bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk prediction models for major surgery: composing a new tune
Authors: Carlisle J. B. 
Published: January 2019

SummaryIn this paper I explain why I think that most of the models that predict postoperative mortality should not be used when we're talking to patients about postoperative survival. Available models are isolated in time (from survival in the present) and space (from survival outside hospital). We know a lot about survival outside hospitals, with sufficient detail that we can discriminate between a man born in 1975 vs. 1976, or a woman aged 64 years vs. 65 years. We can use survival outside hospitals to inform what we do in hospital. I use my own survival to contrast with the survival of people older or younger than me. I will use my survival to illustrate how I might expect my mortality hazard to temporarily change when I have a scheduled operation (total hip replacement) and when I'm unwell and have an operation (for a fractured femoral neck). People live longer and longer and we operate on people older and older. We are also intervening earlier in progressive diseases, knowing that people are living long enough to experience harm from their progression. There is an evolving conflict between operating on older people and operating on younger people. Who has most to gain from the operation and who has most to gain from peri‐operative critical care? Do we prioritise on reducing death now, in patients with relatively short life expectancies, or do we invest in the long‐term survival of patients with relatively low rates of dying now? This conundrum is not informed by current risk models, with their focus on one to three postoperative months: we need to know survival outside hospital to gauge the value of what we do in hospital.
Pre‐operative cardiac optimisation: a directed review
Authors: Lee L. K. K. , Tsai P. N. W. , Ip K. Y. , Irwin M. G. 
Published: January 2019

SummaryCardiac events remain the leading cause of peri‐operative morbidity and mortality, and patients undergoing major surgery are exposed to significant risks which may be preventable and modifiable. Proper assessment and management of various cardiac conditions in the peri‐operative period by anaesthetists can markedly improve patient safety, especially in high‐risk patient populations. This involves understanding and applying current evidence‐based practice and international guidelines on the main aspects of cardiac optimisation, including management of patients with hypertension, chronic heart failure, valvular heart diseases and cardiac implantable electronic devices. Peri‐operative management of antihypertensive drugs in keeping with the current best evidence is discussed. Pre‐operative cardiac risk assessment and cardiac biomarkers can be used to help predict and quantify peri‐operative adverse cardiac events. There is an increasing need for anaesthetist‐led services, including focused transthoracic echocardiography and management of implantable cardiac electronic devices. Anaesthetists should be encouraged to play a proactive role in pre‐operative risk stratification and make timely multidisciplinary referrals if necessary. A personalised approach to pre‐operative cardiac optimisation enables a safer peri‐operative journey for at‐risk patients undergoing major surgery.
Pre‐optimisation of patients undergoing emergency laparotomy: a review of best practice
Authors: Poulton T. , Murray D. ,   the National Emergency Laparotomy Audit (NELA) project team
Published: January 2019

SummaryAlthough the concept of pre‐operative optimisation is traditionally applied to elective surgery, there is ample opportunity to apply similar principles to patients undergoing emergency laparotomy. The key challenge is achieving meaningful improvements in a patient's condition without introducing delays to time‐sensitive surgery, which may be required in a matter of hours. Optimisation can be considered in two parts: that of the patient's condition; and that of the care pathway. Optimising the patient's condition is less about improving long‐term pathology, and more about correcting physiological derangement, such as electrolyte and fluid balance, blood loss, prompt treatment of sepsis, and ensuring appropriate continuation of medication in the peri‐operative period. Optimising the care pathway involves ensuring that the system is designed to deliver reliably the appropriate interventions, such as prompt antibiotics, and access to computed tomography scanning and the operating theatre with minimal delay.
Negative pressure wound therapy use in diabetic foot syndrome—from mechanisms of action to clinical practice
Authors: Borys Sebastian , Hohendorff Jerzy , Frankfurter Claudia , Kiec‐Wilk Beata , Malecki Maciej T. 
Published: January 2019

