bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term outcomes of the ‘primary extension technique’ in the prevention of Steal syndrome
Authors: Charlwood Natasha , Al-Khaffaf Haytham 
Published: November 2018

Purpose To report our 13 years of experience with the ‘primary extension technique’ for the prevention of dialysis-associated steal syndrome. Methods All diabetic patients undergoing upper arm autogenous elbow fistula formation using the primary extension technique between September 2001 and September 2014 at a single centre were included. At follow-up all patients were evaluated for patency, adequacy of needling and the presence or absence of steal symptoms. In primary extension technique, the fistula is formed by anastomosing the median cubital vein with the proximal radial or ulnar artery just below the brachial artery bifurcation. Results In total, 64 operations of the primary extension technique were included in this study. All patients were diabetic. Primary failure was 5%, follow-up 23–84 months. Nine patients (14%) developed cephalic vein thrombosis. In these cases, the basilic vein was successfully transposed to the existing fistula. In eight patients (12.5%), the cephalic vein required superficialisation. In three patients, the flow was preferentially into the basilic vein with poor maturation of cephalic vein. Of these three patients, there was a small proximal cephalic vein in one patient and stenosis in the other two patients. One patient who developed dialysis-associated steal syndrome is included in the results as they were listed for primary extension technique fistula formation but in fact did not have their fistula formed using primary extension technique. Instead, the anastomosis was formed proximal to the bifurcation of the brachial artery. Symptoms improved with revision of the fistula. Conclusion Our 13-year experience demonstrates that the primary extension technique is a safe and effective procedure for fistula formation. Patency rates are comparable to brachio-cephalic and brachio-basilic fistulas and primary extension technique is effective in the prevention of dialysis-associated steal syndrome.
Are YouTube videos useful for patient self-education in type 2 diabetes?
Authors: Gimenez-Perez Gabriel , Robert-Vila Neus , Tomé-Guerreiro Marta , Castells Ignasi , Mauricio Didac 
Published: November 2018

Objective: To evaluate the usefulness of YouTube videos as an educative tool for type 2 diabetes self-management. Design: Search terms were “diabetes diet” and “diabetes treatment.” Videos were jointly assessed by two reviewers. A third investigator evaluated a random sample to check for agreement. Main measures: Usefulness defined as making reference to AAD7 Self-Care Behaviors™ and presence of misleading information. Results: Of the 393 videos included, 42.2 percent (n = 166) classified as “alternative medicine.” 40.2 percent (n = 158) contained useful information. 25.7 percent (n = 101) videos contained misleading information. Videos displaying “alternative medicine” professionals (60 out of 200) were less useful (17% vs 57%; p < 0.001) and more misleading (40% vs 2%; p < 0.001). Conclusion: The probability of finding videos that relate to AADE7™ self-care behaviors is below 50 percent. The odds of finding misleading information are high. Therefore, it is inadvisable for professionals to recommend the use of YouTube as an educating tool if specific videos are not suggested.
Multicomponent intervention combining a cognitive stimulation group and tai chi to reduce cognitive decline among community-dwelling older adults with probable dementia: A multi-center, randomized controlled trial
Authors: Young Daniel Kim-Wan 
Published: November 2018

Objective This research study aims to evaluate the effectiveness of a multicomponent intervention that combines a cognitive stimulation group and tai chi to reduce cognitive decline among community-dwelling Chinese older adults with probable dementia. Methods A multi-center, randomized controlled trial design was adopted in this study. In addition to treat as usual, the treatment group ( n = 41) participated in a structured cognitive stimulation group followed by tai chi twice a week, with a total of 14 sessions held during the study period. The control group ( n = 39) received treat as usual. Mattis Dementia Rating Scale and Mini-Mental State Examination were used for assessing the cognitive abilities of participants in the pre- and post-treatment periods. Results A 2 × 2 repeated measures analysis of covariance demonstrated that the treatment group was more effective than the control group on improving Dementia Rating Scale score ( F = 7.45, p < .01) with a moderate effect size (partial eta square = .09) and Mini-Mental State Examination score ( F = 9.96, p < .01) with a moderate to large effect size (partial eta square = .12) after controlling for age, gender, educational level, marital status, and number of physical illnesses. Conclusion The present study demonstrates the effectiveness of the multicomponent intervention on improving cognitive ability among community-dwelling older adults with probable dementia, suggesting that the multicomponent intervention can facilitate early identification, assessment, and treatment for community-dwelling older adults with probable dementia.
The effect of rapamycin treatment on cerebral ischemia: A systematic review and meta-analysis of animal model studies
Authors: Beard Daniel J , Hadley Gina , Thurley Neal , Howells David W , Sutherland Brad A , Buchan Alastair M 
Published: November 2018

