bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Dual Antiplatelet Therapy Affect Blood Loss and Transfusion Requirements in Robotic-Assisted Coronary Artery Surgery?
Authors: Hemli Jonathan M. , Darla Lincoln S. , Panetta Christopher R. , Jennings Joan , Subramanian Valavanur A. , Patel Nirav C. 
Published: January 2019

Objective Patients who present for coronary surgery often receive preoperative dual antiplatelet therapy with aspirin and a thienopyridine derivative (clopidogrel or prasugrel), especially after a recent acute coronary syndrome. Studies have shown that patients on aspirin and clopidogrel are at increased risk for perioperative bleeding and related events. We sought to examine the impact of dual antiplatelet therapy on bleeding and transfusion requirements in patients undergoing robotic-assisted minimally invasive coronary artery bypass grafting. Methods From January 2010 to November 2011, a total of 110 patients underwent robotic-assisted off-pump coronary surgery at our institution. All patients underwent robotic-assisted harvest of the left internal mammary artery from the chest wall. Some patients then underwent direct coronary anastomosis to the left anterior descending coronary artery via a left minithoracotomy, whereas others had a complete robotic endoscopic procedure within the closed chest. The patients were divided into two groups for outcome analysis on the basis of preoperative antiplatelet therapy: group 1 (either aspirin alone or no antiplatelet agents at all; n = 53) and group 2 (aspirin plus clopidogrel or prasugrel; n = 57). Results Perioperative chest tube drainage was not significantly different between the patient groups, irrespective of the preoperative antiplatelet agents used. Transfusion requirements and other morbidities were also similar in both groups of patients. Conclusions Preoperative dual antiplatelet therapy does not result in significantly increased bleeding or perioperative transfusion requirements. If clinically indicated, it is reasonable to continue preoperative combination antiplatelet therapy in patients undergoing robotic-assisted coronary surgery.
Left Atrial Roof: An Alternative Minimal Approach for Mitral Valve Surgery
Authors: Esposito Giampiero , Cappabianca Giangiuseppe , Bichi Samuele , Patrini Davide , Pellegrino Pasquale 
Published: January 2019

Objective The most common surgical incisions to expose the mitral valve include a paraseptal left atriotomy or a transeptal biatrial approach. Both techniques are normally performed through a full sternotomy and bicaval cannulation. We report our experience with an alternative incision to expose the mitral valve using the left atrial roof (LAR) through a complete sternotomy or a J-shaped upper ministernotomy. Methods Between 2007 and 2011, a total of 512 patients underwent mitral procedures using the LAR approach. A J-shaped ministernotomy was performed in 189 patients, and 61 of these had concomitant aortic valve/root procedures. A standard sternotomy was performed in 323 patients, and 126 of these had concomitant aortic valve/root procedures. The repair rate in patients with mitral regurgitation was 398 of 460 (86.5%). Results In-hospital mortality was 2.3%. An adjunctive pericardial patch to repair the LAR was necessary in 1.9% of patients. A permanent pacemaker was necessary in 3.1% of patients. Four-year survival rate was 91% ± 4.2%. In patients who underwent mitral repair, 4-year freedom from mitral regurgitation greater than 2 was 97.4%. Conclusions The LAR approach is a safe and effective option to perform mitral valve surgery. The limited extension of this incision and the possibility to use a single venous cannula make this approach suitable for minimally invasive isolated mitral valve procedures, whereas the proximity of the LAR to the aortic root makes this approach particularly attractive for combined mitroaortic procedures through a ministernotomy.
Safety of Single-Dose Histidine-Tryptophan-Ketoglutarate Cardioplegia during Minimally Invasive Mitral Valve Surgery
Authors: Savini Carlo , Murana Giacomo , Di Eusanio Marco , Suarez Sofia Martin , Jafrancesco Giuliano , Castrovinci Sebastiano , Castelli Andrea , Di Bartolomeo Roberto 
Published: January 2019

