bluuebunny/crossref_metadata_2025_split huggingface dataset:
Information theory to tachycardia therapy: electrogram entropy predicts diastolic microstructure of reentrant ventricular tachycardia
Authors: Nayyar Sachin , Downar Eugene , Beheshti Mohammadali , Liang Timothy , Massé Stéphane , Magtibay Karl , Bhaskaran Abhishek , Saeed Yawer , Vigmond Edward , Nanthakumar Kumaraswamy 
Published: October 2018

There is no known strategy to differentiate which multicomponent electrograms in sinus rhythm maintain reentrant ventricular tachycardia (VT). Low entropy in the voltage breakdown of a multicomponent electrogram can localize conditions suitable for reentry but has not been validated against the classic VT activation mapping. We examined whether low entropy in a late and diversely activated ventricular scar region characterizes and differentiates the diastolic path of VT and represents protected tissue channels devoid of side branches. Intraoperative bipolar electrogram (BiEGM) activation and entropy maps were obtained during sinus rhythm in 17 patients with ischemic cardiomyopathy and compared with diastolic activation paths of VT (total of 39 VTs). Mathematical modeling of a zigzag main channel with side branches was also used to further validate structural representation of low entropy in the ventricular scar. A median of one region per patient (range: 1–2 regions) was identified in sinus rhythm, in which BiEGMwith the latest mean activation time and adjacent minimum entropy were assembled together in a high-activation dispersion region. These regions accurately recognized diastolic paths of 34 VTs, often to multiple inducible VTs within a single individual arrhythmogenic region. In mathematical modeling, side branching from the main channel had a strong influence on the BiEGMcomposition along the main channel. The BiEGMobtained from a long unbranched channel had the lowest entropy compared with those with multiple side branches. In conclusion, among a population of multicomponent sinus electrograms, those that demonstrate low entropy and are delayed colocalize to critical long-protected channels of VT. This information is pertinent for planning VT ablation in sinus rhythm.NEW & NOTEWORTHY Entropy is a measure to quantify breakdown in information. Electrograms from a protected tissue channel can only possess a few states in their voltage and thus less information. In contrast, current-load interactions from side branches in unprotected channels introduce a number of dissimilar voltage deflections and thus high information. We compare here a mapping approach based on entropy against a rigorous reference standard of activation mapping during VT and entropy was assessed in sinus rhythm.
Summer Cooling Driven by Large Volcanic Eruptions over the Tibetan Plateau
Authors: Duan Jianping , Li Lun , Ma Zhuguo , Esper Jan , Büntgen Ulf , Xoplaki Elena , Zhang Dujuan , Wang Lily , Yin Hong , Luterbacher Jürg 
Published: October 2018

AbstractLarge volcanic eruptions may cause abrupt summer cooling over large parts of the globe. However, no comparable imprint has been found on the Tibetan Plateau (TP). Here, we introduce a 400-yr-long temperature-sensitive network of 17 tree-ring maximum latewood density sites from the TP that demonstrates that the effects of tropical eruptions on the TP are generally greater than those of extratropical eruptions. Moreover, we found that large tropical eruptions accompanied by subsequent El Niño events caused less summer cooling than those that occurred without El Niño association. Superposed epoch analysis (SEA) based on 27 events, including 14 tropical eruptions and 13 extratropical eruptions, shows that the summer cooling driven by extratropical eruptions is insignificant on the TP, while significant summer temperature decreases occur subsequent to tropical eruptions. Further analysis of the TP August–September temperature responses reveals a significant postvolcanic cooling only when no El Niño event occurred. However, there is no such cooling for all other situations, that is, tropical eruptions together with a subsequent El Niño event, as well as extratropical eruptions regardless of the occurrence of an El Niño event. The averaged August–September temperature deviation (Tdev) following 10 large tropical eruptions without a subsequent El Niño event is up to −0.48° ± 0.19°C (with respect to the preceding 5-yr mean), whereas the temperature deviation following 4 large tropical eruptions with an El Niño association is approximately 0.23° ± 0.16°C. These results indicate a mitigation effect of El Niño events on the TP temperature response to large tropical eruptions. The possible mechanism is that El Niño events can weaken the Indian summer monsoon with a subsequent decrease in rainfall and cooling effect, which may lead to a relatively high temperature on the TP, one of the regions affected by the Indian summer monsoon.
Distribution and motor ability of children with cerebral palsy in Scotland: a registry analysis
Authors: Bugler Kate E , Gaston Mark S , Robb James E 
Published: October 2018

