union (EU) is willing to participate as much as possible at the negotiation table to meet the challenges that the Arctic poses and benefit from the opportunities it offers. But the relationship between the EU and the Arctic is ‘problematic’ for both external (EU difficulties particularly with Canada and Russia) and internal reasons (substantive competing interests and ambivalent policies, discrepancies among member States and within EU institutions …). Without a specific policy tradition or a direct geographical link, the EU has not yet gained legitimacy to become a key ‘Arctic actor’ or stakeholder. The EU needs to take an active stance on issues relating to the Arctic (including maritime delimitation, which is critical for determining navigational rights, the scope of Art. 234, etc.); because otherwise, the EU reduces its chances to make an impact on the relevant international fora and, ultimately, on making and implementing Arctic international law.
Hypogean presumably sister species Quedius repentinus sp. n. from Altai and Q. roma from Sikhote-Alin (Coleoptera: Staphylinidae): a disjunct distribution or poorly sampled Siberia?
Authors: SALNITSKA MARIA , SOLODOVNIKOV ALEXEY 
Published: March 2018

Quedius (Microsaurus) repentinus sp. n., a new hypogean montane talus-associated species from Altai is described and considered sister to the morphologically and bionomically similar Q. (M.) roma Solodovnikov et Hansen, 2016 from Sikhote-Alin. Both species seem more closely related to the Q. (M.) przewalskii species group from the mountains of China than to the Q. (M.) mutilatus species group from Tien-Shan. The identity of Q. (M.) przewalskii Reitter, 1887, a core of the respective species group, is clarified by re-examination of the holotype. The broad gap between the distributions of Quedius repentinus and Q. roma is either a noteworthy biogeographic fact pending explanation, or an artefact resulting from poor sampling pending additional records and new species discovery. Inadequate knowledge of the actual diversity and the distributions of the montane hypogean Quedius of the Russian Asia are illustrated by another new hypogean species from Altai. That species, so far known from a single female only, is here reported but not formally described.
Primary Versus Secondary Osteochondral Autograft Transplantation for the Treatment of Large Osteochondral Lesions of the Talus
Authors: Park Kwang Hwan , Hwang Yeokgu , Han Seung Hwan , Park Yoo Jung , Shim Dong Woo , Choi Woo Jin , Lee Jin Woo 
Published: March 2018

Background: Recent studies have reported promising clinical results after osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the talus (OLT). However, no study has yet compared clinical outcomes between primary and secondary OAT for large OLT. Purpose: To compare clinical outcomes among patients with large OLT who receive primary OAT versus those who receive secondary OAT after failure of marrow stimulation and to identify factors associated with clinical failure. Study Design: Cohort study; Level of evidence, 3. Methods: From 2005 to 2014, 46 patients with large OLT (≥150 mm2) underwent OAT: 18 underwent OAT as initial surgical management (primary OAT group), and 28 patients underwent secondary OAT after failure of previous arthroscopic marrow stimulation (secondary OAT group). In both groups, OAT procedures included arthroscopic inspection and debridement of concomitant soft tissue injuries. Clinical outcomes were assessed using pain visual analog scale (VAS), the Roles and Maudsley score, Foot and Ankle Outcome Scores (FAOS), and revisional surgery rates. Factors associated with clinical failures were evaluated using bivariate and logistic regression analyses. Survival outcomes were compared using Kaplan-Meier analysis. Results: Mean follow-up time was 6 years (range, 2-10.8 years). Mean lesion size was 194.9 mm2 (range, 151.7-296.3 mm2). There were no significant differences between groups in patient demographics and preoperative findings. Postoperative pain VAS, Roles and Maudsley score, FAOS, and revisional surgery rates were not significantly different at last follow-up. Prior marrow stimulation was not significantly associated with clinical failure on bivariate analysis. Lesion size greater than 225 mm2 on preoperative magnetic resonance imaging was significantly associated with clinical failure. Survival probabilities from Kaplan-Meier plots were not significantly different between the primary and secondary OAT groups ( P = .947). Conclusion: Clinical outcomes of patients with large OLT treated with secondary OAT after failed marrow stimulation were found to be comparable with those who were treated with primary OAT. These results may be helpful to orthopaedic surgeons deciding appropriate surgical options for patients with large OLT.
Heparin Coating of Extracorporeal Circuits Inhibits Cytokine Release from Mononuclear Cells during Cardiac Operations
Authors: Giomarelli P. , Naldini A. , Biagioli B. , Borrelli E. 
Published: March 2018