AbstractBackgroundDiabetes and its complications constitute a rising medical challenge. Special attention should be given to diabetic foot syndrome (DFS) due to its high rate of associated amputation and mortality. Negative pressure wound therapy (NPWT) is a frequently used supportive modality in a diabetic foot with ulcerations (DFUs).DesignHere, we reviewed the current knowledge concerning the tissue and molecular mechanisms of NPWT action with an emphasis on diabetes research followed by a summary of clinical DFU studies and practice guidelines.ResultsNegative pressure wound therapy action results in two types of tissue deformations—macrodeformation, such as wound contraction, and microdeformation occurring at microscopic level. Both of them stimulate a wound healing cascade including tissue granulation promotion, vessel proliferation, neoangiogenesis, epithelialization and excess extracellular fluid removal. On the molecular level, NPWT results in an alteration towards more pro‐angiogenic and anti‐inflammatory conditions. It increases expression of several key growth factors, including vascular endothelial growth factor and fibroblast growth factor 2, while expression of inflammatory cytokinesis reduced. The NPWT application also alters the presence and function of matrix metalloproteinases. Clinical studies in DFU patients showed a superiority of NPWT over standard therapy in terms of efficacy outcomes, primarily wound healing and amputation rate, without a rise in adverse events. International guidelines point to NPWT as an important adjuvant therapy in DFU whose use is expected to increase.ConclusionsThis current knowledge improves our understanding of NPWT action and its tailoring for application in diabetic patients. It may inform the development of new treatments for DFU.
Linking size‐based trophodynamics and morphological traits in marine fishes
Authors: Ríos María F. , Venerus Leonardo A. , Karachle Paraskevi K. , Reid William D. K. , Erzini Karim , Stergiou Konstantinos I. , Galván David E. 
Published: January 2019

AbstractThe rule of thumb in marine trophodynamics indicates that the bigger an organism, the higher its trophic level (TROPH). This generalization leads to the assumption that fishes increase their TROPH with growth. However, a recent review showed that for many species, TROPH does not increase with body size, suggesting that size‐independent feeding is not rare in marine fishes. Here, we assessed some morphological traits of marine fishes that could potentially be used as indicators for the ability to vary TROPH with body size. Stable isotope values of nitrogen were used as a proxy TROPH. The specific objectives were as follows: (a) to evaluate the relationship between the oral gape and the trophodynamic trend and (b) to quantify the relevance of 11 external morphological traits in determining the size‐based trophodynamics. We used random forest models to identify the morphological traits that would help predict which species would have the potential to increase TROPH with growth and which would have not. The selected traits included the pelvic fin relative position, the dorsal fin shape, total length, and relative mouth size. Our results also showed a marked relationship between the rate of increase in the oral gape and TROPH. The analyses presented here provide the first comprehensive and quantitative review aiming at linking the trophodynamics of marine fishes with external morphological traits.
Elastic correction of fatigue crack growth laws
Authors: Antunes Fernando , Prates Pedro , Camas Daniel , Costa Jose 
Published: January 2019

AbstractFatigue crack growth (FCG) is usually studied assuming that ΔKis the driving parameter. An effective ΔKis considered in the presence of crack closure. However, after crack opening, there is an elastic regime that does not contribute to FCG. The objective here is to quantify this elastic range of ΔK, ΔKel, for different loading conditions and material properties. The yield stress was found to be the most important material parameter, followed by the hardening exponent. A linear decrease of ΔKelwith ΔKwas found for the 7050‐T6, 6082‐T6, and 6016‐T4 aluminium alloys, while the 304L stainless steel presented a slight increase. On the other hand, the increase ofKmaxwas found to increase the elastic fatigue range. Relatively high values of elastic range were obtained for the plane strain state, compared with the plane stress state.
Efficacy and safety of repeated use of lusutrombopag prior to radiofrequency ablation in patients with recurrent hepatocellular carcinoma and thrombocytopenia
Authors: Ishikawa Toru , Okoshi Marina , Tomiyoshi Kei , Kojima Yuichi , Horigome Ryoko , Imai Michitaka , Nozawa Yujiro , Iwanaga Akito , Sano Tomoe , Honma Terasu , Yoshida Toshiaki 
Published: January 2019