Background Amplifying endogenous neuroprotective mechanisms is a promising avenue for stroke therapy. One target is mammalian target of rapamycin (mTOR), a serine/threonine kinase regulating cell proliferation, cell survival, protein synthesis, and autophagy. Animal studies investigating the effect of rapamycin on mTOR inhibition following cerebral ischemia have shown conflicting results. Aim To conduct a systematic review and meta-analysis evaluating the effectiveness of rapamycin in reducing infarct volume in animal models of ischemic stroke. Summary of review Our search identified 328 publications. Seventeen publications met inclusion criteria (52 comparisons: 30 reported infarct size and 22 reported neurobehavioral score). Study quality was modest (median 4 of 9) with no evidence of publication bias. The point estimate for the effect of rapamycin was a 21.6% (95% CI, 7.6%–35.7% p < 0.01) improvement in infarct volume and 30.5% (95% CI 17.2%–43.8%, p < 0.0001) improvement in neuroscores. Effect sizes were greatest in studies using lower doses of rapamycin. Conclusion Low-dose rapamycin treatment may be an effective therapeutic option for stroke. Modest study quality means there is a potential risk of bias. We recommend further high-quality preclinical studies on rapamycin in stroke before progressing to clinical trials.
Articular Cartilage Injuries of the Knee: Patient Health Literacy, Expectations for Management, and Clinical Outcomes
Authors: Cole Brian J. , Redondo Michael L. , Cotter Eric J. 
Published: November 2018

Objective The purpose of this article is to review the orthopedic literature regarding patient understanding of articular cartilage disease, interpret literature reporting patient expectations for surgical management of articular cartilage injuries of the knee, and review patient-reported outcomes and patient satisfaction with management of these injuries. Design A retrospective review of the current literature using the PubMed database (1980-current) was performed on July 15, 2017. The search terms used were “patient understanding knee cartilage,” “patient satisfaction knee cartilage,” “patient expectation knee cartilage,” and “patient reported outcomes knee cartilage.” All searches were filtered to human studies and English language only and were reviewed by 2 independent reviewers. Studies not relevant to articular cartilage injury and/or surgical management in the knee were excluded. Additional references were found by backtracing references from obtained articles. Results The published study search results for the terms: “patient understanding knee cartilage,” “patient satisfaction knee cartilage,” “patient expectation knee cartilage,” and “patient reported outcomes knee cartilage” displayed a total of 873 studies. Two independent reviewers screen all studies A total of 50 published studies were relevant and included. Conclusion The subjective and objective clinical outcomes reported are inconsistently obtained resulting in difficulty drawing comparisons between studies. While the relationship between preoperative patient expectations and patient-reported outcomes and patient satisfaction has yet to be well developed, authors have reported patient and injury specific variables associated with superior and inferior outcomes. In conclusion, more work is needed to correlate patient-reported outcomes and satisfaction for cartilage treatments with preoperative expectations and health literacy.
Possible Herpetic Viral Association in Cases of Acute Exudative Polymorphous Vitelliform Maculopathy
Authors: Zhang Wenlan , Sharma Sumit , Reichstein David A. , Fekrat Sharon 
Published: November 2018

Purpose: We describe 2 retinopathy cases with a possible herpetic association. Methods: Presentation, workup, and clinical course of 2 patients were reviewed and compiled. Results: Patients presented with no to mild symptoms and multiple bilateral funduscopic yellow hypopigmented lesions corresponding to outer retinal thickening with submacular fluid on optical coherence tomography. Findings mimicked central serous chorioretinopathy but lacked any leakage or pooling on angiography. Systemic workups were negative and our patients had anatomic resolution following a treatment course of oral valacyclovir. Conclusion: These cases suggest a possible viral herpes zoster prodrome in some patients who present with acute exudative polymorphous vitelliform maculopathy.
Bleb-Related Endophthalmitis: A 15-Year Review
Authors: Mukkamala Lekha K. , Xia Tian , Mady Rana , Athwal Lisa , Zarbin Marco A. , Bhagat Neelakshi 
Published: November 2018