Purpose To evalute whether the production of interleukin 2 (IL 2), interlukin 6 (IL 6) and interlukin 10 (IL 10) from stimulated peripheal blood mononuclear cells (PBMC) was affected by coating extracorporeal circuits in patients undergoing cardiopulmonary bypass (CPB). In addition, postoperative clinical parameters were compared between patients with heparin-coated and uncoated CPB. Design Prospective, controlled in vivo/ex vivo study. Procedure Blood samples were drawn immediately before, at the end and 24 hours after the end of CPB using either a conventional circuit (n=10) or a heparin-coated circuit (n=10) in patients undergoing CPB. Cytokine release on the supernatants of activated PBMC was detected. Cardiopulmonary parameters were measured before CPB, at ICU admission, 3 hours and 24 hours after ICU admission in both groups of patients. Statistical difference intragroups and between groups were investigated with the analysis of variance for repeated measures. Results IL 6 and IL 10 release was significantly less (p<0.05) in the heparin-coated group. No differences in clinical parameters were observed between the two groups. Conclusions These results suggest that with the use of heparin-coated circuits there is a lower production of IL 6 and IL 10 from isolated PBMC than with uncoated circuits.
Effect of Hemodiabsorption and Sorbent-Based Pheresis on Amino Acid Levels in Hepatic Failure
Authors: Steczko J. , Bax K.C. , Ash S.R. 
Published: March 2018

Changes in plasma amino acid concentrations were measured in patients with hepatic failure during extracorporeal hemodiabsorption (using the Liver Dialysis Unit, “the Unit”) or hemodiabsorption plus sorbent-based pheresis treatment (using the Liver Dialysis Plasmafilter Unit, “the PF-Unit”) Systems. Eight patients with hepatic failure, grade 3 or 4 encephalopathy, elevated bilirubin and/or creatinine levels and respiratory or renal failure were treated for 1–3 days with the Unit alone. Three of these were also treated with the Unit containing 10 g of BCAA in the sorbent suspension. Four patients with hepatic failure treated with the PF Unit also had 10 g of branched chain amino acid (BCAA) added to the sorbents of the Unit portion of this device. Pre- and post-plasma samples were drawn and high performance liquid chromatography (HPLC) was used to separate and detect amino acids in the plasma. Both the Unit and the PF-Unit have the capability to selectively remove various amino acids, especially aromatic amino acids (AAA). The pre-treatment amino acid profiles of plasma were typical for hepatic failure, with abnormally high levels of phenylalanine, tyrosine, tryptophan, and methionine and decreased levels of valine, leucine and isolucine. The average pre-treatment Fischer ratio (BCAA/AAA) for both Unit and PF-Unit patients was 1.43 (±0.58). Treatments by both systems resulted in an increase of BCAA levels in blood and concomitant decrease of AAA levels, with an average Fischer ratio improvement of 30–38% for the Unit and PF-Unit without BCAA. The Fischer ratio improved by 90% (average) for the Unit with BCAA. Levels of many other amino acids (such as alanine, glycine, proline or lysine) increased during both Unit and PF-Unit treatments. The removal of strongly protein-bound toxin and amino acids such as tryptophan and sulphydryl amino acids was more effective by the PF-Unit. Both the Unit and the PF-Unit have the unique capability to remove toxic aromatic amino acids while increasing BCAA levels in patient. The increase in many amino acid levels may be related to the removal of toxins that interfere with normal amino acid metabolism. The addition of the PF module improves the removal of bilirubin and similarly protein-bound chemicals. Changes in amino acid profiles by the Unit and the PF-Unit contrast markedly with other extracorporeal devices.
Dialysate Flow Distribution in Hollow Fiber Hemodialyzers with Different Dialysate Pathway Configurations
Authors: Ronco C. , Brendolan A. , Crepaldi C. , Rodighiero M. , Everard P. , Ballestri M. , Cappelli G. , Spittle M. , La Greca G. 
Published: March 2018