AimsThrombocytopenia is often associated with chronic liver disease. Lusutrombopag is a small molecule thrombopoietin receptor agonist designed to temporarily increase the platelet count in patients with chronic liver disease for whom elective invasive procedures are planned. In the present study, the efficacy and safety of repeated use of lusutrombopag prior to radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma were examined.MethodsEight patients with hepatocellular carcinoma who had a platelet count <50 000/μL prior to both initial and repeat RFA at the time of recurrence received lusutrombopag (3 mg/day) orally for 7 days between March 2016 and August 2018. The following were compared: the effect of lusutrombopag to increase the platelet count as determined by the platelet count after the initial and repeated use of lusutrombopag, the rate of avoiding platelet transfusion, and the presence of any complications.ResultsThe platelet count increased to 103 100 ± 22 800/μL 14 days after the first treatment and to 110 700 ± 17 800/μL 14 days after the repeated use. None of the patients required platelet transfusion. None of the patients developed clinical symptoms such as thrombosis, fever, rash, portal vein thrombosis, bleeding, or any other serious adverse events.ConclusionsRepeated use of lusutrombopag increased the platelet count. It did not cause any serious adverse events and led to avoidance of platelet transfusion. Radiofrequency ablation was carried out safely in all patients. Future studies with more cases of repeated use are needed to examine the long‐term efficacy and safety of lusutrombopag.
Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database
Authors: Phan Kevin , Loya Asad 
Published: January 2019

AbstractBackgroundWith the rising incidence of melanoma in situ (MIS) or cutaneous melanoma, there is an increasing emphasis on the need to understand optimal treatment strategies. The current standard of surgical care is wide local excision (WLE). Alternative surgical techniques have been proposed including Mohs micrographic surgery (MMS). We aimed to compare survival rates following WLE versus MMS surgery for MIS.MethodsWe performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) cancer registry. 24,515 cases of WLE were identified and compared with 4122 cases of MMS surgery for MIS.ResultsThere was a significantly higher proportion of elderly patients aged ≥75 years in the MMS group compared to WLE (23.3% vs. 15.3%). The proportion of females was higher for WLE compared to MMS (48.8% vs. 40%). Facial MIS tumors were significantly higher for MMS, as were scalp/neck tumors. After adjustment for confounding factors, there was no significant difference in cancer‐specific survival (HR 0.928, 95% CI 0.596–1.446, P = 0.74) and overall survival (HR 1.006, 95% CI 0.896–1.129, P = 0.924).ConclusionAdjusted analyses demonstrated no differences in overall survival or cancer‐specific survival between MIS patients treated with MMS compared with WLE.
Giant Goblins above the waves at the southern end of the world: The biogeography of the spider family Orsolobidae (Araneae, Dysderoidea)
Authors: Chousou‐Polydouri Natalia , Carmichael Anthea , Szűts Tamás , Saucedo Alma , Gillespie Rosemary , Griswold Charles , Wood Hannah M. 
Published: January 2019

AbstractAimAs a continental island, much of the biota of New Zealand was initially thought to have been shaped by vicariance. Recent studies, however, have highlighted the role of dispersal, with some even suggesting that the entire biota is the product of dispersal events following emergence of the islands. This study focuses on the interplay between dispersal and vicariance, specifically asking whether the spider family Orsolobidae has Gondwanan origins on New Zealand.LocationThe spider family Orsolobidae was sampled from all continents where they occur (Africa, Australia, New Zealand and South America), comprising a total of 66 specimens representing the phylogenetic diversity of the family.MethodsDNA sequences were obtained from six fragments that were subsequently aligned and analysed with MrBayes3.2 and beast 1.8. The phylogeny was calibrated with fossils used as node calibrations, as well as with the substitution rate of Histone H3.ResultsThe orsolobid fauna of each land mass except Australia forms a monophyletic group in our analyses. The divergence dating analysis suggests that diversification of Orsolobidae started at a minimum of 80 Ma, while the New Zealand clade dates from a minimum of 40 Ma.Main conclusionsThus, while many taxa have colonized the islands by dispersal, certain lineages, including the Orsolobidae, have clearly been capable of persisting through times of reduced land area.
The protective effect of sinapic acid in osteoarthritis: In vitro and in vivo studies
Authors: Li Xiaobin , Lin Jian , Ding Xiaoxia , Xuan Jiangwei , Hu Zhichao , Wu Dengying , Zhu Xingyu , Feng Zhenhua , Ni Wenfei , Wu Aimin 
Published: January 2019