Objective Minimally invasive mitral valve surgery may require a prolonged period of myocardial ischemia. Cardioplegic solutions that necessitate a single dose for adequate myocardial protection are evoked to simplify surgery and result to be appealing in this setting. The aim of this study was to assess early outcomes after minimally invasive mitral valve surgery using one single dose of histidine-tryptophanketoglutarate solution (HTK; Custodiol) for myocardial protection. Methods Between February 2003 and October 2012, a total of 49 consecutive patients underwent minimally invasive mitral valve surgery using a single dose of HTK solution for myocardial protection. The patients’ mean (SD) age was 57 (14) years; the preoperative ejection fraction was normal in all cases. The mean (SD) CPB time and aortic cross-clamp time were 148 (45) minutes and 97 (45) minutes, respectively. Results The heart spontaneously restarted after cross-clamp removal in 37 patients (75.5%). Five patients (10.2%) required prolonged inotropic drug support. Postoperatively, no significant increase in myocardial cytonecrosis enzymes was found [mean (SD) creatine kinase isoenzyme MB, 77.14 (53.67) μg/L at 3 hours, 71.2 (55.67) μg/L at 12 hours, and 42.53 (38.38) μg/L at 24 hours)], and no ischemic electrocardiogram modifications were observed before discharge. Conclusions During minimally invasive mitral valve surgery, HTK solution provided excellent myocardial protection even after prolonged periods of cardioplegic arrest. The avoidance of repetitive infusions may reduce the risk for coronary malperfusion due to dislodgement of the endoaortic clamp (if used) and increase the surgeon's comfort during the procedure.
Minimally Invasive Coronary Artery Bypass Grafting is Associated with Improved Clinical Outcomes
Authors: Rabindranauth Prem , Burns Jacob G. , Vessey Todd T. , Mathiason Michelle A. , Kallies Kara J. , Paramesh Venki 
Published: January 2019

Objective Minimally invasive coronary artery bypass grafting (MICS CABG) via left minithoracotomy is an alternative to off-pump coronary artery bypass (OPCAB) via sternotomy. Our objective was to evaluate the clinical outcomes after MICS CABG versus OPCAB. Methods The medical records of patients who underwent MICS CABG from December 2009 to December 2011 and OPCAB from January 2005 to April 2011 were reviewed. Patients who underwent OPCAB were matched 2:1 to patients who underwent MICS CABG by age, sex, preoperative ejection fraction, creatinine concentration, as well as history of diabetes and myocardial infarction. Results A total of 130 MICS CABG patients were matched with 260 OPCAB patients. Mean bypasses in the MICS CABG and OPCAB groups were 2.1 and 3.2, respectively ( P = 0.001). Extubation in the operating room (OR) occurred in 70.0% and 12.7% of patients in the MICS CABG and OPCAB groups, respectively ( P = 0.001). Mean postoperative length of stay was 4 days for the MICS CABG patients versus 5 days for the OPCAB patients ( P = 0.002) and 3.8 days versus 4.6 days for the MICS CABG patients extubated in the OR compared with those who remained intubated ( P = 0.007). There were no 30-day mortalities in the MICS CABG group and 1 in the OPCAB group (P= 0.999). Thirty-day readmissions were similar, with 5.4% and 7.4% in the MICS CABG and OPCAB groups, respectively ( P = 0.527). Conclusions Minimally invasive coronary artery bypass grafting is safe, and early clinical outcomes are comparable, if not superior in some respects, to OPCAB. Extubation in the OR is feasible, well tolerated, and associated with earlier discharge. Shorter hospital stays may decrease resource use and promote earlier return to activities; however, further research is needed.
Reducing errors in the administration of medication with infusion pumps in the intensive care department: A lean approach
Authors: van der Sluijs Alexander F , van Slobbe-Bijlsma Eline R , Goossens Astrid , Vlaar Alexander PJ , Dongelmans Dave A 
Published: January 2019