Background and aims Cerebral palsy is the commonest long-term physical disability in children with a prevalence of between 1.77 and 2.11/1000 live births. In 2013, the Cerebral Palsy Integrated Pathway Scotland (CPIPS) surveillance programme was introduced in all 14 Health Boards in Scotland and provides a standardised musculoskeletal examination of the spine and lower limbs. The purpose of this study was to report the prevalence, subtypes, motor classification and motor ability of children with cerebral palsy in Scotland. Methods and results The family/carer’s postal address, the child’s neurological classification, motor subtypes, Gross Motor Functional Classification (GMFCS) Level and Functional Mobility Scale of 1972 children at first registration in CPIPS 2013–2018 were analysed. Their mean age at first assessment was 7.6 years. There was an overall prevalence of cerebral palsy in Scotland of 2.02/1000. GMFCS levels and Functional Mobility Scale data and prevalence were reported by Health Board and were comparable to that reported elsewhere. Conclusion For the first time, data are available on the motor abilities of the total population of children with cerebral palsy in Scotland. This information will be highly relevant to resource management of current and future motor needs of these children.
Anesthesiologist and Emergency Medicine Physician Attitudes and Knowledge Regarding Etomidate for Intubation
Authors: Clinkard David , Priestap Fran , Ridi Stacy , Bruder Eric , Ball Ian M. 
Published: October 2018

Purpose: The use of etomidate as an induction agent for critically ill patients is controversial. While its favorable hemodynamic profile is enviable, etomidate has been shown to cause transient adrenal suppression. The clinical consequences of transient adrenal suppression are poorly understood. Anecdotally, some clinicians advocate strongly for etomidate, while others feel it can cause significant harm. To better understand the current clinical environment with respect to single-dose etomidate use in critically ill patients, Canadian anesthesiologists and Canadian emergency medicine (EM) physicians were questioned regarding their opinions, knowledge, and preferences about etomidate use as an induction agent. Methods: Invitations to participate with the electronic survey were sent to 100 Canadian EM physicians and 260 Canadian anesthesiologists. The survey had 4 general parts: demographics, familiarity with the current literature, choice of induction agent given various clinical scenarios, and opinions on the controversy. The Pearson γ2 test was used to detect whether significant differences exist between physician groups. Results: Ninety three anesthesiologists and 42 EM physicians responded for response rates of 36% and 42%. There were no self-reported differences in knowledge about etomidate properties between EM physicians and anesthesiologists. There were significant differences in etomidate use between EM physicians and anesthesiologists in general rapid sequence intubation, noncritically ill patients, and those with undifferentiated hypotension. Both EM physicians and anesthesiologists describe the current etomidate controversy as significant and not adequately resolved. Conclusion: There is no significant difference in self-reported etomidate knowledge between anesthesiologists and EM physicians; however, significant practice pattern differences exist with EM physicians using etomidate more often. Broad agreement supports future research to investigate etomidate’s impact in critically ill patients.
Skin signs in juvenile- and adult-onset systemic lupus erythematosus: clues to different systemic involvement
Authors: Chottawornsak N , Rodsaward P , Suwannachote S , Rachayon M , Rattananupong T , Deekajorndech T , Asawanonda P , Chiewchengchol D , Rerknimitr P 
Published: October 2018