Purpose: The purpose of this study is to describe the patient characteristics, management, and outcomes of bleb-related endophthalmitis (BRE). Methods: A retrospective chart review was conducted of patients who presented to a tertiary care facility from 2001 to 2016 with BRE. Collected data included demographics, medical and ocular history, visual acuity (VA), intraocular pressure (IOP), presence of hypopyon, treatment, microbiology, visual outcomes particularly of VA and IOP, and complications. Results: Thirty-six eyes (36 patients: 21 females, mean 66.8 years old, 78% with primary open-angle glaucoma) presented an average of 4.5 years (range, 2 days-33 years) after glaucoma surgery (30 trabeculectomies with mitomycin C, 6 tube shunts) with endophthalmitis. Mean VA and IOP at presentation were hand motion (HM; logMAR 2.1) and 19.9 mmHg, respectively, with 82% displaying hypopyon and 87% with purulent blebitis. Eighteen (50%) eyes (mean VA HM) underwent vitreous tap and injection (T/I) of intravitreal antibiotics (vancomycin 1 mg/0.1 cc and ceftazidime 2.25 mg/0.1 cc), and 18 (50%) eyes (mean VA HM) underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. Eight (45%) eyes initially treated with T/I required a subsequent PPV, and 5 (28%) eyes treated initially with PPV underwent a second PPV. All patients also received systemic antibiotics (33 intravenous [IV] and 3 oral) and topical medications. Average time to documented resolution was 15 days, with mean VA of HM and IOP of 13.6 mmHg. Thirty-one (86%) eyes had vision worse than 20/200 at resolution, and those presenting with light perception or no light perception (NLP) vision (n = 6) had worse vision final VA (logMAR 2.6) than those with initial vision of HM or better (final VA logMAR 1.7). Three (8.6%) eyes were enucleated, with 4 worsening to NLP during the course of the infection. Conclusions: BRE is a visually devastating infection requiring prompt diagnosis and management. Despite aggressive treatment with antibiotics, visual prognosis is poor.
Cloud algorithm-driven oximetry-based diagnosis of obstructive sleep apnoea in symptomatic habitually snoring children
Authors: Xu Zhifei , Gutiérrez-Tobal Gonzalo C. , Wu Yunxiao , Kheirandish-Gozal Leila , Ni Xin , Hornero Roberto , Gozal David 
Published: November 2018

The ability of a cloud-driven Bluetooth oximetry-based algorithm to diagnose obstructive sleep apnoea syndrome (OSAS) was examined in habitually snoring children concurrently undergoing overnight polysomnography.Children clinically referred for overnight in-laboratory polysomnographic evaluation for suspected OSAS were simultaneously hooked to a Bluetooth oximeter linked to a smartphone. Polysomnography findings were scored and the apnoea/hypopnoea index (AHIPSG) was tabulated, while oximetry data yielded an estimated AHIOXIusing a validated algorithm.The accuracy of the oximeter in identifying correctly patients with OSAS in general, or with mild (AHI 1–5 events·h−1), moderate (5–10 events·h−1) or severe (>10 events·h−1) OSAS was examined in 432 subjects (6.5±3.2 years), with 343 having AHIPSG>1 event·h−1. The accuracies of AHIOXIwere consistently >79% for all levels of OSAS severity, and specificity was particularly favourable for AHI >10 events·h−1(92.7%). Using the criterion of AHIPSG>1 event·h−1, only 4.7% of false-negative cases emerged, from which only 0.6% of cases showed moderate or severe OSAS.Overnight oximetry processedviaBluetooth technology by a cloud-based machine learning-derived algorithm can reliably diagnose OSAS in children with clinical symptoms suggestive of the disease. This approach provides virtually limitless scalability and should alleviate the substantial difficulties in accessing paediatric sleep laboratories while markedly reducing the costs of OSAS diagnosis.
Genomics of response to immune checkpoint therapies for cancer: implications for precision medicine
Authors: Conway Jake R. , Kofman Eric , Mo Shirley S. , Elmarakeby Haitham , Van Allen Eliezer 
Published: November 2018