Background: Medication errors occur frequently and may potentially harm patients. Administering medication with infusion pumps carries specific risks, which lead to incidents that affect patient safety. Objective: Since previous attempts to reduce medication errors with infusion pumps failed in our intensive care unit, we chose the Lean approach to accomplish a 50% reduction of administration errors in 6 months. Besides improving quality of care and patient safety, we wanted to determine the effectiveness of Lean in healthcare. Methods: We conducted a before-and-after observational study. After baseline measurement, a value stream map (a detailed process description, used in Lean) was made to identify important underlying causes of medication errors. These causes were discussed with intensive care unit staff during frequent stand-up sessions, resulting in small improvement cycles and bottom-up defined improvement measures. Pre-intervention and post-intervention measurements were performed to determine the impact of the improvement measures. Infusion pump syringes and related administration errors were measured during unannounced sequential audits. Results: Including the baseline measurement, 1748 syringes were examined. The percentage of errors concerning the administration of medication by infusion pumps decreased from 17.7% (95% confidence interval, 13.7–22.4; 55 errors in 310 syringes) to 2.3% (95% confidence interval, 1–4.6; 7 errors in 307 syringes) in 18 months (p < 0.0001). Conclusion and Relevance: The Lean approach proved to be helpful in reducing errors in the administration of medication with infusion pumps in a high complex intensive care environment.
Grounded theory research: A design framework for novice researchers
Authors: Chun Tie Ylona , Birks Melanie , Francis Karen 
Published: January 2019

Background: Grounded theory is a well-known methodology employed in many research studies. Qualitative and quantitative data generation techniques can be used in a grounded theory study. Grounded theory sets out to discover or construct theory from data, systematically obtained and analysed using comparative analysis. While grounded theory is inherently flexible, it is a complex methodology. Thus, novice researchers strive to understand the discourse and the practical application of grounded theory concepts and processes. Objective: The aim of this article is to provide a contemporary research framework suitable to inform a grounded theory study. Result: This article provides an overview of grounded theory illustrated through a graphic representation of the processes and methods employed in conducting research using this methodology. The framework is presented as a diagrammatic representation of a research design and acts as a visual guide for the novice grounded theory researcher. Discussion: As grounded theory is not a linear process, the framework illustrates the interplay between the essential grounded theory methods and iterative and comparative actions involved. Each of the essential methods and processes that underpin grounded theory are defined in this article. Conclusion: Rather than an engagement in philosophical discussion or a debate of the different genres that can be used in grounded theory, this article illustrates how a framework for a research study design can be used to guide and inform the novice nurse researcher undertaking a study using grounded theory. Research findings and recommendations can contribute to policy or knowledge development, service provision and can reform thinking to initiate change in the substantive area of inquiry.
Identification of recurrent noncoding mutations in B-cell lymphoma using capture Hi-C
Authors: Cornish Alex J. , Hoang Phuc H. , Dobbins Sara E. , Law Philip J. , Chubb Daniel , Orlando Giulia , Houlston Richard S. 
Published: January 2019

AbstractThe identification of driver mutations is fundamental to understanding oncogenesis. Although genes frequently mutated in B-cell lymphoma have been identified, the search for driver mutations has largely focused on the coding genome. Here we report an analysis of the noncoding genome using whole-genome sequencing data from 117 patients with B-cell lymphoma. Using promoter capture Hi-C data in naive B cells, we define cis-regulatory elements, which represent an enriched subset of the noncoding genome in which to search for driver mutations. Regulatory regions were identified whose mutation significantly alters gene expression, including copy number variation at cis-regulatory elements targeting CD69, IGLL5, and MMP14, and single nucleotide variants in a cis-regulatory element for TPRG1. We also show the commonality of pathways targeted by coding and noncoding mutations, exemplified by MMP14, which regulates Notch signaling, a pathway important in lymphomagenesis and whose expression is associated with patient survival. This study provides an enhanced understanding of lymphomagenesis and describes the advantages of using chromosome conformation capture to decipher noncoding mutations relevant to cancer biology.
Novel sulphamoylated 2-methoxy estradiol derivatives inhibit breast cancer migration by disrupting microtubule turnover and organization
Authors: van Vuuren Rustelle Janse , Botes Mandie , Jurgens Tamarin , Joubert Anna Margaretha , van den Bout Iman 
Published: January 2019

Abstract
Background
The estrogen metabolite 2-methoxyestradiol (2ME2) and a number of synthesised derivatives have been shown to bind to microtubules thereby arresting cancer cells in mitosis which leads to apoptosis. In interphase cells, microtubules play an important role in the delivery of proteins to subcellular locations including the focal adhesions. In fact, focal adhesion dynamics and cell migration are in part regulated by microtubules. We hypothesised that novel 2ME2 derivatives can alter cell migration by influencing microtubule dynamics in interphase cells. In this report we describe 2ME2 derivatives that display anti-migratory capabilities in a metastatic breast cancer cell line through their effects on the microtubule network resulting in altered focal adhesion signalling and RhoA activity.