Objective We aim to explore the differences of skin signs between juvenile- and adult-onset systemic lupus erythematosus and to identify their associations to the development of systemic involvement. Methods A retrospective chart review of 377 systemic lupus erythematosus patients was performed. Results In total, 171 patients with juvenile systemic lupus erythematosus and 206 with adult systemic lupus erythematosus were studied. All patients were of Southeast Asian descent. The mean duration of follow up was 8.18 ± 6.19 and 9.36 ± 7.68 years for juvenile systemic lupus erythematosus and adult systemic lupus erythematosus, respectively. At diagnosis, most patients presented with acute cutaneous lupus erythematosus, whereas chronic cutaneous lupus erythematosus was twice as common in adult systemic lupus erythematosus ( p < 0.001). The mean Systemic Lupus Erythematosus Disease Activity Index of juvenile systemic lupus erythematosus was significantly higher than that of adult systemic lupus erythematosus (14.29 ± 7.13 vs 11.27 ± 6.53). Multivariate analysis revealed the following associations in juvenile systemic lupus erythematosus: acute cutaneous lupus erythematosus and non-scarring alopecia with increased risk of arthralgia, mucosal ulcers with leukopenia, cutaneous vasculitis with seizure, and finding of granular casts. On the contrary, the associations for adult systemic lupus erythematosus were oral ulcers with arthralgia and cutaneous vasculitis with myositis. Conclusions Cutaneous signs in systemic lupus erythematosus may signal prognostic implication. Interestingly, despite similar cutaneous lesions in systemic lupus erythematosus, different ages of onset are associated with different systemic involvement.
Gender-specific cut-offs in colorectal cancer screening with FIT: Increased compliance and equal positivity rate
Authors: Blom Johannes , Löwbeer Christian , Elfström K. Miriam , Sventelius Marika , Öhman Daniel , Saraste Deborah , Törnberg Sven 
Published: October 2018

Objective Using quantitative Faecal Immunochemical Test (FIT) in colorectal cancer screening enables adjustment of the cut-off for a positive test. As men have higher stool blood levels and higher prevalence of colorectal neoplasia, different cut-off levels can be chosen for men and women. We evaluated participation and positivity rates switching from guaiac-based faecal occult blood test (gFOBT) (Hemoccult®) to FIT (OC-Sensor), using gender-specific cut-offs. Methods The colorectal cancer screening programme of Stockholm-Gotland, Sweden, started in 2008 and invited individuals aged 60–69 to biennial testing using gFOBT. From 1 October 2015 the test was switched to FIT, with positivity cut-offs of 40 (200) and 80 (400) µg Hb/g (ng/mL) faeces for women and men, respectively. The first year was evaluated for compliance and positivity, number of reminders and incorrect/inadequate tests, compared with gFOBT in the preceding 12-month period. Results There were 127,030 and 87,269 individuals invited to screening with gFOBT and FIT, respectively. The change of test increased overall participation by 11.9% (95% confidence interval 11.5%–12.3%) from 56.5% to 68.4% ( p < 0.001). The increase was larger in men (14.3%) than women (9.7%), and in those aged 60–64 (14.2%) than those aged 65–69 (8.7%). The positivity rate was 2.6% in women and 2.5% in men. There was a lower rate of reminders and incorrect/inadequate tests with FIT. Conclusions Within a well-organised colorectal cancer screening programme, changing the test from gFOBT to FIT markedly increased participation, especially among men, and in the younger age group. With a lower cut-off in women than men, the positivity rate was similar.
A Retrospective Chart Review of Transfusion Practices in the Palliative Care Unit Setting
Authors: Sirianni Giovanna , Perri Giulia , Callum Jeannie , Gardner Sandra , Berall Anna , Selby Debbie 
Published: October 2018

Background: There remains limited data in the literature on the frequency, clinical utility and effectiveness of transfusions in palliative care, with no randomized controlled trials or clinical practice guidelines on this topic. There are no routinely accepted practices in place for the appropriate transfusion of blood products in this setting. Aim: The aim of this study was to retrospectively review all transfusions in the palliative care units of 2, tertiary care hospitals in Canada. The goals were to elucidate the frequency, indications, patient characteristics, and practices around this intervention. Design: Descriptive, retrospective chart review. Setting/Participants: The clinical charts of patients admitted to the palliative care unit and who obtained blood transfusions for the period of April 1, 2015, to March 31, 2017, were reviewed. All patients admitted who obtained a transfusion were included. There were no exclusion criteria. Results: Transfusions in the palliative care units were rare despite their availability (0.9% at Sunnybrook and 1.4% Baycrest) and were primarily given to patients with cancer. The main symptom issues identified for transfusion were fatigue and dyspnea. The majority of patients endorsed symptomatic benefit with minimal adverse reactions though pre- and post-transfusion assessment practices varied greatly between institutions. Conclusions: Transfusions in the palliative care units were infrequent, symptom targeted, and well tolerated, though the lack of standardized pre/post assessment tools limits any ability to draw conclusions about utility. Patients would benefit from additional research in this area and the development of clinical practice guidelines for transfusions in palliative care.
Evaluating the adverse effects of melphalan formulations
Authors: Xiang Elaine , Ni Jian , Glotzbecker Brett , Laubach Jacob , Soiffer Robert , McDonnell Anne M 
Published: October 2018