The efficiency of a hemodialyzer is largely dependent on its ability to facilitate diffusion, since this is the main mechanism by which small solutes are removed. The diffusion process can be impaired if there is a mismatch between blood and dialysate flow distribution in the dialyzer. The objective of the paper was to study the impact of different dialysate compartment designs on dialysate flow distribution and urea clearances. Eighteen hollow fiber 1.3 m2 hemodialyzers were studied, 6 each of 3 designs: Type A- standard fiber bundle (PAN 65DX Asahi Medical, Tokyo, Japan); Type B - spacing filaments external to the fibers (PAN 65SF Asahi Medical, Tokyo, Japan); Type C - fibers waved to give Moiré structure (FB130 Nissho-Nipro, Osaka, Japan). In vitro studies: 3 dialyzers of each type were studied following dye injection into the dialysate compartment. Dynamic sequential imaging of longitudinal sections of the dialyzer were undertaken, using a new generation helical CT scanner (X-Press/HS1 Toshiba Corporation, Tokyo, Japan). In vivo studies: 3 dialyzers of each type were studied, in randomized sequence, in 3 different patients under standardized dialysis conditions. Blood- and dialysate-side urea clearances were measured at 30 and 150 minutes of treatment. Macroscopic and densitometrical analysis revealed that flow distribution was most homogeneous in the dialyzer with Moiré structure (Type C) and least homogeneous in the standard dialyzer (Type A). Space yarns (Type B) gave an intermediate dialysate flow distribution. Significantly increased urea clearances (p<0.001) were seen with Types B and C, compared to the standard dialyzer. Type C (Moiré) had the highest clearances although these were not significantly greater than Type B (space yarns). In conclusion, more homogeneous dialysate flow distribution and improved small solute clearances can be achieved by use of spacing yarns or waved (Moiré structure) patterns of fiber packing in the dialyzer. These effects are achieved probably as a result of reduced dialysate channeling resulting in a lower degree of mismatch between blood and dialysate flows. The new radiological technique using the helical CT scanner allows detailed flow distribution analysis and has the potential for testing future modifications to dialyzer design.
Is there a Role for Hemoperfusion/Hemodialysis as a Treatment Option in Severe Tricyclic Antidepressant Intoxication?
Authors: Frank R.D. , Kierdorf H.P. 
Published: March 2018

Objective Suicidal self-poisoning with tricyclic antidepressants like doxepin is a major therapeutic problem in emergency medicine with a high fatality rate. Deaths are mainly caused by cardiotoxicity with arrhythmias, intraventricular conduction disturbances and myocardial depression. For treatment, alkalinization and hypertonic saline are recommended. The role of extracorporeal treatment procedures is not clear. The possible benefit of hemoperfusion/hemodialysis is discussed in a case report with respect to the published literature. Case Report After ingestion of an amount of at least 5000 mg doxepin a 37-year-old man with endogenous depression developed cardiac arrest. After preclinical resuscitation with prolonged external cardiac massage, he was admitted to the intensive care unit with persistently severe hypotension and wide QRS complexes (230–260 ms). Despite fluid load, alkalinization, hypertonic saline and high-dose vasoactive substances the patient's condition did not improve. Hemoperfusion over hemoresin combined with hemodialysis led to an impressive clinical improvement with shortening of QRS duration (from 230 to 120 ms) and hemodynamic stabilization. The patient fully recovered without neurologic deficits. Conclusion We report a successful treatment with hemoperfusion over hemoresin and hemodialysis in a patient with life-threatening doxepin poisoning intractable with the generally recommended treatment. In such acute TCA intoxication with severe cardiotoxicity, hemoperfusion/hemodialysis should be considered a potential treatment option, as the “toxicokinetics” of drugs may totally differ from their usual pharmacokinetic behaviour. Experimental and clinical studies are needed to clarify the toxicokinetics of TCA in order to improve the therapeutic approach.
Electrical Current Leakage during Hemodialysis May Increase Blood-Membrane Interaction
Authors: Jonsson P. , Forsberg U. , Niklasson J. , Stegmayr B.G. 
Published: March 2018