Methods
Cell migration was assayed using wound healing assays. To eliminate mitosis blockage and cell rounding as a confounding factor cell migration was also assessed in interphase blocked cells. Fluorescence confocal microscopy was used to visualise microtubule dynamics and actin cytoskeleton organisation while western blot analysis was performed to analyse focal adhesion signalling and RhoA activation.

Results
2ME2 derivatives, ESE-one and ESE-15-one, inhibited cell migration in cycling cells as expected but equally diminished migration in cells blocked in interphase. While no significant effects were observed on the actin cytoskeleton, focal adhesion kinase activity was increased while RhoA GTPase activity was inhibited after exposure to either compound. Microtubule stability was increased as evidenced by the increased length and number of detyrosinated microtubules while at the same time clear disorganisation of the normal radial microtubule organisation was observed including multiple foci.

Conclusions
ESE-15-one and ESE-one are potent migration inhibitors of metastatic breast cancer cells. This ability is coupled to alterations in focal adhesion signalling but more importantly is associated with severe disorganisation of microtubule dynamics and polarity. Therefore, these compounds may offer potential as anti-metastatic therapies.
Mobility related physical and functional losses due to aging and disease - a motivation for lower limb exoskeletons
Authors: Grimmer Martin , Riener Robert , Walsh Conor James , Seyfarth André 
Published: January 2019

AbstractBackgroundPhysical and functional losses due to aging and diseases decrease human mobility, independence, and quality of life. This study is aimed at summarizing and quantifying these losses in order to motivate solutions to overcome them with a special focus on the possibilities by using lower limb exoskeletons.MethodsA narrative literature review was performed to determine a broad range of mobility-related physical and functional measures that are affected by aging and selected cardiovascular, respiratory, musculoskeletal, and neurological diseases.ResultsThe study identified that decreases in limb maximum muscle force and power (33% and 49%, respectively, 25–75 yrs) and in maximum oxygen consumption (40%, 20–80 yrs) occur for older adults compared to young adults. Reaction times more than double (18–90 yrs) and losses in the visual, vestibular, and somatosensory systems were reported. Additionally, we found decreases in steps per day (75%, 60–85 yrs), maximum walking speed (24% 25–75 yrs), and maximum six-minute and self-selected walking speed (38% and 21%, respectively, 20–85 yrs), while we found increases in the number of falls relative to the number of steps per day (800%), injuries due to falls (472%, 30–90 yrs) and deaths caused by fall (4000%, 65–90 yrs). Measures were identified to be worse for individuals with impaired mobility. Additional detrimental effects identified for them were the loss of upright standing and locomotion, freezing in movement, joint stress, pain, and changes in gait patterns.DiscussionThis review shows that aging and chronic conditions result in wide-ranging losses in physical and sensory capabilities. While the impact of these losses are relatively modest for level walking, they become limiting during more demanding tasks such as walking on inclined ground, climbing stairs, or walking over longer periods, and especially when coupled with a debilitating disease. As the physical and functional parameters are closely related, we believe that lost functional capabilities can be indirectly improved by training of the physical capabilities. However, assistive devices can supplement the lost functional capabilities directly by compensating for losses with propulsion, weight support, and balance support.ConclusionsExoskeletons are a new generation of assistive devices that have the potential to provide both, training capabilities and functional compensation, to enhance human mobility.
The prognostic and therapeutic implications of circulating tumor cell phenotype detection based on epithelial–mesenchymal transition markers in the first‐line chemotherapy of HER2‐negative metastatic breast cancer
Authors: Guan Xiuwen , Ma Fei , Li Chunxiao , Wu Shiyang , Hu Shangying , Huang Jiefen , Sun Xiaoying , Wang Jiayu , Luo Yang , Cai Ruigang , Fan Ying , Li Qiao , Chen Shanshan , Zhang Pin , Li Qing , Xu Binghe 
Published: January 2019