Introduction For multiple myeloma patients who respond to primary therapy, autologous hematopoietic stem cell transplant (HSCT) is considered standard of care with high-dose melphalan for transplant candidates. There are now two different melphalan formulations available, including a propylene glycol containing (PG-MEL) product and a propylene glycol-free (PG-free MEL) product. Although considered bioequivalent, there remains limited literature directly evaluating the adverse events between the two agents. We seek to assess the tolerability and severity of side effects between the two formulations in a real-life practice setting. Methods A retrospective, descriptive analysis was conducted of multiple myeloma patients who received autologous stem cell conditioning with either melphalan formulation when dosed at 100 mg/m2/dose for two consecutive doses. The primary outcome was the assessment of tolerability and severity of side effects. Tolerability was split into four major categories including hematologic toxicity, gastrointestinal toxicity, renal toxicity, and highest recorded mucositis grade. Results There were a total of 78 patients who received a melphalan preparation during the study. The median time to myeloablation and neutrophil engraftment was five and seven days post-HSCT, respectively, for all patients. Patients who received PG-free MEL were less likely to develop mucositis, with 22 (56%) reported highest grade 0, defined by World Health Organization oral toxicity scale, compared to those who received PG-MEL (33%), p = 0.04. Conclusion There were minimal differences in tolerability or side effects observed between PG-free MEL and PG-MEL. These data may assist in better understanding the anticipated adverse effects of a high-dose melphalan conditioning therapy.
Radiation therapy for intracranial tumours in cats with neurological signs
Authors: Körner Maximilian , Roos Malgorzata , Meier Valeria S , Soukup Alena , Cancedda Simona , Parys Magdalena M , Turek Michelle , Rohrer Bley Carla 
Published: October 2018

Objectives The aim of this study was to evaluate the outcome of cats with intracranial tumours presenting with neurological signs treated with radiation therapy. Methods This study comprised a retrospective multicentre case series. Medical records of a total of 22 cats with intracranial space-occupying lesions, presenting with neurological signs and/or epileptic seizures and treated with external beam radiation therapy, were reviewed. In the treated cats, patient-, tumour- and treatment-related variables were investigated, including age, sex, tumour location, tumour volume, total radiation dose, equivalent dose in 2 Gy fractions (EQD2), corticosteroid dose, overall treatment time and institution for influence on local tumour control and survival. Results Based on advanced imaging characteristics, the 22 treated cats presented with meningioma (n = 11), pituitary tumour (n = 8), choroid plexus tumour (n = 2) or glioma (n = 1). Allocated to the neuraxis, 11 lesions were extra-axial, three were intra-axial and eight were located in the pituitary region. At diagnosis, 21 cats exhibited altered neurological status. One cat presented with epileptic seizures and another cat had both seizures and altered neurological status. The mean total physical dose of radiation was 41.63 Gy (± 4.33), range 24–45 Gy. In all but one cat (95.5%), neurological signs improved after radiation therapy. The median progression-free survival was 510 days (95% confidence interval [CI]: 51–969). The proportion free of progression at 1 year was 55.7% (95% CI: 33–78). Fourteen cats died (only in five cases was death related to the intracranial tumour) and eight cats were still alive or lost to follow-up. The median overall survival time was 515 days (95% CI: 66–964). None of the tested variables influenced outcome. Conclusions and relevance Radiation therapy seems to represent a viable treatment option in cats with intracranial tumours, relieving neurological signs and improving local tumour control. Radiation therapy may be considered for cats with tumours in complicated/inoperable localisations or for cases with a high peri- and postoperative risk.
Pharmacokinetics of furosemide after intravenous, oral and transdermal administration to cats
Authors: Sleeper Meg M , O’Donnell Patricia , Fitzgerald Caitlin , Papich Mark G 
Published: October 2018