During hemodialysis blood - membrane interaction causes complement activation. During dialysis there may be an electrical current leakage to the dialyzer, especially if there is a broken ground or a defect in another electrical device coupled to the patient. This study investigated whether an electric current of 1.5 mA DC could alter blood membrane interaction as measured by changes in C3d in the blood. Such a high current leakage could occur because there is no protection in the dialysis machine (Class 1B) against auxiliary current leakage. Such a current could come from a defective external device in contact with the patient during hemodialysis. Materials A dialysis machine (Fresenius 2008C) with a filled blood-line system containing about 350 ml whole blood from each of 8 different donors was used in vitro. Each of the eight test-runs also contained 1000 U added heparin. The dialysis procedure was performed using hemophan membranes (GFS +12, Gambro) with bicarbonate and potassium 3.0 (D210, Gambro) as dialysate. Two electric poles were placed in the blood line, before and after the dialyzer (connected in parallel) and the ground was placed at entry and exit of the dialysate fluid coming from the machine to the dialysis filter. C3d was measured before the start of “dialysis” and at 15, 30, 45 and 60 min, during dialysis. Thereafter the 1.5 mA current was switched on and additional samples were drawn at 75 and 90 min. The mean C3d values were calculated. Paired non-parametric statistical analyses were performed. Results There was a significant and continuous increase in C3d as compared to the “predialysis” level. The increase during 0 to 30 minutes was greater than that from 30 to 60 minutes (p=0.018); the increase in C3d during 60 to 90 min, was greater than that from 30 to 60 min (p=0.018) and there was no difference between the 0 to 30 and the 60 to 90 min increases. Conclusions A current, used in this study, was able to induce a blood membrane interaction during in vitro dialysis. Even a weaker current leakage might have such adverse effects and similar interactions seem possible during regular dialysis depending on the extent of the leakage.
Influence of Intravenous Iron Therapy on Novel Markers of Iron Deficiency
Authors: Chinnappa Shanmugakumar , Bhandari Sunil 
Published: March 2018

Background Detection of iron deficiency in patients with end-stage renal disease (ESRD) remains challenging due to the lack of reliable markers. The immature reticulocyte fractions (IRF) RET-Y and RBC-Y may serve as useful novel markers. We investigated the ability of IRF to detect functional iron deficiency in ESRD patients in comparison to Serum ferritin (SF) and Transferrin saturation (TSAT) and the influence of intravenous iron therapy on these markers. Methods Cross sectional (n=40) and prospective (n=20) studies of hemodialysis patients were performed; 20 patients received intravenous iron (200 mg) monthly and were followed up for 5 months. Iron deficiency was defined as SF ≤200μg/L and/or TSAT ≤20%. A RBC-Y ≤171 and/or RET-Y ≤168.7 were criteria for iron deficiency. Correlations between traditional and novel markers were examined. Results are given as mean±SEM. Paired t-test was used to test for significance. Results 27 male and 13 female patients, mean age of 56.7±3.02 years were enrolled in the crosssectional study. TSAT correlated with RBC-Y and RET-Y, r=0.47 and 0.61, respectively. Correlations for SF with RBC-Y and RET-Y were r=0.23 and 0.22, respectively. In the prospective component (11 males and 9 females of mean age 60±3.4 years), RET-Y and RBC -Y remained stable during iron therapy. The coefficients of variation were RBC-Y 2.54%, RET-Y 4.23%, TSAT 28.74% and SF 35.34%. Conclusions RBC-Y and RET-Y correlated with TSAT and SF allowing detection of functional iron deficiency. These measures were less susceptible to fluctuations than traditional markers.
Donor Plasmapheresis: A Comparative Study using four Different Types of Equipment
Authors: Perseghin P. , Pagani A. , Fornasari P.M. , Salvaneschi L. 
Published: March 2018

From September 1985 to May 1986, 106 healthy volunteers underwent automated plasmapheresis in our Institution (CT-AVIS, PAVIA) using four different types of equipment. The aim of this study was to verify the feasibility of harvesting plasma from a single donor and to ascertain: 1) the acceptability of the procedure to donors; 2) the speed, economy and safety of the different types of equipment; 3) the quality of the plasma. The equipment employed in this study was: a) PCS (Plasma Collection System-Haemonetics) b) FILTRA (Dideco) c) PLASMAPUR (Organon Teknika). d) AUTOPHERESIS C™ - (Hemascience). All four used a single-needle technique. Procedures were well tolerated by donors; no significant changes were observed in pre- and post- procedure laboratory values.