AbstractBackgroundEpithelial–mesenchymal transition (EMT) is implicated in the metastatic process and presents a challenge to epithelial cell adhesion molecule‐based detection of circulating tumor cells (CTCs), which have been demonstrated to be a prognostic indicator in metastatic breast cancer. Although evidence has indicated that heterogeneity of CTCs based on EMT markers is associated with disease progression, no standard recommendations have been established for clinical practice. This study aimed to evaluate the prognostic significance of dynamic CTC detection based on EMT for metastatic breast cancer patients.MethodsWe enrolled 108 human epidermal growth factor receptor 2‐negative metastatic breast cancer patients from the prospective phase III CAMELLIA study and applied the CanPatrol CTC enrichment technique to identify CTC phenotypes (including epithelial CTCs, biphenotypic epithelial/mesenchymal CTCs, and mesenchymal CTCs) in peripheral blood samples. Receiver operating characteristic curve analyses of total CTC count and the proportion of mesenchymal CTCs for predicting the 1‐year progression‐free survival (PFS) rate were conducted to determine the optimal cut‐off values, and Kaplan–Meier analysis and Cox proportional hazards regression analysis were performed to investigate the prognostic value of the cut‐off values of both total CTC count and the proportion of mesenchymal CTCs in combination.ResultsFor predicting the 1‐year PFS rate, the optimal cut‐off value of total CTC count was 9.5 (Area under the curve [AUC] = 0.538, 95% confidence interval [CI] = 0.418–0.657), and that of the proportion of mesenchymal CTCs was 10.7% (AUC = 0.581, 95% CI = 0.463–0.699). We used the two cut‐off values in combination to forecast PFS in which the total CTC count was equaled to or exceeded 10/5 mL with the proportion of mesenchymal CTCs surpassed 10.7%. Patients who met the combined criteria had significantly shorter median PFS than did those who did not meet the criteria (6.2 vs. 9.9 months, P=0.010). A nomogram was constructed based on the criteria and significant clinicopathological characteristics with a C‐index of 0.613 (P= 0.010).ConclusionsThe criteria, which combine the total CTC count and the proportion of mesenchymal CTCs, may be used to monitor therapeutic resistance and predict prognosis in patients with metastatic breast cancer.Trial registrationClinicalTrials.gov. NCT01917279. Registered on 19 July 2013, https://clinicaltrials.gov/ct2/show/NCT01917279?term=NCT01917279&rank=1.
Landscapes of Refuge and Resiliency: Native Californian Persistence at Tomales Bay, California, 1770s–1870s
Authors: Schneider Tsim D. , Panich Lee M. 
Published: January 2019

AbstractResearch on Native American interactions with colonial institutions increasingly stresses the persistence of indigenous places and identities despite the challenges wrought by missionary, mercantile, and settler colonialism. This article expands on the theme of persistence through a case study investigating the various ways indigenous people, including Coast Miwok and Southern Pomo individuals, worked against and within colonial systems to maintain residency and autonomy in their ancestral homelands in central California. Focusing on the Tomales Bay area in what is now western Marin County as a refuge, the article examines the ethnohistorical evidence for long-term histories of indigenous persistence and strategic engagement with colonial peoples and processes.
The Point of View of a Stone: Looking at the Colonization of the Northern Plains from the Standing Rock
Authors: Grillot Thomas 
Published: January 2019

Abstract
The Standing Rock of North Dakota is not merely the namesake for an agency and a Sioux tribe. Its monumentalization as well as the publication of the legend associated with it point to the web of interactions between Indians (Lakotas, Dakotas, and Arikaras) and non-Indians that made possible the transition from war to peace, pre-reservation and reservation life after the 1870s. They are a rare opportunity to grasp the quiet work that went into preparing Native traditions for life under colonialism and reveal the complexity of the colonial encounter in North America.