AbstractThe anti‐inflammatory effect of sinapic acid (SA) has been reported in several studies. However, whether SA has the same effect on osteoarthritis (OA) has yet to be clearly elucidated. We designed a series of in vitro and in vivo procedures to verify the above conjecture. Compared with controls, SA‐pretreated human chondrocytes showed lower levels of interleukin (IL)‐1β‐induced IL‐6, prostaglandin E2 (PGE2), nitric oxide (NO) and tumour necrosis factor‐α (TNF‐α) in vitro. Meanwhile, SA could also reverse the degradation of type II collage and aggrecan, as well as the overproduction of matrix metalloproteinase‐9 (MMP‐9) and matrix metalloproteinase‐13 (MMP‐13), inducible nitric oxide synthase (iNOS), cyclooxygenase (COX)‐2 and a disintegrin and metalloproteinase thrombospondin motifs (ADAMTS)‐5. Furthermore, activation of nuclear factor κB (NF‐κB), which was induced by IL‐1β, was also inhibited by SA through the pathway of nuclear factor‐erythroid 2‐related factor‐2 (Nrf2)/heme oxygenase 1. In vivo, SA could delay the progress of mice OA models. We propose that SA may be applied as a potential therapeutic drug in OA treatment.
Leadership, Inside and Out: The Tideswell‐AGS‐ADGAP Emerging Leaders in Aging Program
Authors: Chang Anna , Lundebjerg Nancy E. , Abrams Joan , Barnes Deborah E. , Fain Mindy J. , Hall William J. , Johnson Theodore M. , Michael Harper G. , Williams Brie , Ritchie Christine S. 
Published: January 2019

BACKGROUND/OBJECTIVESTo optimize health and well‐being for all older people, we must collectively develop leaders to pioneer models of care, educate the healthcare workforce, advance research, and engage the community.METHODSThe Emerging Leaders in Aging (ELIA) program was created to train a multiprofessional cadre of leaders focused on the health and well‐being of older people. ELIA uses the social change curricular framework and addresses knowledge of self, community, and engagement with change. Program impact measured included scholar satisfaction, confidence related to curricular domains before and after the program, project progress, and scholar productivity.RESULTSFour cohorts of 65 scholars in seven health professions from 24 states were selected for the year‐long 55‐hour program. Overall satisfaction from members of the first three cohorts who have completed the program (n = 46) was 4.86 (scale = 1–5), and scholar confidence increased from 5.8 to 8.0 (scale = 1–9) (p < .001). These scholars reported 85 presentations, 63 publications, and 21 awards subsequent to training. All scholars described the importance of a program focused on early and mid‐career leaders in health and aging.DISCUSSIONThe ELIA program leverages longitudinal, distance mentor communities, and project‐based learning strategies. It has improved confidence and skills in emerging leaders who commit their efforts toward the care of older persons. Programs like ELIA are critical to preparing a healthcare workforce to optimize care for all as our health needs and expectations change with age. J Am Geriatr Soc 67:437–442, 2019.
Venoprotective drugs in pigmented purpuric dermatoses: A case report
Authors: Gupta Aastha , Sardana Kabir , Kishan Gautam Ram 
Published: January 2019

SummaryPigmented purpuric dermatoses (PPD) or capillaritis represent a benign condition, presenting with extravasation of erythrocytes in the skin and prominent hemosiderin deposition. The eruption runs a chronic relapsing course and is resistant to therapy. Capillary fragility, cellular immunity, and microvascular inflammation play important roles in the pathogenesis of PPD. Bioflavonoids, currently used as venoprotective agents for the management of chronic venous insufficiency, have been shown to reduce capillary fragility and permeability by inhibiting endothelial cell activation and modulating the leukocyte‐endothelium interaction. We report a case of PPD with dramatic improvement consequent to a therapy with a fixed dose combination containing flavonoids like diosmin, hesperidin, and Euphorbia prostata extract along with calcium dobesilate.
Neurosonography After Mechanical Thrombectomy for Acute Stroke Treatment
Authors: Ikenberg Benno , Scharsich Benjamin , Mönch Sebastian , Wunderlich Silke , Bernkopf Kathleen , Boeckh‐Behrens Tobias , Friedrich Benjamin , Maegerlein Christian , Poppert Holger , Seifert Christian L. 
Published: January 2019