Objectives The aim of this study was to determine the pharmacokinetics of furosemide in cats following intravenous (IV), oral and transdermal administration. Methods This study used six healthy adult cats in a three-phase design to compare plasma furosemide concentrations in cats that received one IV 2 mg/kg dose of furosemide, one oral 2 mg/kg dose of furosemide and 3 days of q12h dosing with 2 mg/kg furosemide transdermally applied to the ear pinna. Results After IV administration the elimination half-life was (mean and coefficient of variation) 2.25 h (72%), systemic clearance was 149 ml/kg/h (27.4%) and volume of distribution was 227 ml/kg (22%). After oral administration the terminal half-life was 1.2 h (18.7%), peak concentration was 3.4 μg/ml (51.7%) and bioavailability was 48.4%. The transdermal plasma concentrations were undetectable or very low at most time points, and pharmacokinetics were not determined from the transdermal dose. Conclusions and relevance Furosemide was rapidly eliminated in cats after oral and IV administration and is probably best administered orally at least q12h in cats with heart failure. The oral dose absorbed was approximately 50%, but the absorption from transdermal administration was negligible.
Analysis of intraoperative radiation use in vascular surgery: Catalyst for quality improvement in patient and personnel safety
Authors: Kiang Sharon C , Ahmed Khwaja A , Cha Victoria J , Farley Donald V , Oyoyo Udochukwu E , Abou-Zamzam Ahmed M , Tomihama Roger T 
Published: October 2018

Objectives There is paucity in the literature reporting radiation usage analysis in vascular surgery. In the era of endovascular surgeries, analyzing the surgeons’ use of radiation in vascular procedures can help establish quality improvement initiatives. Methods A retrospective review was undertaken of intraoperative fluoroscopic-guided vascular surgery procedures at a single institution from 2010 to 2017. Mobile C-arms were utilized to gather the six radiation usage metrics and cases were categorized into 6 anatomic surgical fields and 10 surgical procedure types. Results Three hundred and eighteen vascular surgery cases were analyzed and notable trends in all radiation usage metrics were identified both across the surgical field location and type of surgical procedure. The highest cumulative dose was identified in embolization cases with a mean of 932.5 mGy. The highest fluoroscopic time was seen in atherectomies with a mean of 2629.6 s. In terms of surgical field, the highest cumulative does and fluoroscopic time was identified in abdomen/pelvis procedures with a mean of 352.1 mGy and 1186.8 s, respectively. Analysis of dose reduction techniques also demonstrated notable trends. Conclusions There were notable trends in the analyzed radiation usage variables both across the surgical field location and type of surgical procedure. Specifically, cases that involve the abdomen/pelvis, embolization and atherectomy have the highest radiation use. These types of cases can be targeted for future improved dose reduction techniques or staged procedures. This data can serve as baseline information for future quality improvement initiatives for patient and personnel radiation exposure safety.
Clinical significance of colorectal polyp detection on colonoscopy insertion
Authors: Sakamoto Taku , Ramaraj Raji , Tomizawa Yutaka , Cho Hourin , Matsuda Takahisa , Saito Yutaka 
Published: October 2018

BackgroundColorectal lesions are generally evaluated during the withdrawal phase of colonoscopy. Minimising the risk of missed lesions is crucial to determine an appropriate future surveillance colonoscopy interval.ObjectiveThis study aimed to evaluate the clinical significance of detecting sigmoid colon lesions during the insertion phase.MethodsThis retrospective study included 172 consecutive patients undergoing colonoscopy between October 2017 and April 2018. The total number of detected polyps, mean polyps per procedure, mean polyps per positive procedure, and histological and clinical characteristics of detected lesions were recorded. The primary endpoint was the difference in sigmoid colon polyp detection rates during insertion and withdrawal.ResultsA total of 172 colonoscopies were performed for each patient and 322 lesions were detected. Sixty‐two (19%) polyps were detected during insertion, 312 (97%) during withdrawal, and 52 (16%) during both insertion and withdrawal. Although all polyps except for those in the sigmoid colon could be detected during withdrawal, 10 of 87 (11%) polyps in the sigmoid colon could only be detected during insertion.ConclusionsIn this study, attempts to detect polyps, even in the insertion phase, showed the clinical significance to decrease the risk of missed adenomatous polyps in the sigmoid colon.