AbstractImmune checkpoint blockade (ICB) therapies, which potentiate the body’s natural immune response against tumor cells, have shown immense promise in the treatment of various cancers. Currently, tumor mutational burden (TMB) and programmed death ligand 1 (PD-L1) expression are the primary biomarkers evaluated for clinical management of cancer patients across histologies. However, the wide range of responses has demonstrated that the specific molecular and genetic characteristics of each patient’s tumor and immune system must be considered to maximize treatment efficacy. Here, we review the various biological pathways and emerging biomarkers implicated in response to PD-(L)1 and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) therapies, including oncogenic signaling pathways, human leukocyte antigen (HLA) variability, mutation and neoantigen burden, microbiome composition, endogenous retroviruses (ERV), and deficiencies in chromatin remodeling and DNA damage repair (DDR) machinery. We also discuss several mechanisms that have been observed to confer resistance to ICB, such as loss of phosphatase and tensin homolog (PTEN), loss of major histocompatibility complex (MHC) I/II expression, and activation of the indoleamine 2,3-dioxygenase 1 (IDO1) and transforming growth factor beta (TGFβ) pathways. Clinical trials testing the combination of PD-(L)1 or CTLA-4 blockade with molecular mediators of these pathways are becoming more common and may hold promise for improving treatment efficacy and response. Ultimately, some of the genes and molecular mechanisms highlighted in this review may serve as novel biological targets or therapeutic vulnerabilities to improve clinical outcomes in patients.
A Comparison of Spinal Anesthesia Versus Monitored Anesthesia Care With Local Anesthesia in Minimally Invasive Fetal Surgery
Authors: Ferschl Marla B. , Feiner John , Vu Lan , Smith Devon , Rollins Mark D. 
Published: November 2018

BACKGROUND:
Minimally invasive fetal surgery is commonly performed to treat twin-to-twin transfusion syndrome with selective fetoscopic laser photocoagulation and twin-reversed arterial perfusion sequence using radiofrequency ablation. Although an increasing number of centers worldwide are performing these procedures, anesthetic management varies. Both neuraxial anesthesia and monitored anesthesia care with local anesthesia are used at different institutions. We sought to determine the efficacy and outcomes of these 2 anesthetic techniques for fetal procedures at our institution.

METHODS:
All patients undergoing minimally invasive fetal surgery for twin-to-twin transfusion syndrome or twin-reversed arterial perfusion sequence over a 6-year time period (2011–2016) were reviewed. Patients receiving monitored anesthesia care with local anesthesia were compared with those receiving spinal anesthesia in both selective fetoscopic laser photocoagulation and radiofrequency ablation fetal procedures. The primary outcome examined between the monitored anesthesia care and spinal anesthesia groups was the difference in conversion to general anesthesia using a noninferiority design with a noninferiority margin of 5%. Secondary outcome measures included use of vasopressors, procedure times, intraoperative fluids administered, maternal complications, and unexpected fetal demise within 24 hours of surgery.

RESULTS:
The difference in failure rate between monitored anesthesia care and spinal was −0.5% (95% CI, −4.8% to 3.7%). Patients receiving monitored anesthesia care plus local anesthesia were significantly less likely to need vasopressors, had a shorter presurgical operating room time, and received less fluid (P < .001). Operative time did not differ significantly.

CONCLUSIONS:
Monitored anesthesia care plus local anesthesia is a reliable and safe anesthetic choice for minimally invasive fetal surgery. Furthermore, it decreases maternal hemodynamic instability and reduces preincision operating room time.
Aerobic Exercise Improves Microvascular Function in Older Adults
Authors: HURLEY DAVID M. , WILLIAMS EWAN R. , CROSS JEFF M. , RIEDINGER BRADLEY R. , MEYER RONALD A. , ABELA GEORGE S. , SLADE JILL M. 
Published: November 2018

ABSTRACT
Microvascular function is reduced with age, disease, and inactivity. Exercise is well known to improve vascular health and has the potential to improve microvascular function in aging and disease.

Purpose
The study aimed to assess changes in peripheral microvascular function in sedentary older adults after aerobic exercise training.

Methods
Twenty-three sedentary older adults (67 ± 5 yr, body mass index = 29 ± 5, mean ± SD) successfully completed a randomized 12-wk graded treadmill walking intervention. The exercise group (EX) performed 40 min of uphill walking 4 d·wk−1 at 70% heart rate reserve. The control group (CON) maintained a sedentary lifestyle for 12 wk. Blood oxygen level–dependent (BOLD) responses of the soleus measured by magnetic resonance imaging were used to evaluate microvascular function; brief (1 s) maximal plantarflexion contractions were performed. Separately, blood flow in the popliteal artery was measured by ultrasound after brief contraction. Phosphorus magnetic resonance spectroscopy of the calf was used to examine muscle oxidative capacity, and whole-body peak oxygen consumption (V˙O2peak) was used to confirm training-induced cardiorespiratory adaptations.