ABSTRACTBACKGROUND AND PURPOSEMechanical thrombectomy has been shown to be effective for acute stroke treatment, but lesions of cerebral vessels can develop thereafter. Such lesions of recanalized vessels and altered cerebral hemodynamics after mechanical thrombectomy are poorly investigated. In particular for neurosonography, data are sparse. We aimed to describe hemodynamic changes and incidence of de‐novo stenosis after mechanical thrombectomy with neurosonography.METHODSRetrospective analysis of patients after successful mechanical thrombectomy for acute stroke therapy who received one neurosonography at baseline and during follow up. Peak systolic velocity (PSV) of all intracranial recanalized and reference vessels was extracted for analysis. Patients with an isolated increase or decrease of PSV (50% or 50 cm/second for anterior and 30% or 30 cm/second for posterior circulation) were identified and characterized.RESULTSEighty‐eight patients (mean age 64.4; 34.1% female) were included in this study. In 9 (10.2%) patients, the vessel occlusion was located in the posterior, and in 79 (89.9%) patients the vessel occlusion was located in the anterior circulation. With predominance to the recanalized vessel, mean PSV decreased at both, the recanalized and the reference vessel during follow up. In 3 (3.4%) patients, an isolated increase of PSV was observed in the recanalized vessel, and in 6 (6.8%) patients an isolated decrease of PSV was observed in the recanalized vessel.CONCLUSIONSonographic incidence of de‐novo stenosis following mechanical thrombectomy seems to be low, in line with prior angiographic studies. However, as measured by neurosonography, cerebral hemodynamic in the recanalized vessel is dynamic after thrombectomy. This result is of interest for further prospective analysis.
Pattern of Sedentary Behavior in Different Periods of School Time of Brazilian Adolescents
Authors: da Costa Bruno G. G. , da Silva Kelly S. , Bandeira Alexsandra S. , Martins Cilene R. , Vieira Jéssika A. J. , Petroski Edio L. 
Published: January 2019

ABSTRACTBACKGROUNDSedentary behavior (SB) is related to unhealthy outcomes and is performed in many contexts, including school. The aim of this study was to identify sociodemographic, biological, and psychosocial correlates of SB performed at school in a sample of adolescents.METHODSAdolescents provided information regarding sex, age, socioeconomic status, and psychosocial variables related to physical activity (self‐efficacy, attitudes, perception of school environment, peer and parental support). Body fat was estimated using skinfolds, and maximum aerobic capacity with a 20 m shuttle run. Adolescents wore accelerometers and SB performed during class time, physical education (PE) classes, and recesses was estimated.RESULTSAdolescents (N = 567, 53% female, 12.9 ± 5.3 years old) spent 67% of class time, 41% of PE classes, and 41% of recesses in SB. Girls spent more time in SB, and age was negatively associated with SB. Body fat was positively associated with SB in class time and PE classes. Peer support for physical activity was negatively associated with SB in class time, whereas attitudes related to physical activity were negatively associated with SB during PE classes and recesses.CONCLUSIONAdolescents spend long periods in SB at school, even during opportunities to be active like PE classes and recesses.
The Patterns of Moderate to Vigorous Physical Activity and Physical Education Enjoyment Through a 2‐Year School‐Based Program
Authors: Gråstén Arto , Yli‐Piipari Sami 
Published: January 2019

ABSTRACTBACKGROUNDIn this study, we examined the development of children's moderate to vigorous physical activity (MVPA) and physical education (PE) enjoyment through the Physical Activity as Civil Skill Program 2012‐2014.METHODSParticipants were 661 (265 intervention, 396 control) elementary school children in central and northeast Finland. The program was implemented across 2 years with 3 measurement phases using self‐reported MVPA and PE enjoyment, and accelerometer‐determined MVPA of a random subsample (N = 76).RESULTSThe proportion of children meeting the current MVPA guidelines declined from 38% to 22% (intervention) and 14% to 9% (control), whereas PE enjoyment was stable in both groups. Boys were more physically active than girls only within control group children. Teachers' feedback indicated that violence and bullying among intervention students reduced during the program, which can be considered as an additional benefit.CONCLUSIONSIt may be that both MVPA and PE enjoyment may require more tailored actions to be increased across a long‐term program. It is important to ensure that school‐based physical activity programs, especially including transition from elementary to middle school level, provide all children positive experiences, and thus, may improve their motivation, and MVPA participation during school days and leisure time.