Results
Peak postcontraction BOLD response increased by 33% in EX (PRE, 3.3% ± 1.0%; POST, 4.4% ± 1.4%) compared with CON (PRE, 3.0% ± 1.3%; POST, 3.2% ± 1.5%), P < 0.05. EX with hypertension tended to show a blunted peak BOLD increase (n = 6, 15%) compared with EX normotensive (n = 7, 50%), P = 0.056. Peak postcontraction blood flow increased by 39% in EX (PRE, 217 ± 88 mL·min−1; POST, 302 ± 167 mL·min−1) compared with CON (PRE, 188 ± 54 mL·min−1; POST, 184 ± 44 mL·min−1), P < 0.05. EX muscle oxidative capacity (k
PCr) improved by 40% (PRE, 1.60 ± 0.57 min−1; POST, 2.25 ± 0.80 min−1) compared with CON (PRE, 1.69 ± 0.28 min−1; POST, 1.76 ± 0.52 min−1), P < 0.05. V˙O2peak increased by 9% for EX (PRE, 19.0 ± 3.1 mL·kg−1·min−1; POST, 20.8 ± 2.9 mL·kg−1·min−1) compared with a 7% loss in CON (PRE, 21.9 ± 3.6 mL·kg−1·min−1; POST, 20.4 ± 3.5 mL·kg−1·min−1), P < 0.05.

Conclusion
Moderate aerobic exercise significantly improved microvascular function of the leg in older adults.
El legado del constituyente de querétaro: avances y agenda
Authors: Raigosa Luis 
Published: November 2018

Este ensayo aborda el análisis de la evolución del constitucionalismo mexicano al cumplirse cien años de vigencia de la Constitución Mexicana, que fue emitida en la Ciudad de Querétaro el 5 de febrero de 1917. El ensayo sostiene que la longevidad de esta Constitución se debe a la intensa actividad de los órganos legislativos mexicanos que ejercen la función de reforma constitucional, lo que ha aportado una gran plasticidad al texto escrito, favoreciendo la adaptación entre la norma fundamental y la evolución de la sociedad mexicana. Al mismo tiempo, el desarrollo del constitucionalismo mexicano, que históricamente había privilegiado la mirada política propia de los mencionados órganos legislativos, ha arribado a un reforzamiento del entendimiento jurídico de la Constitución. Esto conduce a admitir –en un nuevo entendimiento del constitucionalismo mexicano- la coexistencia entre el tradicional entendimiento político, que actúa a través de adaptaciones formales al texto constitucional, junto a una creciente presencia de los órganos judiciales que imprimen un sello claramente jurídico a la constitución mexicana, creando con ello un entorno de diálogos constitucionales entre las funciones de reforma constitucional y el control de la regularidad constitucional.
Barriers to Early Hospital Discharge: A Cross‐Sectional Study at Five Academic Hospitals
Authors: Zoucha Jeff , Hull Madelyne , Keniston Angela , Mastalerz Katarzyna , Quinn Roswell , Tsai Arnold , Berman Jacob , Lyden Jennifer , Stella Sarah A. , Echaniz Marisa , Scaletta Nicholas , Handoyo Karina , Hernandez Estebes , Saini Inderpreet , Smith Aneesah , Young Andrew , Walsh Meghaan , Zaros Mark , Albert Richard K. , Burden Marisha 
Published: November 2018

BACKGROUNDUnderstanding the issues delaying hospital discharges may inform efforts to improve hospital throughput.OBJECTIVEThis study was conducted to identify and determine the frequency of barriers contributing to delays in placing discharge orders.DESIGNThis was a prospective, cross‐sectional study. Physicians were surveyed at approximately 8:00 AM, 12:00 PM, and 3:00 PM and were asked to identify patients that were “definite” or “possible” discharges and to describe the specific barriers to writing discharge orders.SETTINGThis study was conducted at five hospitals in the United States.PARTICIPANTSThe study participants were attending and housestaff physicians on general medicine services.PRIMARY OUTCOMES AND MEASURESSpecific barriers to writing discharge orders were the primary outcomes; the secondary outcomes included discharge order time for high versus low team census, teaching versus nonteaching services, and rounding style.RESULTSAmong 1,584 patient evaluations, the most common delays for patients identified as “definite” discharges (n = 949) were related to caring for other patients on the team or waiting to staff patients with attendings. The most common barriers for patients identified as “possible” discharges (n = 1,237) were awaiting patient improvement and for ancillary services to complete care. Discharge orders were written a median of 43‐58 minutes earlier for patients on teams with a smaller versus larger census, on nonteaching versus teaching services, and when rounding on patients likely to be discharged first (all P < .003).CONCLUSIONSDischarge orders for patients ready for discharge are most commonly delayed because physicians are caring for other patients. Discharges of patients awaiting care completion are most commonly delayed because of imbalances between availability and demand for ancillary services. Team census, rounding style, and teaching teams affect discharge times.